Health insurance has become a financial lifeline for families today. With rising hospital costs, a policy offers much-needed protection during medical emergencies. However, many policyholders face a harsh reality when their claim gets rejected due to non-disclosure—meaning incomplete or incorrect information was provided while buying the policy. This situation can be extremely stressful, both emotionally and financially.
The good news is that a rejected claim is not always the end of the road. With the right approach, documents, and awareness of your rights, you can appeal and, in many cases, get the claim approved.
Non-disclosure refers to hiding or not fully revealing medical history, existing illnesses, or health conditions while filling out the insurance proposal form. For example, if someone had diabetes, high blood pressure, thyroid issues, or heart problems but failed to mention them, the insurer may consider it a risk concealment.
If later the person is hospitalized for a related issue, the insurance company may reject the claim stating that critical health information was not disclosed at the time of policy purchase.
Yes, in many cases appeals have led to successful claim approvals. Not every non-disclosure is intentional. Often, people are unaware that a minor condition needs to be declared or they don’t realize its importance.
If you can show that:
The current treatment is not directly related to the undisclosed condition
The condition was cured long ago
Or medical reports do not prove it was pre-existing
then the insurer may reconsider the decision.
Ask for a Written Explanation – Contact the insurer and request the rejection reason in writing.
Review Your Policy Document – Carefully check the terms, exclusions, and clauses.
Collect Medical Records – Gather doctor’s reports, discharge summaries, test results, and prescriptions.
You can submit a formal appeal to the insurer’s grievance or customer support department. Clearly explain:
That the non-disclosure was unintentional
The illness is not linked to the current claim
Attach all supporting documents
Many insurers conduct an internal review and may approve the claim after reassessment.
If the insurer still refuses, you can:
File a complaint with the Insurance Ombudsman
Or lodge a grievance on the IRDAI (Insurance Regulatory and Development Authority of India) portal
These authorities ensure fair practices and protect consumer rights. Several policyholders have received justice through these channels.
When a family faces high hospital bills and a claim rejection, the stress can be overwhelming. It’s not just about money—it’s about security and trust. The appeal process gives you a chance to fight for what you paid for. Many cases have shown that persistence and proper documentation can change the outcome.
Always disclose complete and accurate medical history
Never ignore minor health issues while filling the form
Avoid rushing through policy documents
Keep all medical and insurance records safe
Experts say that honesty and awareness are your strongest shields in health insurance. If your claim gets rejected, don’t lose hope—appeal, escalate, and use your rights.
