#Pre-Existing Disease

The Delhi State Consumer Commission upheld a ₹2.7 lakh health insurance claim, holding that a mere history of diabetes and cerebrovascular accident - without recent hospitalisation proximate to policy inception - cannot trigger the pre-existing disease exclusion. The insurer bears the burden of proving the policyholder's knowing concealment, and failure to physically supply policy terms and conditions constitutes a deficiency in service.

The Gujarat State CDRC upheld the insurer’s pre-existing disease exclusion, ruling that an illness occurring before a mediclaim sum-insured enhancement bars reimbursement under the enhanced limit. The decision limits insurer payouts to the original sum insured, affecting policyholders who enhance coverage after a disease onset.

The NCDRC ruled that the insurer, not the claimant, must establish that a pre-existing disease was concealed when the policy was taken. This shifts the evidential burden onto insurers in death-claim disputes, safeguarding policyholders from arbitrary refusals.

West Bengal State Consumer Disputes Redressal Commission rules that insurers cannot reject ported health insurance claims merely on grounds of pre-existing disease non-disclosure unless fraud is conclusively proven. The ruling mandates reimbursement, interest, and compensation, reinforcing consumer protection under the doctrine of uberrima fides.

Punjab State Consumer Disputes Redressal Commission rules that insurers cannot repudiate life insurance claims based on pre-existing diseases unless proven within 48 months of policy issuance, as mandated by IRDAI. The ruling sets a critical precedent for consumer protection, shifting the burden of proof squarely onto insurers in material concealment disputes.

The Rajasthan High Court holds that renewing a health policy after rejecting a claim for pre-existing disease waives the exclusion, entitling beneficiaries to coverage under IRDA guidelines.