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Reliance Health Insurance Claim Rejected for Pre-Existing Disease Non-Disclosure

Milind

Milind Vadjikar  | Answer  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on Mar 17, 2025

Milind Vadjikar is an independent MF distributor registered with Association of Mutual Funds in India (AMFI) and a retirement financial planning advisor registered with Pension Fund Regulatory and Development Authority (PFRDA).
He has a mechanical engineering degree from Government Engineering College, Sambhajinagar, and an MBA in international business from the Symbiosis Institute of Business Management, Pune.
With over 16 years of experience in stock investments, and over six year experience in investment guidance and support, he believes that balanced asset allocation and goal-focused disciplined investing is the key to achieving investor goals.... more
S Question by S on Mar 17, 2025Hindi
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Sir need clarification regarding 1.i have done Reliance health infinity insurance for 15 lacks .date of inception is 11-6-2020 PEDs not disclosed ( DM,Hypothyroidism)( done by agent not verified me at that time) 2. Did Reliance Super top up policy after 11-7-2022 online by Reliance agent during this i disclosed that PEDs (DM,Hypothyroidism) and at that time specifically mentioned to online agent regarding PEDs and also told him to PEDs not mentioned in base policy please correct it. I never utilised insurance policy for any claims. During 23-4-24 i diagnosed to have Acute Myeloid Leukemia for which i applied for cashless admission for Reliance health infinity insurance ( base policy) They simply rejected on the basis of PEDs not disclosed. And told that your policy is canceled. But i kept a letter to company stating that in base policy PEDs not disclosed, but in super top up policy i mentioned Again the base policy renewal done after expiry by company online. Later also i went for cashless admission again they rejected claim for base policy. My question is why they did renewal of that base policy inspite of first rejection. And for super top up policy it can be claimed after spending 15 lacks i applied for cashless, they processed it and told to come for reimbursement claim After discharge i applied for reimbursement claim they simply replied that your PEDs not told correct duration since how many days. So we are rejecting this policy also For this what should i do, please Ag

Ans: Hello;

In any insurance adequate disclosure is essential to get a thorough underwriting check and risk acceptance.

Once insurance company agrees to insure with the disclosures then chances of claim rejection are remote.

You may escalate the matter with Compliance Officer of the insurance company, insurance ombudsman or IRDAI for an amicable settlement, if possible.

You may also check with organisations such as "beshak.org" for any possible help in the matter.

Best wishes;
DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.
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Dear Sir, Greetings of the day. I have got a health insurance of family floater type from Tata AIG for a sum of four lakhs. Recently, I got hospitalised and full four lakhs was paid by Tata Aig. But my hospital bill was six lakhs and sixty two thousand. So there was a shortfall of two lakhs sixty-two thousands. I have an Aditya Birla health Policy of family floater type for 45 lakhs. But it will come in to effect after 5 lakhs expenditure. So I myself paid one lakh from my pocket. And for rest one lakh sixty two thousand only I applied for cashless to Aditya Birla .But they denied it. Finally I paid that amount myself and came home. Afterwards I kept continuous follow up with them. Reconsideration and reminder letter was sent by TPA and Treating doctor. But again it was rejected. Now Aditya Birla employee is saying apply for reimbursement. When Tata Aig is clearing full amount, how come Aditya Birla is denying it? And how can I bridge the gap one lakh between two policies? Tata Aig says you have taken full claim so we cannot make your limit from four to five lakhs this year. Pls advise suitably. Best Wishes
Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

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The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

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Ramalingam

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I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

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Milind

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Asked by Anonymous - Sep 09, 2024Hindi
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Hello Team, I have clarification w.r.t Insurance and please find my details below 12-Jul-2023: Second Child born 10-Aug-2023: Floater Policy(2 Adults and 1 Child) took as suggested by Agent with 3 years Premium Second child cannot be added due to minimum eligibility days Agent recommended to add 2nd child after 60days and difference premium to be paid After 90 days (not sure about the date): Tried to add 2nd child to the policy through agent but it was not able to done Agent suggested that "We can add it in next year (i.e during Start of August 2024) 10-Aug-2024: When checked with Star health, they said that "Addition/deletion can be done at 2026" and said that "Addition of child should be done through mail after 91 days and website will not support to add a child" and when I asked the document reference for the same and no response yet from Star Health Current Policy holding: Corporate Insurane : SI (3L) for 2 Adults and 2 Childs Personal Insurance : SI (25L) for 2 Adults and 1 Child Star Health Suggestion: Take a separate policy for 2nd Child for 5L and it can be added to existing policy in 2026. Please let me know how to proceed further 1. Whether the Separate policy can be taken here or wait until 2026, to add the 2nd child 2. Whether the Star Health was really worth or can I consider for porting in 2026 due to disappointment with above issue Thank you in advance!
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Milind

Milind Vadjikar  | Answer  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on Feb 11, 2025

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my policy number was taken on 19 February 2021, in the first week of March 2021 suddenly my blood pressure increased, due to which the doctor asked me to undergo angiography. After that the doctor asked to do angioplasty immediately and thus on 18 March 2021 I got angioplasty done. Now I am completely healthy, since my illness occurred within 31 days of taking the policy, company agent told me that there is no provision to cover any health related problem within 31 days. Company agent told me that there is no provision to declare any illness midway. Now I am completely healthy. Company not include my above mentioned health condition in my policy. And compny given me reply "Dear Mr. Jain, We acknowledge the receipt of your mail. With reference to our previous telcon, this is to inform that any disease or ailment/illness if found after inception of policy. It is not required to disclose under policy. But if you still wish to disclose the disease then kindly find the attached PED inclusion form, fill and submit us for further evaluation. Note : To note the disease in the policy PED form is mandatory. We request you to provide the Medical reports/ Discharge summary /any relevant /First consultation paper / medical document of the said procedure/diagnosis, which shall be kept for our reference. " What can I do.
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However you may update it to the insurance company sighting change in health status before next renewal.

Most likely renewal will get rejected or will be accepted without this condition.

Check on cardiac exclusive policies to cover your ailment.

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What you are experiencing at Sairam is not engineering, it is rote-based credential production.

“When did engineering become memorizing instead of learning?”

Sadly, this shift happened decades ago in most Tier-3 private colleges in India.

About “coding platforms & points” – your observation is sharp

You are absolutely right:

Mandatory coding points → students copy solutions

Copying ≠ learning

Debugging & thinking are missing

This is pseudo-skill education — it looks modern but produces shallow engineers.

The fact that you noticed this in 1st year already puts you ahead of 80% students.

Should you DROP OUT and prepare for JEE / VITEEE / SRMJEEE?

Although VIT/SRM is better than Sairam Engineering College, but you may face the same problem. You will not face this type of problem only in some top IITs, but getting seat in those IITs will be difficult.
Instead of dropping immediately, consider:

???? Strategy:

Stay enrolled (degree security)

Reduce emotional investment in college rules

Use:

GitHub

Open-source projects

Hackathons

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Hardware / software self-projects

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Ans: Your brother’s distance is not a rejection of you. It is his way of protecting himself. He went through a difficult marriage, an emotional collapse, and then watched people around him — including you — react out of desperation to fix things for him. Even though your intentions came from love, he may have associated those actions with more pain and pressure. When a person has been wounded, silence feels safer than conversation. His withdrawal simply means he is tired, not that he dislikes you.
You also need to understand that the guilt you are carrying is heavier than it needs to be. You tried to intervene in his marriage because you wanted to protect him, not because you wanted to cause harm. Looking back now, with more maturity and clarity, you see the mistakes, but at that time, you were acting out of fear and love. This is why it’s important to forgive yourself instead of punishing yourself over and over.
The conflict between your wife and your brother only added another layer of stress, because it forced you into choosing sides. Your wife reacted emotionally, your brother pulled away, your parents questioned the imbalance — and in the middle of all this, you lost your sense of peace. But their disagreements are not failures on your part. They are the natural result of people operating from insecurity, fear, and past hurt.
What needs to happen now is a shift in your role. You cannot continue trying to solve everything for everyone. You cannot carry your brother’s marriage, your wife’s fears, and your parents’ judgments all at once. It’s time to step out of the role of rescuer and step into the role of a grounded, calm brother who offers presence, not solutions.
Rebuilding your bond with your brother will not come from pushing proposals, sending gifts, or trying to fix his life. It will come from offering him emotional safety. A simple message, expressing that you are sorry for any hurt, that you care for him, and that you are available whenever he feels ready, will speak louder than any effort to arrange his future. Once you send such a message, the healthiest thing you can do is give him space. Sometimes relationships repair themselves in silence, when pressure is removed.
And for yourself, healing begins when you stop believing that every problem in the family rests on your shoulders. You have given more than enough over the years. Now you deserve emotional rest. You deserve peace. You deserve to feel like a brother, not a crisis manager.
Your brother may take time, but distance does not erase love. When he feels safe, he will come closer again. Your responsibility is not to force that moment, but to make sure you are emotionally steady and ready when it happens.

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DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.

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