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The Economic Times

Business

Anshika Jain

Rs 5 lakh health insurance claim denied by insurer over waiting period for pancreatitis; here's why the policyholder's wife won

Insurance Commission Mayank Arora Disease

A health insurer cannot mechanically rely on a waiting-period clause to reject a claim when it fails to establish that the insured's condition was pre-existing, the Mumbai Suburban District Consumer Disputes Redressal Commission has held in a case involving a ₹5 lakh pancreatitis claim.

The commission directed Max Bupa Health Insurance Co. Ltd., currently known as Niva Bupa Health Insurance Co. Ltd., to pay the policyholder's ₹5 lakh claim after the insurer rejected it, citing a 24-month specific waiting period for pancreatitis.

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