My Mom is 67 and she is to undergo a knee replacement surgery next month. She had met with an accident 10 years ago and had her leg fractured (steel plate inside) below the knee. The knee replacement is not at all related to the accident as she started to get pain only late last year. This week, we went to get pre-auth done by ICICI LOMBARD and the hospital staff expressed a concern the claim may be rejected due to the accident. Is it true? The doctor said clearly he'll be mentioning in the report that both are totally un-related.

Since the insurance co. will see X-ray reports, they'll get to see the steel plate and hence know about the accident. The hosp staff suggested that we mention that the accident happened just 5 years ago (my policy is in force since 2007) and NOT tell about the accident being so old because I was not covered then. I'm confused as I thought we 'll stand a better chance to say the accident happened 10 years ago which will make our case stronger to say knee repl is not related to the accident. After the accident, there was an FIR and she had received some insurance amount as well. Should I mention it all as it is ? OR should I say it just happened 5 years back with no mention of FIR etc ...?

In case of a dispute, we'll be better off having mentioned the true story....


In any case, I understand we have to mention that the pain in the knee is very recent. Please advice

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