Senior citizen's ₹10 lakh health insurance policy cancelled despite disclosing pre-existing disease; here's why he fought and won

A 70-year-old doctor disclosed a pre-existing condition when he bought a health insurance policy. However, the insurer later cancelled his policy, claiming that he had hidden details about his symptoms and medication.

The doctor challenged the decision, arguing that he had answered the insurer's questions truthfully. His complaint before the consumer commission focused on the cancellation without notice and the insurer’s refusal to renew the policy, and not on reimbursement for his rejected hospitalisation claim.

The Telangana State Consumer Disputes Redressal Commission has ruled in his favour. On October 23, 2026, it dismissed Care Health Insurance's appeal and upheld the order directing the insurer to renew his policy and pay compensation and litigation costs.


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Why did Care Health Insurance cancel the doctor's health insurance policy?

Dr Swarup, aged 70, a Hyderabad-based doctor, had initially purchased a health insurance policy from Oriental Insurance in December 2015, with a sum insured of Rs 5 lakh.

He later ported the policy to Care Health Insurance under its Care Shield plan, with individual coverage of Rs 10 lakh. He paid a premium of Rs 85,522 for the policy.

“In July 2023, he was hospitalised for prostate-related treatment. When he sought cashless treatment, Care Health Insurance rejected the request, alleging non-disclosure of a pre-existing medical condition,” says Vivek Kumar, Advocate, Delhi High Court.

The insurer claimed that:

• The policyholder had been experiencing frequent urination since December 2020.
• He had been taking medication for the condition.
• A biopsy conducted in November 2021 confirmed prostate cancer.
• He had concealed this medical history while obtaining the policy.

Subsequently, the insurer rejected his reimbursement claim as well, stating that he had not provided the past medical records it had requested in several letters.

However, the dispute before the District Consumer Commission was not about reimbursement of the hospitalisation expenses.

Dr Swarup's complaint centred on the insurer's decision to cancel his policy without any notice, despite the policy being ordinarily renewable. He sought renewal of the policy, along with compensation and litigation costs.

Why did the consumer commission rule in favour of the policyholder?

The Telangana State Consumer Commission examined two important questions: whether Dr Swarup had concealed a medical condition when taking the policy and whether Care Health Insurance had followed the procedure prescribed for cancelling it.

Was the doctor aware of prostate cancer when he took the policy?

Care Health Insurance argued that the medical records showed Dr Swarup had been experiencing frequent urination and taking medication since December 2020. It also pointed to the biopsy that confirmed prostate cancer.

However, the Commission noted that Dr Swarup's policy with Care Health Insurance had commenced on January 17, 2021, whereas the biopsy report confirming prostate cancer was dated December 2021.

The Commission observed that the policyholder could not have been expected to know that he had prostate cancer when he bought the policy, since the diagnosis came several months after its commencement.

Therefore, the insurer's allegation that he had concealed a confirmed diagnosis of prostate cancer at the time of obtaining the policy was not sustainable.

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Had the doctor concealed his symptoms and medication?

The Commission then examined whether Dr Swarup had suppressed the fact that he was experiencing frequent urination and taking medication before obtaining the policy.

The Commission then examined the proposal form submitted to Care Health Insurance. According to Kumar, it found that the form contained only five questions, including:

1. Whether the insured had any pre-existing disease.
2. Whether the insured had previously filed an insurance claim.
3. Whether any health insurance proposal had been rejected, cancelled or charged a higher premium.
4. Whether the insured was already covered under another Care Health Insurance policy.
5. Whether the insured's occupation involved hazardous activities.

Most importantly, when asked whether he had any pre-existing disease, the policyholder answered YES. The Commission observed that the insurer had accepted this disclosure, issued the policy and collected the premium, explains Kumar.

However, the proposal form did not specifically ask whether the policyholder:

• Had experienced symptoms such as frequent urination; or
• Was undergoing treatment or taking medication for any medical condition.

The Commission reasoned that when the insurer had not specifically asked these questions, the policyholder could not be accused of suppressing those particular details, he adds.

Why was the insurer's cancellation of the policy found to be improper?

The Commission also examined whether Care Health Insurance had followed the cancellation procedure prescribed under the policy.

Clause 5.1.7(c) of the policy stated that the insurer could cancel the policy on grounds of misrepresentation, non-disclosure of material facts or fraud by giving 15 days' written notice.

The Commission found that Care Health Insurance had cancelled the policy without issuing the required prior written notice to Dr Swarup.

It observed that even if an insurer believes that a policyholder has suppressed material information, it must follow the cancellation procedure specified in the policy. Unilaterally cancelling the policy without the required notice amounted to deficiency in service.

Therefore, the Commission found no reason to interfere with the District Commission's order.

What was the final order?

The District Commission had directed Care Health Insurance to renew the policy upon receiving the applicable premium, along with ₹20,000 compensation and ₹10,000 litigation costs.

The Telangana State Consumer Commission dismissed Care Health Insurance's appeal on October 23, 2026, and upheld the District Commission's order.

ET Wealth Online has approached Care Health Insurance for its inputs on this case and is awaiting a response at the time of publication.

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What does this order mean for health insurance policyholders?

The ruling reinforces the dictum that insurance companies cannot arbitrarily reject claims or cancel policies merely by invoking non-disclosure of pre-existing diseases.

“Such allegations must be supported by evidence, and insurers must comply with the contractual procedure prescribed for cancellation. However, policyholders must continue to disclose their medical history truthfully and accurately, particularly in response to questions in the proposal form,” says Kanishk Poswal, Legal Associate at Jotwani Associates.

Additionally, portability does not mean losing continuity benefits or automatically facing rejection.

“When a policyholder ports an existing health insurance policy, the insurer must consider the applicable portability benefits and the disclosures made in the proposal form. An insurer cannot casually allege concealment without establishing the relevant facts,” explains Kumar.

There is one distinction worth highlighting: the Commission did not hold that policyholders are free from the obligation to disclose medical conditions simply because the proposal form does not contain a specific question.

According to Kumar, the Commission's reasoning was based on the particular facts:

• The policyholder had expressly answered YES to the pre-existing disease question.
• The insurer had accepted that answer without seeking clarification.
• The cancer diagnosis was established after the policy commenced.
• The insurer failed to establish suppression and did not issue the contractually required 15-day cancellation notice.

This is a fact-specific ruling, not a blanket exemption from the duty of disclosure.