Can your insurer reject a claim after you port your health insurance policy?

I have been continuously insured under a health policy since 2020 and recently ported my plan to another insurer. A few months later, my hospitalization claim was rejected for non-disclosure of a pre-existing condition (acidity and heartburn before the original policy). Since my coverage has been continuous for over four years and was correctly ported, is the insurer right to deny the claim? What can I do?

— Name withheld on request

This is a common issue faced by policyholders who move their health insurance from one insurer to another. Portability, as per the Insurance Regulatory and Development Authority of India (Irdai), ensures that you don’t lose your benefits when you switch insurers.

When you port your health policy, the new insurer must credit the tenure you’ve already completed under your old policy. This means waiting periods for pre-existing conditions continue seamlessly—you don’t start from zero again.

Moratorium clause offers protection

Another key safeguard is the moratorium clause. Under Irdai rules, once a policy has been active for five consecutive years, no claim can be denied on grounds of non-disclosure or misrepresentation, unless there’s proven fraud.

Even before five years, insurers are expected to consider the policyholder’s continuous coverage history and past claim record before rejecting claims. Since your policy has been active since 2020, portability ensures that exclusions for pre-existing conditions should not reset.

While it’s always best to disclose all known health issues during proposal or porting, insurers cannot deny claims purely on technical grounds if continuity is maintained and there’s no evidence of wilful fraud.

In your case, occasional heartburn or acidity is not typically material enough to justify complete repudiation.

How to appeal a rejection

If your claim has been rejected, start by writing to the insurer’s Grievance Redressal Officer (GRO) requesting a detailed repudiation letter that cites specific policy clauses.

If unsatisfied, escalate the matter through the Bima Bharosa portal (the Irdai grievance platform), or approach the Insurance Ombudsman with all supporting documents—including policy copies, premium receipts, medical records and hospital bills.

Emphasize that your policy has been continuously active since 2020 and highlight the Irdai portability provisions that safeguard your coverage continuity.

In similar past cases, the Insurance Ombudsman has ruled in favour of consumers, directing insurers to settle claims. The rationale: portability protects policyholders from losing accumulated benefits due to technical lapses or minor non-disclosures.

Shilpa Arora is co-founder and COO at Insurance Samadhan