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Health insurance rejected my claim for a pre-existing disease
What usually matters in this situation, and the papers to keep ready before you meet an advocate or free legal aid (call 15100).
Make my own list — free, 2 minutesYour situation
- What kind of insurance? Health / mediclaim
- What happened to the claim? Fully rejected
- What reason did they give? Pre-existing disease / non-disclosure
Papers to gather
- Policy document with schedule, terms and all renewal certificates
The wording decides most disputes. Where: Insurer portal, email. - Proposal form (application) — ask the insurer for a copy
Central to non-disclosure rejections. Where: Insurer (request in writing). - Rejection / settlement letter with reasons
What you must answer. Where: Email, letter. - Claim form and acknowledgement with date
Answers "late claim" objections. Where: Your records. - Discharge summary, hospital bills, prescriptions, test reports
Supports the claim amount. Where: Hospital. - Doctor's certificate on when the illness began
Answers pre-existing disease objections. Where: Treating doctor.
You may also need, depending on your answers
- Grievance complaint and insurer's reply — Needed for Ombudsman.
- File a written grievance with the insurer and keep the reference — First step before Ombudsman.
- Renewal and portability records showing continuous cover — Limits non-disclosure rejections after long cover.
What the law says
Complain first to the insurer's grievance officer. If not resolved, you can approach the Insurance Ombudsman (free) or a consumer commission. IRDAI rules set timelines for claim decisions.
General information, not legal advice.
Saboot will also ask
- Have you complained to the insurer's grievance cell in writing?
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Sources
The full guide: Insurance claim rejected, delayed or underpaid · All situations