Health insurance claims will not be rejected due to BP, diabetes, or headaches! Find out what to keep in mind when purchasing a policy..
Insurance companies can no longer reject your health insurance claims on the grounds of common, lifestyle-related conditions such as high blood pressure (BP), diabetes, joint pain, or headaches. In a landmark ruling concerning a senior citizen, the Central District Consumer Disputes Redressal Commission has put an end to such arbitrary practices by insurance companies. The Commission clarified that unless an insurance company produces past medical records, a condition cannot be classified as a "pre-existing disease" or a case of "concealment of illness."
Taking a firm stance against this approach, the Central District Consumer Disputes Redressal Commission has explicitly stated in its significant verdict that common lifestyle-related ailments cannot serve as a basis for rejecting insurance claims.
The Case in Detail
Yashpal Bahl, a 65-year-old resident of Rohini, Delhi, had purchased a group medical insurance policy for himself and his wife, with a coverage amount of Rs 7.5 lakh. In 2021, he was hospitalized, and his treatment incurred expenses of approximately Rs 4.71 lakh. When he filed a claim with the insurer, Cholamandalam MS General Insurance, the company rejected it, alleging that the patient had been suffering from high blood pressure for four years—a fact they claimed he had concealed when purchasing the policy. Furthermore, shortly after rejecting the claim, the company also cancelled the couple's insurance policy. Aggrieved by this, the policyholder approached the Consumer Commission.
A Setback for the Insurance Company
During the proceedings, a bench comprising the Commission’s President, Divya Jyoti Jaipuriar, and member Dr. Rashmi Bansal, completely dismissed the insurance company’s contentions. The Commission observed that the insurer failed to produce any official medical prescriptions, diagnostic reports, or doctor’s records to substantiate its claim that the patient had been suffering from high blood pressure or undergoing treatment for it for the past four years. Consequently, the commission ordered the insurance company to pay the elderly couple’s claim of Rs 4.71 lakh, along with 6 percent interest. Furthermore, for the wrongful cancellation of the policy, the company was directed to pay the aggrieved couple Rs 25,000 for mental agony and Rs 15,000 toward litigation costs.
Things to keep in mind when purchasing health insurance
In light of this verdict, if you are planning to purchase a new health insurance policy or renew an existing one, pay close attention to the following points. When applying, ensure that you provide accurate information in the proposal form regarding any pre-existing medical conditions and ongoing medications. Typically, there is a waiting period of 2 to 4 years for pre-existing diseases; be sure to review this carefully before finalizing the policy. Once you receive your policy documents, you are entitled to a 'free-look period'—usually lasting 15 to 30 days—during which you may cancel the policy if you are not satisfied with the terms and conditions. Additionally, keep all your medical records—including prescriptions, diagnostic test reports, and bills—safely stored; this will help prevent the insurance company from making any false assertions when you file a claim.
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