Claims & Traps6 min readFebruary 2026Plain-English Explained

Forgot to Declare BP or Thyroid? What Happens to Your Claim

The truth about medical history, Section 45 rules, and how to avoid claim rejection.

Ayush Mishra

Co-Founder · Letsbima.com

IRDAI Compliance & Fact Checked

Forgot to Declare BP or Thyroid? What Happens to Your Claim

In this guide

5 Sections

Executive Summary

When purchasing health insurance online, many people rush through the medical questionnaire, clicking "No" to questions about hypertension, thyroid medication, or an appendectomy done 7 years ago. Months or years later, a claim is filed for chest pain, and the insurer rejects the entire ₹4 Lakh bill citing "Non-disclosure of pre-existing hypertension." How does this happen, and what does the law say?

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01What Legally Qualifies as a Pre-Existing Disease (PED)?

According to IRDAI definitions, a Pre-Existing Disease (PED) is any condition, ailment, injury, or disease that was diagnosed by a physician within 36 months (3 years) prior to the issuance of the policy, or for which medical advice or treatment was recommended or received.

This includes chronic lifestyle ailments like Type-2 Diabetes, Hypertension (High BP), Hypothyroidism, Asthma, Cholesterol, PCOD, or any prior hospitalization.

The "My Doctor Said It Was Mild" Trap

Taking a single 2.5mg Telmisartan tablet daily for BP is legally a pre-existing condition.
Thyroid medication (Thyronorm 25mcg) must be declared even if your TSH levels are now normal.
Habitual smoking or alcohol consumption (even social) must be accurately declared.

02Section 45 & The 3-Year Incontestability Clause

Section 45 of the Insurance Act 1938 provides a powerful consumer protection clause known as the Moratorium Period (Incontestability Rule).

Under updated IRDAI regulations: Once a health or life insurance policy has completed 36 continuous months (3 years) without a break, the insurer CANNOT repudiate or reject a claim on the grounds of misstatement of facts, unless they can prove deliberate fraud.

However, relying on the 3-year rule as a loophole to conceal medical history is extremely risky. If you make a claim within the first 36 months, the insurer has full legal power to investigate your medical history, cancel your policy, and forfeit all paid premiums.

Consider a real pattern we see often: a policyholder buys a ₹10 Lakh policy at age 42 without disclosing a 2-year-old hypertension diagnosis, pays premiums honestly for 30 months, then suffers a stroke and files a ₹6 Lakh claim. Because the policy is 6 months short of the 36-month moratorium, the insurer is fully within its rights to pull hospital records, find the undisclosed diagnosis, and repudiate the entire claim — not just the portion related to hypertension. The 30 months of premiums paid are also forfeited under Section 45(3).

03Top 5 Conditions People Forget to Declare

During our claims audit sessions at Letsbima.com, we routinely see policyholders surprised by what triggered an investigation:

1. Minor day-care procedures (e.g. kidney stone lithotripsy or endoscopic cyst removal done 5 years ago).

2. Family medical history of early cardiac arrest or cancer.

3. Prescribed anti-anxiety or depression medication.

4. Fatty Liver Grade 1 noticed in a routine office health check-up.

5. Occasional puff inhalers used during seasonal allergy episodes.

04Will the Insurer Reject My Application If I Disclose?

Many buyers conceal minor ailments because they fear rejection. In reality, modern underwriting has become highly inclusive:

• Loading: The insurer may charge a 10% to 20% higher premium to cover the increased risk, but your policy remains 100% airtight.

• Specific PED Waiting Period: You receive standard coverage immediately for everything else, while your declared ailment is covered after 2 to 3 years.

• Co-pay or Sub-limit: In severe cases, an insurer may offer cover with a small 10% co-pay on the specific declared ailment.

A policy issued with a 15% medical loading is infinitely better than a "cheap" policy that gets rejected when your family needs ₹5 Lakh in an emergency.

05What to Do If You Forgot to Disclose on an Active Policy

If you realize that your existing policy has undisclosed medical history, do not panic and do not hide it.

Rectification Action Plan

Write an official voluntary disclosure email to your insurer’s underwriting desk detailing the omitted medical diagnosis.
Provide latest medical test reports and prescription copies.
The insurer will re-evaluate the risk. They may ask for a small additional premium (loading) or impose a waiting period.
Once endorsed in writing on your policy schedule, your claim can never be questioned on that ground.

Got Questions?

Frequently Asked Questions

Clear answers to common questions about this policy clause.

Yes. During a major hospital claim, third-party administrators (TPAs) request the hospital admission notes. The initial doctor notes almost always record: "Patient has history of HTN since 4 years." If that conflicts with your proposal form, an immediate investigation is triggered.

Effective 2024–2025, IRDAI reduced the maximum permissible Pre-Existing Disease waiting period from 48 months (4 years) down to 36 months (3 years).

No. The moratorium bars rejection for misstatement or non-disclosure, but it does not protect deliberate, provable fraud — such as forging medical documents or filing a claim for a condition that never occurred. Section 45 exists to stop insurers from digging up minor, honestly-forgotten details after years of premium payment, not to shield intentional deception.

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