Your mediclaim was rejected for a “pre-existing disease.” You may be able to challenge it.
A rejection on this ground is often challengeable — here's why, and exactly how to fight it, free.
Reviewed by the BimaHaq Insurance Grievance Desk — BimaHaq's in-house insurance-grievance team — specialists in IRDAI grievance redressal, the Insurance Ombudsman process, and policyholder rights in India. · Last reviewed 2026-10-26
A rejection for non-disclosure of a pre-existing disease can be challenged on the facts, but it is not won by showing you meant no harm. The insurer must show the undisclosed condition was material, and the Supreme Court has held that an inaccurate proposal-form answer about a known material condition entitles the insurer to repudiate a mediclaim policy — deliberate intent is not needed (Civil Appeal No. 2776 of 2002, decided 10 July 2009). A condition first diagnosed after the policy began, or one you had no means of knowing about, is not concealment. And once a health policy has run continuously for IRDAI's moratorium period (60 months), it cannot be contested for non-disclosure or misrepresentation at all, except on established fraud.
Why insurers reject on this ground
Insurers reject when they believe a condition — such as diabetes, hypertension, or thyroid disease — existed before the policy started and was not declared in the proposal form.
When you can challenge it
A non-disclosure repudiation is not automatic, but intent is not the test. The condition must be a material fact, and what you knew matters: a diagnosis made after the policy began, or a condition you had no means of knowing about, is not concealment. If you did know of a material condition and the proposal form recorded a wrong answer, the Supreme Court has held that this entitles the insurer to repudiate a mediclaim policy, whether or not the answer was deliberate (Civil Appeal No. 2776 of 2002, decided 10 July 2009). Under IRDAI's health-insurance rules a policy also has a moratorium period (60 months of continuous cover), after which it cannot be contested for non-disclosure or misrepresentation except where fraud is established. And where the proposal-form question or the exclusion wording is genuinely ambiguous, it is read against the insurer that drafted it.
How to fight this rejection
- 1
Get the repudiation letter and the exact clause
Obtain the written rejection citing the specific policy clause, plus your proposal form and policy wording, so you know exactly what the insurer says you failed to disclose. The insurer must have given you a copy of the completed proposal form along with the policy within fifteen days of accepting it (IRDAI's 2024 Master Circular on Protection of Policyholders' Interests) — if it never came, ask for it in writing.
- 2
Gather proof of when the condition was diagnosed
Collect medical records, prescriptions, and doctor's notes showing the date of first diagnosis — especially if it was after the policy started, or if you had no prior knowledge.
- 3
Check whether the moratorium period applies
If the policy (or its ported predecessor) has run continuously for five years, the insurer generally cannot repudiate for non-disclosure except for established fraud — say so in your grievance.
- 4
Raise a written grievance with the insurer's GRO
Send a dated grievance to the insurer's Grievance Redressal Officer setting out why the rejection is wrong. The insurer must acknowledge it immediately and resolve it within 14 days.
- 5
Optionally, complain to IRDAI on Bima Bharosa
If it isn't resolved in time or the reply is unsatisfactory, you can also register the complaint on IRDAI's Bima Bharosa portal. It is optional: the Insurance Ombudsman does not require it.
- 6
Take it to the Insurance Ombudsman
Free, and the award binds the insurer. The Ombudsman can award up to ₹50 lakh — a cap on the award rather than the claim. File within one year of receiving the insurer's rejection — or, if it never replied, within one year of one month after you sent your representation.
Common questions
Can an insurer reject a health claim for a pre-existing disease?
Only within limits. The insurer must show the condition was a material fact that the proposal form did not disclose; it does not have to prove you hid it deliberately. A condition first diagnosed after the policy started, or one you had no means of knowing about, is not concealment, and after the IRDAI moratorium period (60 months of continuous cover) the policy cannot be contested on this ground except for established fraud.
What is the moratorium period in health insurance?
Under IRDAI's health-insurance norms, once a health policy has been continuously renewed for the moratorium period (five years), the insurer cannot call the policy into question on grounds of non-disclosure or misrepresentation — except where fraud is established. Ported policies carry over the credit for the period already served.
Is not disclosing diabetes or hypertension a valid reason to reject a claim?
It can be. The insurer must show the condition was material and that the proposal form's answer about it was wrong; a deliberate intent to suppress it is not required (Supreme Court, Civil Appeal No. 2776 of 2002, decided 10 July 2009). The points to check are whether the proposal form's question actually asked about the condition, whether you knew of it when you answered, and whether the 60-month moratorium has run.
What BimaHaq costs, if you want help with this:
Fixed fees, never a share of your claim. No outcome is guaranteed. See all prices
This guide is general information about the insurance-grievance process in India, not legal advice, and figures (timelines, monetary limits, jurisdiction) can change — verify against the official sources linked above before you rely on them.