Sum Insured=50L
Claim amount 4L
The insurer used the clause material non-disclosure of pre-existing diseases to reject the claim and cancel the policy!🤯🤯
A thread🧵on what is material non-disclosure and what you can do about it?👇
Claim amount 4L
The insurer used the clause material non-disclosure of pre-existing diseases to reject the claim and cancel the policy!🤯🤯
A thread🧵on what is material non-disclosure and what you can do about it?👇
What is the underwriting of a health insurance policy?
Whenever you buy a health insurance?
Medical underwriting is the process of evaluating an application for health insurance coverage by examining the applicant's medical history.
If you disclose any diseases that you have had before buying the insurance.
The insurer can do three things
1. Reject your policy
2. Impose waiting period and exclusions
3. Increase the premium due to higher risk called Loading
Whenever you buy a health insurance?
Medical underwriting is the process of evaluating an application for health insurance coverage by examining the applicant's medical history.
If you disclose any diseases that you have had before buying the insurance.
The insurer can do three things
1. Reject your policy
2. Impose waiting period and exclusions
3. Increase the premium due to higher risk called Loading
So what is material Non disclosure?
Insurance is a contract b/w u and the insurer where you must disclose all pre existing medical conditions before buying the policy
Many people do not disclose pre-existing diseases as they fear the insurer will impose waiting period or reject the policy entirely
Insurance is a contract b/w u and the insurer where you must disclose all pre existing medical conditions before buying the policy
Many people do not disclose pre-existing diseases as they fear the insurer will impose waiting period or reject the policy entirely
What are pre-existing diseases?
At the time of buying your health insurance policy
Any past hospitalization must be declared to the insurer while buying the policy
Any type of ongoing medication is also considered as pre-existing medication (pre-existing condition)
Any past hospitalization for removal of a body part like Appendix, bariatric surgery must also be declared to the insurer
At the time of buying your health insurance policy
Any past hospitalization must be declared to the insurer while buying the policy
Any type of ongoing medication is also considered as pre-existing medication (pre-existing condition)
Any past hospitalization for removal of a body part like Appendix, bariatric surgery must also be declared to the insurer
Are u on some sort of medication?
If Yes, You need to disclose it to the insurer
Have u ever been operated upon?
If Yes, You need to disclose this to the insurer
Have u ever had high blood pressure but now it is normal?
If Yes, You need to disclose this to the insurer
Did u have high sugar which has now normalised?
If Yes, You need to disclose this to the insurer
If Yes, You need to disclose it to the insurer
Have u ever been operated upon?
If Yes, You need to disclose this to the insurer
Have u ever had high blood pressure but now it is normal?
If Yes, You need to disclose this to the insurer
Did u have high sugar which has now normalised?
If Yes, You need to disclose this to the insurer
Did u have puffs for Asthama and now u don't have the puff?
If Yes, You need to disclose this to the insurer
Has any body part been removed?
If Yes, You need to disclose this to the insurer
Are u smoking?
If Yes, You need to disclose this to the insurer
Are u drinking?
If Yes, You need to disclose this to the insurer
All your pre-existing conditions right from birth up to the day you buy the policy must be disclosed to the insurer
If Yes, You need to disclose this to the insurer
Has any body part been removed?
If Yes, You need to disclose this to the insurer
Are u smoking?
If Yes, You need to disclose this to the insurer
Are u drinking?
If Yes, You need to disclose this to the insurer
All your pre-existing conditions right from birth up to the day you buy the policy must be disclosed to the insurer
What if you do not disclose pre-existing diseases and get a policy issued?
If you do not disclose pre-existing diseases and the insurer later finds out during a claim.
The insurer has the power to not only REJECT YOUR CLAIM but also cancel your policy.
Remember honesty is the best policy in health insurance
If you do not disclose pre-existing diseases and the insurer later finds out during a claim.
The insurer has the power to not only REJECT YOUR CLAIM but also cancel your policy.
Remember honesty is the best policy in health insurance
Lets Take an example:-
If Mr X has a pre-existing disease of High Blood pressure in 2010.
In 2015 he bought a policy without disclosing the said high
In 2020 after paying 10 continuous premiums,
He had a claim for heart issue,
During scrutiny of the claim,
The insurer discovered Mr X had high BP before buying the policy but did not disclose it to the insurer.
If Mr X has a pre-existing disease of High Blood pressure in 2010.
In 2015 he bought a policy without disclosing the said high
In 2020 after paying 10 continuous premiums,
He had a claim for heart issue,
During scrutiny of the claim,
The insurer discovered Mr X had high BP before buying the policy but did not disclose it to the insurer.
The insurer,
Went on to reject the claim and also cancelled the policy.
The premiums paid for the 10 years were wasted and Mr X who has a heart problem now is left without a health insurance policy for life
Went on to reject the claim and also cancelled the policy.
The premiums paid for the 10 years were wasted and Mr X who has a heart problem now is left without a health insurance policy for life
Can the insurer reject your claim after 5 years?(Moratorium period)
IRDAI has now reduced the moratorium period from 8 years to 5 years.
This means an insurer cannot reject a claim after 5 years of covered(even in nondisclosure of pre-existing diseases)
However, if you willfully hide pre-existing diseases to gain an insurance policy.
Most likely the insurer will categorize this as fraud and this clause won't be applicable(it is a real grey area as of now)
Therefore, rather than having a false promise,
Disclose all diseases properly to the insurer
IRDAI has now reduced the moratorium period from 8 years to 5 years.
This means an insurer cannot reject a claim after 5 years of covered(even in nondisclosure of pre-existing diseases)
However, if you willfully hide pre-existing diseases to gain an insurance policy.
Most likely the insurer will categorize this as fraud and this clause won't be applicable(it is a real grey area as of now)
Therefore, rather than having a false promise,
Disclose all diseases properly to the insurer
So what should u do?
At the time of buying the insurance policy,
Disclose all pre-existing diseases honestly to the insurer.
Even if it leads to the insurer rejecting you,
it is okay As you will not a false promise of not paying the claims later.
Remember honesty is the nest policy in health insurance.
At the time of buying the insurance policy,
Disclose all pre-existing diseases honestly to the insurer.
Even if it leads to the insurer rejecting you,
it is okay As you will not a false promise of not paying the claims later.
Remember honesty is the nest policy in health insurance.
Thanks for reading😁😁😁
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Follow me @NIKHILLJHA as I write deep insights into health insurance
Go to my profile and hit the bell icon🔔to always stay updated
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