A proposer may not be aware of a prevailing condition, and if a medical test reveals it, no doubt the insurer will exclude it as pre-existing, but the discovery in the test would enable the person to take suitable remedial steps/treatment.
Most health insurance policies will require a medical test. However, some insurers may offer you a health policy even without a medical check-up, especially if you are young. These policies are normally available for those aged 18-45 years. At this age, insurers assume lower health risks and issue the policy almost immediately with minimal paperwork.
However, looking at ‘pre-acceptance’ health tests while buying a health insurance policy is not correct. Says R Balasundaram, secretary general, Insurance Brokers Association of India (IBAI): “One is supposed to reveal all pre-existing ailments/conditions truthfully at the time of proposal, whether or not a medical test is demanded by the insurer. Pre-existing conditions are generally excluded under health policies.”
So, one cannot argue that, as the insurer did not insist on a medical test, he should not decline a claim for pre-existing conditions. The proposer ought to have stated the condition as pre-existing.
“Besides, a proposer may not be aware of a prevailing condition, and if a medical test reveals it, no doubt the insurer will exclude it as pre-existing, but the discovery in the test would enable the person to take suitable remedial steps/treatment. For example, diabetes comes to light only during pre-acceptance tests. The proposer can take steps to keep it under control,” says Balasundaram.
Disclosing A Pre-Existing Disease Is Mandatory
One should also remember that the onus is on the policyholder to declare any pre-existing disease. Even if you think that a pre-existing disease is under control, you should disclose it when getting health insurance.
If you do not do a proper disclosure and a claim arises later, the insurer has the right to deny your claim. So, just because a health insurance policy is being sold without a medical test does not mean that you can get away with a pre-existing disease.
“Yes, there is a possibility of insurers rejecting the claim on the grounds of non-disclosure in such cases. Even if no test is done when buying the policy, the insured is expected to disclose all known medical conditions. If any of such information is missing or hidden intentionally or unintentionally, it can lead to claim rejection due to non-disclosure,” says Sarita Joshi, head, health and life insurance, Probus.