Rejected · Pre-existing disease
Claim rejected for a pre-existing disease or non-disclosure? Know your rights
Pre-existing disease (PED) and non-disclosure are the reasons insurers cite most often for full rejections. The 2024 IRDAI rules changed a lot in your favour.
By the MediclaimSaathi team Updated 3 November 20268 min read
Quick answer
Under IRDAI’s 2024 rules, the waiting period for pre-existing diseases can be at most 36 months, and after 60 months of continuous cover (the moratorium period, ported years included) an insurer cannot contest a claim for non-disclosure or misrepresentation except for established fraud. Before 60 months, ask the insurer to prove the condition existed before the policy, was material, and is linked to this claim. Send a written grievance with your doctor’s note and coverage history, then escalate to Bima Bharosa and the Insurance Ombudsman if needed.
The rules that protect you
| Rule | What it means |
|---|---|
| PED definition | A condition diagnosed by a doctor, or for which medical advice or treatment was received, within 36 months before the policy started. |
| PED waiting period | At most 36 months. After that, the pre-existing condition is covered. |
| Moratorium | After 60 months of continuous cover, no claim can be contested for non-disclosure or misrepresentation, except for established fraud. |
| Portability | Years with your previous insurer count towards waiting periods and the moratorium when you port. |
How to challenge the rejection
- 1Count your continuous coverAdd up all years without a break, including ported years. Keep renewal receipts and the portability letter.
- 2Check the datesWas the condition really diagnosed before the policy started, and within the 36-month look-back? Ask the insurer for the record they relied on.
- 3Get a doctor’s noteAsk your treating doctor to state when the condition was first diagnosed and whether this illness is related to it.
- 4Answer “non-disclosure” directlyIf you were not aware of the condition, or it is unrelated to this claim, say so clearly with evidence.
- 5Send a written grievance and escalateIf the insurer does not reverse it, go to Bima Bharosa and the Insurance Ombudsman (free, up to ₹50 lakh).
Mistakes to avoid
- Accepting a phone call explanation. Always ask for the rejection reason and clause in writing.
- Ignoring ported years. They count.
- Sending only an emotional appeal. Insurers and Ombudsmen respond to dates, documents and rules.
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Check my letter freeFrequently asked questions
What is the moratorium period in health insurance?+
After 60 months of continuous health cover, IRDAI’s 2024 rules say the insurer cannot contest a claim on grounds of non-disclosure or misrepresentation, except for established fraud.
What is the maximum waiting period for a pre-existing disease?+
36 months under IRDAI’s 2024 rules. Your policy may have a shorter period.
My insurer says I hid diabetes, but this claim is for an accident. Can they reject it?+
An unrelated condition is a weak reason to reject an accident claim. Ask the insurer to explain the link in writing and send a grievance with your doctor’s note.
Do years with my old insurer count after porting?+
Yes. Ported tenure counts towards waiting periods and the 60-month moratorium.
Related guides
Sources
- IRDAI — Master Circular on Health Insurance Business (May 2024)
- IRDAI Bima Bharosa grievance portal
- Council for Insurance Ombudsmen
This guide is general information, not legal advice. Rules change; always check the current IRDAI circulars and your policy wording. MediclaimSaathi is a document-preparation platform, not a law firm, insurer or broker.