There is always debate on the pre-existing diseases and how and when Pre-existing disease will be covered?, in health insurance. Now a District Consumer Disputes Redressal Forum gave a ruling that, “For medical insurance claim settlement, a disease cannot be said to be pre-existing unless it has been certified so by a doctor on basis of various tests prior to the purchase of policy”.
Some other Important Points Raised in the Ruling:
1- The disease cannot be said to be pre-existing if it was merely opined so by the doctor on basis of talks with the patient.
2- The disease in order to be pre-existing should be in the knowledge of insured.
3- If a doctor on talking with a patient gives a particular name to a condition explained by patient, it is not sufficient as a positive evidence of pre-existing disease for purpose of insurance.
Source – FT