Health Insurance Claims being rejected under preexisting disease clause

Rejecting the claim in the first instance by declaring it as a preexisting disease is a very common excuse. This is turning out to be a common complaint of more and more insured persons, whom I meet. It is only on persuasion of the insured with Insurance co or its TPA that most of the cases are reconsidered and processed. The common grievance of the insured clients is that they are told this in oral only and not in writing.

It is natural that those whose cases are not considered a good number of them either end up in Consumer Forum courts or become negative publicity in the society and discourage others from buying health insurance.

In a recent judgment New India Assurance has been directed to pay Rs. 2.29 lakhs+interest @ 9% from February 1, 1999.In this case client was paid Rs. 88,000 under 1 claim and after 5 years a case was filed again. The Insurance company repudiated the claim as it was preexisting disease.

With this judgment it is clear that if the policy is continuing then as and when the insured goes again for hospitalization (with the same illness/disease)then the claim is payable.

We appreciate the judiciary system of India, which is protecting the interests of the consumers.