You will hear many cases where insurance claim has been rejected on non-disclosure of pre-existing diseases. In Health and Life Insurance, pre-existing diseases are a material fact which increases the probability of occurrence of insured event. But, most of advisors as well as customers are not very clear that which diseases need to be declared. Do we declare diseases which are non-common and where we took medication? Do we declare diseases which required hospitalization? Do we declare diseases which happened in our childhood or college days? You will not get a correct answer to these questions.
What is a disease?
Diseases are often known to be medical conditions that are associated with specific signs and symptoms.
What are the different types of Diseases?
There are five types of diseases as mentioned below:-
- Infectious diseases like Cold, cough, Covid etc. Common diseases like cold need not be declared bur uncommon diseases like COVID should be declared because it affects morbidity. Insurance Companies are concerned about diseases which can increase the probability of occurrence of insured event. Infections in the stomach can be common but if it required hospitalization then it needs to be declared.
- Deficiency diseases like Anemia need to be declared. There are common deficiency which is taken care by taking supplements. As you are taking supplement hence need to be declared.
- Genetic Diseases: You need to declare it if you had been declared with a genetic disorder. It affects morbidity and many genetic disorders are not covered under Life and Health Insurance.
- Physiological Diseases like Diabetes, Heart. Liver. The kidney must be declared because these diseases increases the risk and Insurers are very particular on these diseases.
- Psychological Diseases: These diseases are not manifested and need to be declared if it is under treatment.
Diseases are also to be seen from symptoms and diagnosis. If there are symptoms but no diagnosis then it need not be declared but if a disease is diagnosed then it must be declared.
All the above declaration need to be made on Proposal Form which has approx 15 questions related to health. These questions are very specific and can be answered, few examples are given below:
- Chest pain, heart attack, stroke, heart murmur, shortness of breath and heart condition: These questions are related to heart conditions hence if you have undertaken any heart-related treatment then it should be declared. A chest pain not related to heart condition need not be declared. If you have taken ECG or Echo as part of regular medical checkups then it need not be declared but if you had a symptom and gone for ECG then it should be declared.
- Hypertension or blood pressure: Many cases are rejected because of non-declaration of Hypertension or bold pressure. Once again, declare if you are diagnosed and taking a normal treatment or advised lifestyle changes.
- Asthma or Lung related Problem: Declare if diagnosed.
So it is necessary that we declare all information related to health. It is easy to declare and handle the case when you are in good health and alive, it will be difficult to counter objections by claim department post occurrence of event.
How claim department analyze the case?
- In most of cases, declaration by family members and noting by attending doctors play an important role. Amit, age 35, had chest pain and was taken to the emergency. Family mentioned that he was working under stress, had tension for the last six months and was not able to sleep. Doctor noted “Known case of Hypertension “. Amit died due to cardiac arrest. His claim was rejected due to the doctor noting.
- All Insurers investigate case and check email records, interview nearby chemists and family Doctors. If they get hold of any prescription or lab report then same is used as evidence of non-declarations.
- Declare all health-related information which has been diagnosed and under treatment.
- If some disease has been treated even then it should be declared.
- It is better to give information rather regret later, so be transparent.
- It is advised to make a separate note and give details about your health in childhood and young age.
- It is your duty to check your form if it is digitally filled and inform discrepancies during the free-look period of 15 days.