Insurance Claim Denial Based on Non-Disclosure of Conditions Developed After Policy Issuance

Based on my research, here's what you need to know about insurance companies denying claims for conditions that develop after policy issuance:

Key Legal Principles

1. Post-Policy Conditions: Insurance companies generally cannot deny claims for medical conditions that develop after the policy has been issued. Such conditions are not pre-existing and therefore should be covered under the policy terms.

2. Burden of Proof: According to legal precedents, insurers must provide "concrete and credible evidence" when alleging non-disclosure or fraud. The burden of proof lies with the insurance company to demonstrate that information was deliberately withheld.

Relevant Case Law

1. NCDRC Ruling: The National Consumer Disputes Redressal Commission has established that insurers cannot reject claims by citing non-disclosure of pre-existing conditions if the policy was issued after assessing the insured's health status.

2. Pavan Sachdeva vs Office of The Insurance Ombudsman (Delhi High Court, July 27, 2020): This case reinforced protections for policyholders against arbitrary claim denials.

3. Judicial Interpretation: Courts have consistently held that if an insurer issues a policy after reviewing medical reports and determining there was no risk of pre-existing illness, they cannot later repudiate a claim alleging pre-existing illness, particularly when such illness is not expressly excluded under the policy.

Legal Protections for Policyholders

1. If an insurance company accepts premiums and issues a policy despite incomplete information (such as blank columns in the application), they generally cannot later deny claims based on alleged suppression or non-disclosure.

2. When a medical condition develops after the policy is in force, it is considered a new condition covered under the policy, not a pre-existing condition subject to disclosure requirements.

Conclusion

Based on established legal principles and case law, insurance companies cannot legitimately deny claims for conditions that develop after the policy is issued on grounds of non-disclosure. Such denials would be considered improper and can be successfully challenged through consumer forums, insurance ombudsman, or courts.

If you're facing such a situation, you may want to:

• Review your policy documents carefully
• Gather medical evidence showing when the condition was first diagnosed
• Consult with a legal expert specializing in insurance claims
• File a complaint with the insurance regulatory authority or consumer forum