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

Milind

Milind Vadjikar  |1114 Answers  |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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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.

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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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K. Ramalingam, MBA, CFP,

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www.holisticinvestment.in

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