I have been continuously insured under a health policy since 2020 and recently transferred my plan to another insurer. A few months later, my hospitalization claim was rejected for non-disclosure of a pre-existing condition (acidity and heartburn prior to the original policy). As my cover has been continuous for more than four years and has been transferred correctly, is the insurer right to refuse the claim? What can I do? — Name withheld on request This is a common issue faced by policyholders who move their health insurance from one insurer to another. Portability, according to the Insurance Regulatory and Development Authority of India (Irdai), ensures that you do not lose your benefits when you change insurers. When you transfer your health policy, the new insurer must credit the term you have already completed under your old policy. This means waiting periods for existing conditions continue seamlessly—you’re not starting from scratch. Moratorium clause provides protection Another important protection is the moratorium clause. Under Irdai rules, once a policy has been active for five consecutive years, no claim can be denied on the basis of non-disclosure or misrepresentation unless there is proven fraud. Even before five years, insurers are required to consider the policyholder’s ongoing coverage history and prior claims record before rejecting claims. Since your policy has been active since 2020, portability ensures that exclusions for pre-existing conditions are not reset. While it is always best to disclose all known health issues during proposal or transfer, insurers cannot deny claims simply on technical grounds if continuity is maintained and there is no evidence of intentional fraud. In your case, occasional heartburn or acidity is typically not significant enough to warrant complete rejection. How to appeal a rejection If your claim has been rejected, start by writing to the insurer’s Grievance Redressal Officer (GRO) and request a detailed repudiation letter citing specific policy clauses. If you are dissatisfied, escalate the matter through the Bima Bharosa portal (the Irdai grievance platform), or approach the Ombudsman for Insurance with all supporting documents—including policy copies, premium receipts, medical records and hospital bills. Emphasize that your policy has been continuously active since 2020 and highlight the Irdai portability provisions that protect your coverage continuity. In similar previous cases, the Insurance Ombudsman ruled in favor of consumers and ordered insurers to settle claims. The rationale: portability protects policyholders from losing accrued benefits due to technical lapses or minor non-disclosure. Shilpa Arora is Co-Founder and COO at Insurance Samadhan
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