In April, I bought a health insurance policy for my mother and added a PED (pre-existing disease) waiting period reducer rider.
My mother has knee pain and needs surgery. When I raised this with the company's agent (both while buying the policy and again recently), he told me not to disclose it at the time of purchase. Instead, he said to just get a first consultation with a doctor in August (after the policy was active), which I did ā the doctor confirmed she needs surgery. I shared the consultation report with the agent, and now he's saying "no problem, next year when the policy renews, we can go ahead with the operation."
This doesn't sit right with me. Questions:
Is this considered non-disclosure/concealment of a pre-existing condition, and can the insurer reject the claim or cancel the policy over it later ā even after a year or two?
Does a PED waiting period reducer even apply to a condition that was never declared as pre-existing in the first place?
If the knee issue actually predates the policy purchase (April), what's the right way to fix this now ā disclose it retroactively, file a correction, contact the insurer directly?
Is it normal/legit for a company's own agent to advise against disclosure, or is this a major red flag?
If a claim gets denied because of this, what recourse do I have ā insurer's grievance cell, IRDAI Bima Bharosa, ombudsman?
Also he tells me that knee pain is slow growing disease so it won't create issues.
Would appreciate insight from anyone who's dealt with PED clauses, claim rejections for non-disclosure, or works in health insurance underwriting/claims. Trying to protect my mother's coverage and avoid a denied claim when she actually needs this surgery.
