Mumbai Commission Rules Against Automatic Health Insurance Claim Rejections Over Waiting Periods

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The Mumbai Consumer Commission ruled that health insurers cannot reject claims solely based on waiting-period clauses without proving a condition was pre-existing, as seen in a case where Max Bupa (now Niva Bupa) was ordered to pay a Rs 5 lakh pancreatitis claim. Insurers commonly reject claims due to factors like waiting periods, non-disclosure of medical history, exclusions, and documentation issues. Policyholders are advised to understand policy terms and disclose medical history accurately to avoid claim denials.