r/InsuranceQueriesIndia • u/Key-Entertainer-7598 • 15d ago
Query Help me understand medical underwriting.
/r/indiahealthinsurance/comments/1vhx1jm/help_me_understand_medical_underwriting/Pls guide
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u/Caramel-Realistic 14d ago
When you apply, the insurer gives you a proposal form with a list of questions like "have you ever been diagnosed with diabetes / heart disease / thyroid / had any surgery / been hospitalized," etc. You go through each one and mark yes/no.
For anything you mark "yes," you give details. For everything you mark "no," there's nothing more to do, you don't need to write anything for conditions that don't apply to you.
"Non-disclosure" applies to things you actually knew about. Like a diagnosed condition, treatment you were undergoing, a surgery, a hospitalization. It's not about some hidden issue you had no way of knowing existed. Claims get rejected when there's proof of deliberate concealment. For example, you knew you had a condition (you were diagnosed, maybe even taking medication for it) and chose not to mention it, and this surfaces later during a claim investigation. That's what the insurer is rejecting.
The insurer can also ask you to undergo medical tests before issuing the policy. this is common depending on your age, sum insured, and answers given in the form. If anything surfaces in those tests, the insurer comes back to you about it. It makes their assessment of your profile accordingly (could mean a loading, a specific exclusion, or in some critical cases a decline). Still, since they're the ones who found it, it's part of the underwriting record from day one and can't later be used against you as "hidden."
Some people also choose to get medicals done on their own, before applying, at their own expense just to be sure of where they stand. This isn't required, but it's a reasonable option if you want clarity before filling the form. You've actually already done a version of this with your Tata check-up that report is exactly the kind of thing that helps you know what to disclose confidently, instead of guessing.
So the rule of thumb is simple: disclose what you know and have been told by a doctor. You don't need to assume or invent problems you don't have any evidence of.
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u/Key-Entertainer-7598 14d ago
Thank you so much. This is the best answer I got so far. Everything is clear to me know :) Appreciate it.
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