Rejected · Non-disclosure · Misrepresentation
Claim rejected for non-disclosure? How to challenge “you hid your medical history”
Non-disclosure is the reason insurers use most often to refuse a claim in full. It is also one of the easiest to challenge when the facts are on your side.
By the MediclaimSaathi team Updated 8 November 20267 min read
Quick answer
Under IRDAI’s 2024 rules, once you have completed 60 months of continuous cover (ported years count), an insurer cannot contest a claim for non-disclosure or misrepresentation except for established fraud. Before 60 months, the insurer should show that the condition existed before the policy, was material, and is connected to this claim. Ask for the rejection and the record it relied on in writing, get a doctor’s note on when the condition was diagnosed and whether it is related, and send a grievance. If it is not resolved in 30 days, go to Bima Bharosa and the Insurance Ombudsman.
What “non-disclosure” really means
Non-disclosure means the insurer says you did not tell it about a medical condition or fact that it asked about in the proposal form, and that this affected its decision to insure you.
Not every omission counts. The insurer usually has to show that the fact was material, that it was asked about, and that it relates to the claim made.
The protections you have
| Protection | What it means |
|---|---|
| 60-month moratorium | After 60 months of continuous cover, including ported years, a claim cannot be contested for non-disclosure or misrepresentation, except for established fraud. |
| 36-month look-back | A pre-existing disease is one diagnosed, or treated on medical advice, within 36 months before the policy started. |
| Waiting period cap | The waiting period for a pre-existing disease can be at most 36 months. |
| Court view | The Supreme Court in Manmohan Nanda v. United India Assurance, (2022) 4 SCC 582, held that an insurer that assessed the proposer and issued the policy cannot reject a claim citing a pre-existing condition the policy did not specifically exclude. Facts matter, so treat it as support for your argument, not a guarantee. |
How to challenge the rejection
- 1Get the record the insurer relied onAsk in writing for the document showing the alleged earlier diagnosis or treatment.
- 2Check the datesCompare it with the policy start date, renewals, any porting date and the 36-month look-back.
- 3Count continuous coverAdd every year without a break, including ported years. If it is 60 months or more, say so clearly.
- 4Get a doctor’s noteAsk the treating doctor to state when the condition was diagnosed and whether this claim is related to it.
- 5Write to the Grievance Redressal OfficerAnswer the allegation, attach proof and state the amount you want.
- 6EscalateAfter 30 days of silence or a rejection, use Bima Bharosa and the Insurance Ombudsman within one year.
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Check my letter freeFrequently asked questions
Can an insurer reject a claim after 5 years for non-disclosure?+
Under IRDAI’s 2024 rules, after 60 months of continuous cover, not except for established fraud. Count ported years too.
What if I did not know about the condition?+
Say so with evidence. An unknown or unrelated condition is a weak basis to refuse a claim. Ask the insurer to explain the link in writing.
Is every unmentioned condition “non-disclosure”?+
No. The insurer usually has to show it was asked about, was material and relates to the claim.
Can I go to the Ombudsman for a non-disclosure rejection?+
Yes, after you have complained to the insurer and it rejected it or did not reply in 30 days, within one year of its final reply, for claims up to ₹50 lakh.
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.