Insurance claim rejection

Dear Client,
When an insurance claim is repudiated/rejected by the Insurance company, they inform the insured person of the reason/ground behind the rejection of the claim. Your query lacks that information and consequently, in the absence of grounds/reason behind the rejection of an insurance claim, no remedies to your grievance can be suggested as of now. However, be informed that the terms and conditions of an insurance policy are the most crucial and vital to go through before raising a claim against the policy. Based on the self-declaration of the policy buyer and post-medical tests of the insured wherever required, the risk and coverage are underwritten and the premium is calculated by the Actuaries of the Insurance Company following the guidelines of the regulatory authority IRDAI. Despite non-disclosure of Pre-Existing disease (PED), some PEDs are covered by continuous renewal of the policy for two or four years from the date of inception of the policy. If any claim is raised before it comes under the coverage on continuous renewal of the policy for prescribed periods, the insurer repudiated/rejected the claim of the insured on the grounds of non-disclosure of PED, which is likely to cover under the policy after the waiting period and continuous renewal of the policy. Further, the observations or findings of the treating doctor play a crucial role in the sanction or rejection of any insurance claim by the Insurer. So, if the terms and conditions of the health insurance policy do not support a claim, a complaint before the Consumer Court may not yield an order in favour of the claimant.