Introduction
I just lately learn an eye-opening article on Enterprise In the present day a few Chartered Accountant, Neeraj Khanchandani. His mother and father’ medical health insurance declare was rejected. I additionally learn the put up of Neeraj on Linkedin.
The explanation? “Non-disclosure.”
This bought me pondering, what actually occurred right here? Why do insurers reject claims, particularly for senior residents?
On this put up, I’ll share my private understandings about medical health insurance claims. I had an analogous expertise in 2007 with my private family-insurance, however the claimant was not for a senior citizen.
I can really really feel the ache.
1. Neeraj Khanchandani Story: A Recap
On July 30, 2025, MSN revealed this text titled “‘This may very well be your mother and father subsequent’: CA exposes how India’s insurance coverage system fails senior residents.”
It tells the story of Neeraj Khanchandani, a Mumbai-based CA, who confronted a nightmare along with his mother and father’ medical health insurance.
He ported their coverage to a brand new insurer, hoping for higher protection.
However once they filed a declare, the insurer rejected it, citing “non-disclosure” of a pre-existing situation. Worse, they canceled the coverage solely in 2024.
Khanchandani insisted he had disclosed every part. His makes an attempt to resolve the problem by grievance mechanisms additionally failed.
I’ll discuss concerning the broader points our medical health insurance sector.
We’ll IRDAI’s reforms, like decreasing the ready interval for pre-existing ailments from 4 to a few years (learn this put up of Bajaj Allianz).
We all know, how premiums for seniors are skyrocketing, typically by 30% or extra.
There may be additionally a Policybazaar survey that notes that 75% of policyholders have protection of Rs.10 lakh or much less, usually inadequate for rising medical prices.
The Ayushman Bharat scheme affords hope for seniors above 70, however consciousness and implementation are missing.
This story isn’t nearly one household, it’s a wake-up name for all of us.
2. Why I’m Writing This Publish
I’ve seen many individuals battle with insurance coverage claims past my private story).
Medical health insurance is meant to be a security web, particularly for our mother and father. However tales like Khanchandani’s make me surprise, why do claims get rejected?
Was it actually non-disclosure, or is one thing else at play?
I’m digging into this case to know what may have gone flawed.
My objective is to interrupt down the attainable causes, primarily based on customary insurance coverage guidelines in India.
By the top, I’ll share my view on whether or not this rejection was honest. So, let’s get began.
3. Understanding Well being Insurance coverage in India
Medical health insurance is a contract.
You pay premiums, and the insurer guarantees to cowl medical bills. It’s speculated to be this straightforward.
However the fantastic print is the place issues get messy. Insurance policies include phrases like ready intervals, exclusions, and disclosure necessities.
For senior residents, these guidelines are stricter. Insurers know medical prices for the aged are excessive. So, they scrutinize claims carefully (probably with intentions to seek out small-small causes to reject the declare).
In 2022, in my shut household, a senior citizen’s (70+) well being declare (angioplasty) was rejected. However I’ll give the advantage of doubt to the insurance coverage supplier because the coverage was new (nearly a 12 months plus).
In Khanchandani’s story, the case revolves round “non-disclosure.”
Let’s discover what which means.
4. What Is Non-Disclosure?
If you purchase medical health insurance, you have to declare all pre-existing situations, like diabetes, hypertension, or coronary heart points.
That is referred to as full disclosure.
Should you miss one thing, even by mistake, the insurer can name it “non-disclosure.”
This offers them grounds to reject claims or cancel insurance policies.
In Khanchandani’s case, the insurer stated a situation wasn’t disclosed. He claims he shared every part. So, who’s proper?
Word: Keep in mind, in Neeraj’s case the coverage was 13-years outdated (until 2021) when he determined to port his coverage. It was not a brand new coverage.
5. Was the Ready Interval a Issue?
A lot of you may suppose the rejection was because of the ready interval.
Most insurance policies have a 3-year ready interval for pre-existing situations.
After this, insurers should cowl these situations. IRDAI diminished this era to a few years just lately.
Since Khanchandani ported his mother and father’ coverage, the ready interval from the outdated coverage ought to carry over.
It means, if they’d protection for over three years, the ready interval shouldn’t apply.
The article doesn’t point out the coverage’s age (however I assume it was about 2 years outdated – primarily based on the Linkedin put up of Neeraj), however the rejection was about “non-disclosure,” not the ready interval.
So, ‘ready interval’ probably wasn’t the problem.
6. Different Attainable Causes for the Rejection
Let’s dive into why the declare may need been rejected.
Primarily based on how insurance coverage works in India, listed here are the important thing prospects (you may as well bounce to my particular person view about this case right here):
- Discrepancy in Medical Historical past: Insurers ask for detailed medical historical past throughout coverage buy or porting. If Khanchandani’s mother and father missed itemizing a situation, like a minor surgical procedure or occasional medicine, it may very well be labeled non-disclosure. Even trustworthy errors can result in rejections. Did one thing comparable occur right here?
- Porting Problems: Porting means transferring your coverage to a brand new insurer with out dropping advantages. IRDAI guidelines say the ready interval carries over. However the brand new insurer rechecks your well being particulars. In the event that they discovered a situation not listed within the outdated coverage’s data, they may cry foul. Possibly there was a spot in documentation throughout porting. It’s frequent for insurers to dig deep whenever you port, particularly for seniors (you understand why – danger is larger). Therefore, I’ll by no means port a well being coverage of a senior citizen or of a affected person with a essential well being situation.
- Insurer’s Strict Interpretation: Insurers usually interpret “non-disclosure” broadly. Say Khanchandani’s mother and father talked about diabetes however not a associated complication, like neuropathy. The insurer may declare this wasn’t absolutely disclosed. There are variety of tales of insurers rejecting claims over tiny particulars, like not mentioning a one-time hospital go to. It’s irritating, but it surely occurs. These small-small issues develop into larger when the coverage will get ported and the declare occurs in inside the ready interval of three years (although in Neeraj’s case, ready interval was not relevant).
- Coverage-Particular Exclusions: Some insurance policies exclude sure therapies or situations, even after the ready interval. As an illustration, a coverage may cap protection for a selected heart-related points. If the declare fell beneath such an exclusion, it may very well be rejected. However in Neeraj’s case, as the main target was on non-disclosure, so this appears much less probably.
- Suspected Fraud: If the insurer thought Khanchandani intentionally hid a situation to get decrease premiums. On this case they may reject the declare and cancel the coverage. That is severe. Khanchandani’s public put up on LinkedIn suggests he’s assured in his transparency. However let me inform you, insurers are fast to imagine the worst.
7. What Might Khanchandani Have Executed In a different way?
There’s a phrase which says “Hindsight is 20/20.”
It’s very straightforward for individuals like me to see what ought to have been performed after an occasion has occurred, as issues develop into clearer on reflection.
I imply no disrespect to Neeaj, I do know he being a CA, is properly certified for take care issues like this – a lot better than me.
However taking the advantage of age, I’ll share a few fast ideas for my readers.
- Do Not Port: If a senior citizen has an outdated well being coverage (like 13+ years), don’t port. Possibly the premium shall be barely larger, however I’ll bear with it. That is additionally true for youthful sufferers (non senior residents). If they’d been handled for a essential sickness prior to now, beneath a well being cowl, don’t port such a coverage. In my case, I had a Tata Aig well being cowl. After the prognosis of a really essential illness they elevated the premium by virtually 60% (however they stated its due to post-covid state of affairs – so I don’t know for certain), however after doing the evaluation I discovered it higher to stay to the identical Insurance coverage supplier. although I’ll say, other than this premium hike episode, Tata Aig is sweet.
- Double-Examine Disclosures: All the time record each medical situation, even minor ones, in writing. Preserve proof of the submissions. This rule is legitimate if you are shopping for a brand new polity or porting an older one. Attempt to brutally trustworthy in your disclosures. Allow them to see all of the experiences. Our worry is, they may hike the premium. In a manner it’s good, as a result of then you’ll be able to evaluate the precise premium between your present supplier and the brand new one.
- Perceive Porting: Earlier than porting, verify all well being particulars switch appropriately. Ask the brand new insurer to make clear what they want, maintain asking them until they offer you in writing that the necessity nothing extra.
- Search Professional Assist: A CA like Khanchandani probably knew the foundations very deeply, however everybody will not be an professional like him. So, I’ll counsel, consulting an insurance coverage advisor to purchase a brand new cowl and even throughout porting.
8. My Views: Was the Rejection Justified?
I don’t suppose the rejection was justified.
IRDAI guidelines are clear: insurers can’t reject claims for pre-existing situations after the ready interval, except there’s clear proof of non-disclosure.
Khanchandani, a CA, probably knew the significance of full disclosure. His public outcry on LinkedIn suggests he’s assured in his transparency.
The insurer’s declare of “non-disclosure” appears like a handy excuse.
With out seeing the precise coverage or medical data, I can’t be 100% certain. However rejecting a declare and canceling the coverage solely? That smells like a tactic to keep away from paying out.
Insurers usually use “non-disclosure” as a catch-all to dodge claims, particularly for seniors in a ready interval zone.
It’s a sample I’ve personally seen too usually.
Because the burden of proof falls on the policyholder, which is unfair whenever you’re already coping with medical emergencies.
Neeraj Khanchandani’s failed makes an attempt at grievance redressal solely strengthen my view.
I’ve little doubt in saying that the system let him down.
If the insurer had stable proof of deliberate non-disclosure, they need to’ve shared it transparently. As a substitute, they left a household excessive and dry.
That’s not proper.
What Can We Be taught?
This story is a reminder to be proactive.
Examine your coverage’s fantastic print. Declare each well being element, irrespective of how small. Preserve data of all communications along with your insurer.
Should you’re porting, double-check the method. And push for higher protection, Rs.10 lakh won’t minimize it anymore.
Let’s additionally hope IRDAI tightens the screws on insurers to make declare rejections fairer.
What do you suppose, buddies? Have you ever confronted comparable points with insurance coverage claims? Should you really feel the ache of Neeraj, could I ask you to share this put up of social Media. You’ll be able to put up your views within the feedback part under.
