Health Insurance Claim Rejected for Non-Disclosure: Proposal Form, Medical History and Contestability File
By Ravi Sisodia · Reviewed by CA Divyanshu Sengar · Updated 5 October 2026
2-minute summary
- A health claim rejected for non-disclosure needs a document-by-document test of the proposal form, underwriting record and alleged omitted fact.
- After 60 continuous months of health-insurance coverage, the IRDAI moratorium materially narrows contestability: non-disclosure or misrepresentation cannot ordinarily be used except established fraud, subject to the rule for enhanced sum insured.
- Do not confuse the life-insurance contestability rule in section 45 with the health-insurance moratorium framework.
Current position
Control and evidence map
| # | Control / evidence requirement | |
|---|---|---|
| 1 | Obtain the signed/electronic proposal form, call recording or tele-underwriting transcript and policy schedule. | |
| 2 | Ask the insurer to identify the precise question allegedly answered incorrectly and the medical fact said to be material. | |
| 3 | Map continuity, portability and migration to the 60-month moratorium; separately map any later enhancement in sum insured. | |
| 4 | Collect pre-policy medical records, test reports and disclosure correspondence to establish what was actually known and asked. | |
| 5 | If repudiation persists, preserve the speaking rejection letter and grievance trail for insurer GRO, Bima Bharosa/IRDAI and Ombudsman/court routes as applicable. | |
Worked example
A family has maintained continuous health cover for more than five years, but the insurer rejects a hospitalisation claim alleging that an old thyroid consultation was not disclosed. The first question is not simply whether that consultation existed; the file should test the exact proposal question, continuity period, any later sum-insured enhancement and whether the insurer is alleging established fraud. That sequence can change the legal analysis materially.
Common mistakes
- Citing section 45 of the Insurance Act as if it directly governs a health-policy repudiation.
- Sending only hospital bills while ignoring the original proposal and underwriting trail.
- Ignoring portability credit when calculating continuity.
- Treating every medical omission as established fraud.
Frequently asked questions
Is every pre-policy medical omission fatal?
No. The legal effect depends on the proposal question, materiality, timing, continuity and the current moratorium rule.
Does portability reset the moratorium clock?
IRDAI guidance allows relevant continuity credits to travel with portability/migration.
What happens after an increase in sum insured?
The enhanced portion carries its own moratorium-period analysis from the date of enhancement.
What should be requested from the insurer?
A reasoned repudiation, the proposal/underwriting record and the exact policy clause relied on.
Official sources
- Insurance Regulatory and Development Authority of India - Master Circular on Health Insurance Business - 29 May 2024 (IRDAI/HLT/CIR/PRO/84/5/2024; 2024-05-29)
- Insurance Regulatory and Development Authority of India - Protection of Policyholder Interests, Operations and Allied Matters Regulations, 2024 (IRDAI/Reg/11/205/2024; 2024-04-01)
- Insurance Regulatory and Development Authority of India - Master Circular on Protection of Policyholders Interests, 2024 (IRDAI/PP&GR/CIR/MISC/117/9/2024; 2024-09-05)
Disclaimer
Educational and professional reference only; confirm the current law, rates and the facts of your case before relying on this page.