Definition
Claim Repudiation
Repudiation is the insurer's rejection of a claim, in whole or part, on grounds such as policy exclusions, non-disclosure or breach of conditions.
Common reasons for repudiation in India include non-disclosure of a pre-existing disease, claims falling within a waiting period, treatment for an excluded condition, or material misrepresentation in the proposal form. Insurers must give written reasons referencing the specific policy clause.
After the moratorium period (continuous coverage for the prescribed years), health insurers generally cannot repudiate on grounds of non-disclosure except for proven fraud. Policyholders can escalate wrongful repudiation to the insurer's grievance cell, the Insurance Ombudsman, or consumer courts.
Related terms
- Moratorium PeriodThe moratorium period in health insurance is the span of continuous coverage after which an insurer cannot challenge a claim on grounds of non-disclosure or misrepresentation, except for proven fraud.
- Non-DisclosureNon-disclosure is the failure to reveal a material fact to the insurer, which can render a policy voidable or lead to claim rejection.
- Insurance OmbudsmanThe Insurance Ombudsman is a quasi-judicial authority that resolves policyholder complaints against insurers quickly and at no cost to the complainant.
Plain-English explainer from The Dispatch Investors Encyclopedia. General information, not financial advice.