Need advice on two questions regarding my health insurance situation.

    Background:

    • My family health insurance policy (me, wife, son) was cancelled by the insurer in June 2025 over a pre-existing condition non-disclosure related to my son.
    • I took the matter to the Insurance Ombudsman. After 6+ months, the outcome: claim was rejected, but the Ombudsman directed the insurer to reinstate the policy.
    • The insurer has now reinstated the policy for me and my wife under the same plan with full continuity benefits from the original inception. My son was moved to a separate, inferior plan with sub-limits, room rent caps, and co-payment.
    • My original policy was due for renewal in Feb 2026. The insurer cancelled it in June 2025 but has now issued the reinstated policy from 17-Feb-2026 to 16-Feb-2027. I made the payment in April 2026.

    The issue:

    • During the cancellation period (June 2025 to Feb 2026), I was uninsured.
    • In December 2025, I was diagnosed with otosclerosis and had surgery on my right ear — entirely at my own expense since I had no active policy.
    • My left ear also needs the same surgery in the coming months.
    • The reinstated policy shows "Pre-existing diseases: NONE" because during the renewal/reinstatement process, the insurer only shared a payment link — there was no proposal form or health declaration where I could disclose my recent surgery.

    My questions:

    1. Can I claim reimbursement for the December 2025 right ear surgery? The policy was cancelled by the insurer (not by me), and had they not wrongfully cancelled it, the surgery would have been covered. The reinstated policy preserves continuity from the original date.
    2. For the upcoming left ear surgery — how should I handle disclosure? The insurer didn't collect any health declaration during reinstatement, so I had no opportunity to declare the otosclerosis. I don't want to end up in another non-disclosure dispute. What's the right approach?

    Any guidance from people who understands the insurance industry nuances would be really helpful.

    Policy reinstated by Ombudsman after wrongful cancellation — can I claim for surgery done during the uninsured gap period?
    byu/leekesh inInsurance



    Posted by leekesh

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