Can an insurer include an illness from 10 years ago in pre-existing diseases? | Mint

Q. What is the time limit for pre-existing diseases when buying a health insurance policy? Do I have to declare a decade-old hospitalisation or illness to the insurer? I declared an illness from 10 years ago, and the insurer has excluded it from the list of pre-existing diseases. Is this correct?

Under the current rules , illnesses that were diagnosed or for which treatment was administered in the past three years are classified as pre-existing diseases. Illnesses that were cured or treated more then three years ago are generally not classified as pre-existing diseases. As a result, the waiting period for pre-existing diseases applies only to illnesses that were recently diagnosed or treated.

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However, this does not absolve the policyholder from disclosing any treatment they may have undergone more than three years ago. When issuing a policy, the insurer will want to know the complete health history of the individual. In some cases, based on the medical history, the insurer may not want to issue a policy. In other cases, the insurer either make the diseases a temporary or permanent exclusion. The rules do not prohibit this.

If you have a past illness that you inadvertently did not disclose, the rules specify a moratorium period of five years as a safeguard. After this period has elapsed, the insurer cannot deny a claim based on policyholder’s non-disclosure unless there was fraudulent intent. Insurers have the right to deny such claim only if it is proven to be fraudulent, and the onus of proof is on the insurer. This is a stringent condition that insurers must meet to deny a claim.

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So, when buying a health insurance policy, you should not limit your health disclosures to only the past three years. Read the medical disclosure question in the proposal form carefully and be very specific in answering it.

Q. Can I get insurance for fraud committed by my employees against the company? In one case, one of my employees submitted fake bills and siphoned off a large amount of money from the company.

Yes, you can insure yourself for such outcomes with commercial crime insurance. This policy covers white-collar crimes against companies, including those committed by its own employees. These includes things like issuing fake bills, wire fraud, etc. Forgery or alteration of signature on bank checks are also covered. Such fraud can involve substantial amounts, so it is highly recommended for companies to have it. Do note that when an insured event has already occurred in the past, insurers become circumspect about the company controls. So, it is best to buy this coverage when there is no adverse history.

Abhishek Bondia is principal officer and managing director at SecureNow.in.