T01 · 38 documents tagged to this reason
“Pre-existing disease not disclosed”
This is the reason insurers reach for most often — 38 of the 120 documents we have indexed turn on it. It is also the one they most often cannot prove. The test is not whether you had the condition; it is whether you knew about it and consciously concealed it when you filled in the proposal form.
How insurers word it
- The insured failed to disclose pre-existing disease at the time of proposal
- Could not ascertain the duration of the disease
- Suppression of material facts in the proposal form
- The condition is pre-existing and falls outside the waiting period
Arguments that have beaten this
C-T01-1
The five-year moratorium
After 60 continuous months of coverage, no health insurance policy or claim can be contested on grounds of non-disclosure or misrepresentation. Only established fraud survives. Years carried over through portability or migration count towards the 60.
Source
IRDAI Master Circular on Health Insurance Business, IRDAI/HLT/CIR/PRO/84/5/2024 (29.05.2024), para 13. Reduced from 96 months by the IRDAI (Insurance Products) Regulations, 2024.
Where this argument fails
Coverage is under 60 continuous months, or the insurer proves fraud. On an enhanced sum insured, the clock restarts from the enhancement date — but only for the enhanced portion.
C-T01-2
The burden of proof is theirs, not yours
The insurer must prove with medical evidence that you knew of the condition and consciously concealed it. An assertion, a stray line of “history” in a hospital file written by somebody else, or an inability to “ascertain duration” is not proof of anything.
Source
OA-023 (Delhi, 2017): the question was not whether the insured had the problem before the proposal, but whether he was aware of it — in the absence of evidence, pay. Also OA-007, where history recorded in a third party's handwriting was rejected as evidence.
Where this argument fails
Documented pre-policy treatment or diagnosis exists and was left off the proposal form. Where the history shows up in several independent records — anaesthesia notes, an older scan, your own written statement — this argument does not hold.
C-T01-3
No connection between the condition and the treatment
Even where something genuinely was not disclosed, the rejection fails if it has no causal connection to what you were actually treated for.
Source
OA-001 — undisclosed hypertension against a knee replacement: “no nexus between BP and Knee Replacement.” OA-009 — an old head injury against an aneurysm, where the insurer had no expert opinion and the complainant did.
Where this argument fails
The undisclosed condition is the one treated, or its direct complication, and the moratorium has not run. It also fails for a concealed major surgery: an undisclosed past operation is material in itself, because it removes the insurer's ability to price the risk. This argument is for conditions, not for concealed procedures.
C-T01-4
They never asked for a medical test
An insurer that issued the policy without requiring a medical examination accepted the risk on your declaration. It cannot then reconstruct a pre-existing disease out of the records of your very first claim.
Source
Bangalore District Consumer Commission ruling reported in RL-010; consistent with the evidence standard set in OA-023.
Where this argument fails
The proposal form contains demonstrably false answers about conditions you knew about and were being treated for.
We publish the losing side too. An appeal built on an argument that does not fit your facts wastes the one year you have.
My policy is six years old. Can they still reject for non-disclosure?
Not on non-disclosure grounds. Para 13 of the IRDAI Master Circular of 29 May 2024 makes a claim non-contestable on non-disclosure or misrepresentation after 60 continuous months of coverage. Only established fraud survives that. Years carried over through portability count, so check your original start date rather than your current insurer's.
The hospital file mentions my illness was “since 2 years”. Is my claim finished?
Not necessarily. Ombudsman awards in our corpus have repeatedly declined to treat a history line as proof of knowledge and concealment, particularly where it was written by hospital staff rather than by you (OA-007, OA-023). It becomes much harder to argue when the same history appears across several independent records.
Does appealing cost anything?
No. The insurer's Grievance Redressal Officer, IRDAI's Bima Bharosa portal and the Insurance Ombudsman are all free to approach, and the ombudsman's award binds the insurer while leaving you free to go elsewhere if you disagree with it.
Is this the reason on your letter?
Ladai will read your specific letter and policy and tell you which of these arguments actually reaches your facts — and how strong that makes your case.