Buying Health Or Term Insurance? Don't Ignore This Critical Question, Which Can Lead To Claim Rejections

Many policyholders who have experienced their health or term insurance claim getting rejected, would know how often the reason traces back to some previous disease or medical condition. When you buy a health or term insurance plan, you are asked a question, even after ticking off any pre-existing disease you have, “Any other disease/condition not mentioned above?”

This question appears at the bottom of most insurance proposal forms, in both online or offline mode, and is easy to gloss over. Most would feel tempted to answer with a quick “No,” especially after pages of other, more specific medical queries.

The trouble is, this question is anything but harmless.

“It’s the most loaded question in insurance,” says Mahavir Chopra, Founder of insurance advisory platform Beshak.org, in a recent LinkedIn post. “It doesn’t ask about specific ailments. It doesn’t define a time frame. It doesn’t even clarify what counts as a condition. But it’s the one that can trip you up.”

The Risk Between the Lines

Insurance forms today are mostly filled digitally, often rushed through, guided by sales agents or online advisors focused on closing the transaction quickly. And in this process, disclosures that seem minor, a back pain that flares up occasionally, a benign cyst removed years ago, a one-time high blood pressure reading, may get left out.

However, insurers may later treat such omissions as non-disclosure of material information. And that could be enough to void your claim, even if the treatment sought is unrelated to what was undisclosed.

Consider this: According to the Insurance Regulatory and Development Authority of India's latest annual report, nearly 46 per cent of health insurance claim rejections were due to non-disclosure or misrepresentation of pre-existing conditions.

In another LinkedIn post on the same issue, Shilpa Arora, co-founder and COO of Insurance Samadhan, writes:

"This simple act of full disclosure can be the difference between your loved ones receiving the claim amount or facing rejection during their most difficult time." Her advice? Disclose everything, even if you are not sure it falls under the insurer's current definition of a pre-existing disease (PED). And yes, even if the issue was years ago, fully treated, and benign.

So What Is a Pre-Existing Disease?

The insurance regulator Irdai defines PEDs as any condition diagnosed, or for which treatment was taken, within 36 months before the start of the policy. This definition was updated in 2024, and the maximum waiting period for covering PEDs is now capped at three years (down from four).

However, experts caution that relying strictly on the timeline can be risky. Let's say someone had surgery for a non-cancerous growth over a decade ago. Do they need to mention it?

Experts say it is best if you do, even if outside the PED window. Because the insurer may not reject on pre-existing disease grounds, but they can still do it on the grounds of non-disclosure of a material fact.

Avigyan Mitra, an insurance and investment advisor, noted on Mahavir's post "Many advisors don't explain the weight of this question to the customer, because they themselves don't know an iota about underwriting. You're absolutely right that people assume. But the industry wants it both ways like they want to automate the buying journey for scale, but still retain the right to reject claims. "

He points out that if insurers truly care about clarity, they need to redesign this question, add examples, or make disclosure forms more interactive.

What should policyholders do?

The best defence, as Chopra puts it, is over-disclosure and documentation.

Here's what he recommends:

Err on the side of caution: Mention even old or minor issues — backaches, diagnostic tests, surgeries, or even just a prescription that was suggested but never taken.

Keep evidence of disclosure: Email your declaration to the insurer. Save screenshots of the proposal form. Store it in a way that family members can access it, especially in case of a claim during a health emergency.

Understand the moratorium clause: If your health policy has run without a break for eight years, Irdai's moratorium rule means the insurer cannot reject claims on grounds of past non-disclosures (unless it is proven fraud). But until then, you are exposed.

The Bottom Line

When buying health or life insurance, don't just skim through the forms. And definitely don't underestimate vague-sounding questions. That one line at the bottom, like "Any other condition not mentioned above?" could mean the difference between a policy that protects and one that gets your claim rejected in the hour of need.