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Health insurance rejected by saying reason of non disclosure, what legal action can be taken?

Dear sir, my brother got covid-19 on 16-05-2021 and got hospitalised on 20-05-2021. I applied for the cashless treatment and it got rejected by saying the non disclosure of pre existing disease .we told doctor that my brother taking medicines for chest pain from since 2 years then doctor asked about previous reports and submitted the reports since 2017..later we came to know that in 2017 report it mentioned as CRHD & I taken the policy on 09-06-2018 from cigna ttk (now Manipal cigna) . After checking all documents & discussion with my brother I understand that in 2017 my brother went hospital for chest pain then doctor suggested to take 2d echo then doctor written CRHD in prescription (as we not aware that time ) and told that don't worry use medicines for 2 months.we used same and stopped the medicines. As we don't know about CRHD at the time of taking the policy we not disclosed the same in 2018..we also went to hospital in 2019 for the chest pain then doctor told to use medicine for every day continuosly ,from that day we are using medicines daily and same is intimated during hospitalisation..please tell me shall I proceed legally for claim settlement on insurance company. Some of my comments are 1. We not aware or we don't about pre existing disease at the time of taking the policy & insurance company also not asked any previous health documents at the time of taking the policy. 2. We went hospital in 01/02/2017 and used the medicines for 2 months and stopped ..again we went in 22/01/2019..in 2018 and we have taken the policy. 3. We are admitted for covid-19 not for CRHD

( Hyderabad, Telangana )

3 years ago

Reply

hi,
If you move to a consumer court there are very less chances to win, as it was your insurance agent fault to not mention the earlier disease at the time of taking the policy and insurance. It would be suggested to file a complaint against the agent for such irresponsible act.
Thanks

Vidhikarya

Helpful

hi,
First of all it is mandatory for agent of insurance company to mention the earlier disease at the time of taking the policy. You could file a complaint against the agent for such irresponsible act because of which you could not avail the cashless treatment or your brother.
Thanks.

Vidhikarya

Helpful

Usually whenever you take up an insurance policy the the agent will ask you to fill up a column where you need to put in the details of your pre-existing diseases and that's the normal practice for any life insurance and it is never missed then it is really a surprise that your agent has missed it for health insurance.
Out my experience of all he case that I have seen I can tell you that this will not be a good case to move the consumer forum as you are (may be because of your agent or whose fault can't say) default and you will not win the case. Hence suggested to let it go. At max you can take a chance to lodge a complain with the Insurance Ombudsman and see what order he passes.