How Pre Existent Diseases Can Affect Your Health Insurance Claims

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Health is wealth, and health insurance is your shield. In today’s uncertain times, health insurance serves as a vital shield against the financial burden of medical emergencies. However, when it comes to health insurance claims, it can be a daunting experience for a policyholder, as even the tiniest thing can make the journey of claim processing challenging. 

Today, we will discuss a scenario where health insurance companies sometimes reject a claim on the basis of pre-existing disease which can be challenged.

Pre-existing Disease in Health Insurance_ Insights from Insurance Samadhan


Pooja was covered under the group insurance. Her journey took an unexpected turn when she noticed a lump in her right breast. Following mammography, she was advised to undergo chemotherapy at Rajiv Gandhi Cancer Institute. Unfortunately, the insurance company rejected her genuine claim, citing a previous non-cancerous breast tumor operation she had undergone in 2003. Despite Pooja’s explanation that the previous operation was unrelated to her current diagnosis, she faced challenges due to the unavailability of medical records from 18 years ago. 

After watching on shark tank, she reached out to the Insurance Samadhan’s team and with our experts’ technical expertise, the case was represented properly and Pooja got her complete claim amount.

Insurance Samadhan

How Insurance Companies Reject Claims – Key Issue

One key issue faced when insurance companies reject claims is the lack of medical records for past treatments or procedures. In Pooja’s case, her genuine claim for breast cancer treatment was denied due to a previous non-cancerous breast tumor operation she had undergone 18 years ago. 

Proper disclosure of all the PEDs

We at Insurance Samadhan always promote the fact that insurance is based on the principle of Utmost good faith and a proposer must always disclose all the pre existing diseases and information related to past hospitalizations and diseases.

What Can You Do If You Face Health Claim Rejections

In some situations, you can face similar issues and feel helpless. If your genuine claim gets rejected or there were some unnecessary deductions in the claim amount, then you can reapply for the claim. If you need guidance in your case, you can contact Insurance Samadhan. We have resolved 15000+ insurance-related complaints.

Insurance Samadhan

Bottom Line 

Also Read:  How to Deal with Health Insurance Claim Rejection?

Facing claim rejections can be disheartening, especially when the previous condition is unrelated to the current diagnosis. However, with the right guidance and support, policyholders can challenge these rejections and seek the rightful benefits of their health insurance policies. Remember, your health and financial well-being deserve proper protection, and Insurance Samadhan is here to help you achieve it.

Click here to register your complaint with Insurance Samadhan

You can also

Visit our website: insurancesamadhan.com

Call us on +91 9513631312

WhatsApp:  9910998252

Mail us at corporate@insurancesamadhan.com

Shailesh Kumar

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