Critical Illness Claim Rejected for Non-Disclosure? How to Fight It

Reviewed on: 2026-06-12.

Vikram, a 47-year-old in Chennai, bought a critical illness policy of Rs 25 lakh in June 2021. In late 2025 he was diagnosed with a heart condition and filed a claim. The insurer repudiated it, saying he had not disclosed high blood pressure on the proposal form. Vikram pulled the signed proposal form, which the insurer is required to share, and found the form never asked a direct question about blood pressure. He also held the policy for more than three years. Under Section 45 of the Insurance Act, 1938, a life policy cannot be repudiated on the ground of misstatement or non-disclosure once it has run for three years from the date of issue, revival, or rider addition. He set out both points in a written appeal, attached a dated certificate from his cardiologist showing the heart condition was first diagnosed in 2025, and escalated to the IRDAI Bima Bharosa portal when the insurer stalled. The reasoning above is what turns most of these cases.

This guide shows you how to build the same kind of file: get the proposal form, fix the diagnosis date, check the three-year bar, and escalate in order.

A non-disclosure rejection stands only if the proposal form asked a clear question and you knew a material fact and answered it wrongly. So two facts decide the case.

1. What the form actually asked. Non-disclosure is judged only against questions that were put to you. If the form never asked about the condition the insurer now cites, there is nothing you failed to disclose. Request the signed proposal form in writing before you argue anything.
2. When the illness was first diagnosed. A pre-existing disease is one that existed before the policy. If your first diagnosis date falls after the policy start date, the illness cannot be a hidden pre-existing condition. Get a dated doctor's certificate, the first prescription, and the first test report.

Section 45 of the Insurance Act, 1938 is your strongest shield on an older policy. Once a life insurance policy has been in force for three years from the date of issue, revival, or addition of a rider, the insurer cannot repudiate it on the ground of misstatement or suppression of a material fact. After three years the policy is, in effect, incontestable on non-disclosure. Within three years the insurer can repudiate, but it must communicate the ground in writing with the material it relied on. Note that critical illness cover sold as a health rider or a standalone health product may sit under health regulations rather than the life framework, so check whether your policy is a life or a health contract. Where it is a life policy past three years, lead your appeal with Section 45.

On a single page, list the policy start date, every relevant doctor visit, each diagnosis date, and the claim and rejection dates. Place each proposal-form question next to what you actually knew on the day you signed. Highlight any question that was never asked and any diagnosis that came after the policy began. This page is the spine of your appeal.

• The signed proposal form, requested in writing from the insurer.
• The full policy wording and policy schedule.
• The detailed repudiation letter, not just an SMS, stating the exact ground.
• A dated certificate from your treating doctor on the date of first diagnosis.
• The first prescription and first test report fixing that date independently.
• Any pre-policy medical examination report. If the insurer checked your health and still issued the policy, that weakens a later non-disclosure claim.
• Premium receipts and proof of the policy start date.

To: The Claims Manager (copy: Grievance Redressal Officer), [Insurer]

Subject: Appeal against repudiation for non-disclosure, Policy No. [number],
Claim No. [number]

I appeal the repudiation of my critical illness claim dated [date], rejected
for non-disclosure of [condition cited].

1. Proposal form: the signed form [did not ask about this condition / I
answered honestly to my knowledge]. Non-disclosure applies only to a
question actually asked and a material fact known to me.

2. Date of first diagnosis: my illness was first diagnosed on [date], shown
by the enclosed certificate of Dr [name], the first prescription and first
test report. This date is after the policy start date of [date].

3. Section 45, Insurance Act 1938: this policy commenced on [date] and has
been in force for over three years. It cannot be repudiated on the ground of
misstatement or non-disclosure. [Use only if a life policy past three years.]

I request you to reconsider and admit the claim of Rs [amount], and to give a
written reasoned decision citing the exact proposal-form answer if you
maintain the rejection. Failing this I will escalate to IRDAI Bima Bharosa
and the Insurance Ombudsman.

Enclosures: repudiation letter, proposal form, doctor's certificate, first
prescription and test report, policy schedule, dated timeline.

[Name, mobile, email, date]

1. Insurer claims team and grievance officer. Send the appeal with your timeline and ask for a written reasoned decision within the grievance window.
2. IRDAI Bima Bharosa. Register at bimabharosa.irdai.gov.in if the insurer fails or does not reply. This works for private and public insurers alike.
3. Insurance Ombudsman. File free at cioins.co.in. The Ombudsman decides disputes up to a ceiling of Rs 50 lakh and expects you to file within one year of the insurer's final rejection, so watch that limitation.
4. Consumer commission or civil court. Through a qualified professional, for large or complex claims.

Only a public-sector insurer. LIC and the public-sector general insurers are public authorities, so you can file an RTI with their PIO for the claim-file notings, the exact material fact relied on, and whether a pre-policy medical check was done. IRDAI is also a public authority, so you can RTI it about the action taken on your Bima Bharosa complaint. Private insurers are not under RTI. For them, use the grievance, Bima Bharosa and Ombudsman route. See how to file RTI online and first appeals if a public-sector insurer's PIO is silent.

• Arguing without the signed proposal form. You cannot rebut a ground you have not seen.
• Confusing a waiting-period rejection with a non-disclosure rejection. They need different rebuttals.
• Failing to fix the first-diagnosis date with documents. A verbal “it started later” is not enough.
• Overlooking Section 45 on a life policy that is already three years old.
• Letting an agent's wrong ticks on the form go unchallenged in writing.
• Filing an RTI against a private insurer and losing weeks.
• Accepting a low settlement under pressure without checking your options.

Section 45 of the Insurance Act sits in the life framework. Critical illness sold as a life rider or a life-linked product is squarely covered. A pure indemnity health policy is governed mainly by IRDAI health regulations, which also limit reopening of cover after a continuous period. Check whether your contract is a life or a health product, and cite the provision that fits.

State in writing that the agent filled the form and that you are entitled to a form reflecting your true answers. Ask the insurer to produce the question it says you answered wrongly and your recorded answer. If the form never carried that question, the non-disclosure ground fails.

No. Within three years the insurer can repudiate, but only with a clear ground, the material relied on, and written communication. You still rebut on the proposal form and the diagnosis date. A weak or vague ground inside three years can still be overturned at the Ombudsman.

Many critical illness policies pay only if you survive a fixed number of days after diagnosis, often around 14 to 30 days, set by the policy. That is a policy-condition rejection, separate from non-disclosure. Read your wording and do not let the two grounds be blurred together.

The Insurance Ombudsman can pass a binding award up to Rs 50 lakh. You should approach it within one year of the insurer's final reply, or one year of the date when the reply was due if none came. File early and carry the full paper trail.

No. RTI gives you information, such as the claim-file notings or proof that no pre-policy issue was flagged. That is evidence for your appeal and your Ombudsman case. The decision to admit the claim still comes through the grievance and Ombudsman process.

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Download the non-disclosure claim appeal checklist (PDF).