Summary

This account and its amounts are reported by Insurance Support and have not been independently verified. Details are selective, and the outcome of another claim may differ.

A retired school teacher's LIC health claim was rejected within 7 days of submission, citing non-disclosure of diabetes. The policy had been in force for 8 years. We analyzed the rejection letter, submitted additional medical records from 3 different hospitals spanning 3 years, and demonstrated that the diabetes was a known but controlled condition, not newly developed. The claim was approved in full within 42 days.

How We Solved It

S Situation

58-year-old retired school teacher from Malleshwaram had a pre-existing diabetes diagnosis for 5 years. LIC rejected the claim citing material non-disclosure — diabetes was mentioned in one hospital record but not all.

T Task

Demonstrate that the diabetes was properly disclosed across relevant medical records, not selectively omitted. Prove the rejection was based on an incomplete medical review, not fraud.

A Action

1. Collected 3 years of medical records from 4 different hospitals
2. Cross-referenced with the original proposal form — diabetes was listed under existing conditions
3. Drafted a 15-page appeal letter citing IRDAI Health Insurance Regulations 2016
4. Built a timeline showing no symptoms or treatments were hidden
5. Escalated to the GRO with specific reference to IRDAI regulations

R Result

LIC's GRO reviewed the case within 12 days and approved the full claim. The approval letter cited incomplete initial review as the reason for reversal.

Lessons Learned

Always submit complete medical history
Insurers must review ALL available medical records
A well-drafted appeal with proper regulation references gets faster responses
IRDAI regulations protect policyholders

"I was devastated when LIC rejected the claim. Hari Kotian Sir analyzed 3 years of my medical files and found that LIC's own doctor had only looked at one hospital's records. Within 6 weeks, the full amount was in my account."

— I was | Malleshwaram, Bangalore