Archive · 20 Nov 2025
Insurer's Claim Rejection: Disclosure of Old, Resolved Illness
A person's health insurance claim was rejected because they didn't tell the insurer about an old illness that was fully treated and certified as resolved.
The person thinks this is unfair because the old illness is not related to their current health problem.
The Insurance Regulatory and Development Authority of India (IRDAI) has rules about when people must tell their insurer about their health history, and the insurer must show that the old illness is connected to the current problem to reject a claim.
Insurer rejected claim for acute motor axonal polyneuropathy (AMAN)
Grounds: Non-disclosure of old ankylosing spondylitis diagnosis in 2008
Policyholder argued illness was resolved, certified by doctor
IRDAI rules on material facts and causal link
- Who
- A policyholder with acute motor axonal polyneuropathy (AMAN)
- What
- Health insurance claim rejection
- When
- Present, with a past illness in 2008
- Where
- Not specified
- Why
- Non-disclosure of old ankylosing spondylitis diagnosis
Insurer's perspective
Policyholder's perspective
Disclosure of old illness
Insurer's perspective
Required for accurate risk assessment
Policyholder's perspective
Not relevant if fully resolved and unrelated to current illness
Causal link
Insurer's perspective
May exist, requiring further investigation
Policyholder's perspective
No medical evidence of connection
- Old illness
- Ankylosing spondylitis (2008)
- Current illness
- Acute motor axonal polyneuropathy (AMAN)
- Insurer's action
- Rejected claim
- Policyholder's argument
- Illness was resolved and unrelated
- IRDAI rules
- Material facts and causal link