Your mediclaim was rejected for a “pre-existing disease.” You can often 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 2026-07-11
Non-disclosure of a pre-existing disease is the single most common reason health claims are refused — and one of the most challengeable. To repudiate on this ground the insurer must show you knowingly withheld a material fact, and once a health policy has run continuously for the IRDAI moratorium period (five years), it generally cannot be questioned for non-disclosure at all, except for proven fraud.
Why insurers reject on this ground
Insurers reject when they believe a condition — commonly diabetes, hypertension, or thyroid disease — existed before the policy started and was not declared in the proposal form. It accounts for roughly a quarter of all health-claim rejections.
When you can challenge it
A non-disclosure repudiation is not automatic. The condition must be a material fact that you actually knew about and deliberately suppressed — a diagnosis made after the policy began, or a condition you were genuinely unaware of, is not concealment. Under IRDAI's health-insurance rules a policy also has a moratorium period (five years of continuous cover), after which it cannot be repudiated for non-disclosure or misrepresentation except where fraud is established. And where the proposal-form question or the exclusion wording is ambiguous, it is read against the insurer that drafted it.
How to fight this rejection
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.
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.
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.
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.
Escalate to IRDAI on Bima Bharosa
If it isn't resolved in time or the reply is unsatisfactory, register the complaint on IRDAI's Bima Bharosa portal.
Take it to the Insurance Ombudsman
Free, binding on the insurer, and open to claims up to ₹50 lakh — file within one year of the insurer's rejection or final reply.
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 you knew about and deliberately did not disclose. A condition diagnosed after the policy started, or one you were unaware of, is not concealment, and after the IRDAI moratorium period the policy generally can't be repudiated on this ground except for proven 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?
Not by itself. The insurer must prove the condition was material, that you knew about it, and that you deliberately suppressed it when buying the policy. Common, controlled conditions are frequently contested successfully, especially where the proposal form's questions were unclear.
See the full escalation ladder for a rejected claim, or use a free complaint-letter template.
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.