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The Moratorium: Health insurance claim rejection and the moratorium
Raghavan has held a family floater health policy with the same insurer since 1 April 2020, renewed without a break. He was hospitalised in February 2026 and the bill came to ₹6.8 lakh. The insurer rejected the claim for non-disclosure of diabetes that it says has existed since 2018.
Client: Raghavan Krishnan, 58 (policyholder) · As on: 12 Mar 2026
What you will learn
Governing law
- Consumer Protection Act, 2019 — Deficiency in service by insurers; Consumer Commissions.
Key provisions
- s.2(11): Deficiency in service
- s.34: Jurisdiction of the District Commission (up to ₹50 lakh)
- s.35: Manner of filing a complaint
The six rooms
- The Mystery — sort 7 statements into facts that matter and distractions, then name the legal issue.
- The Evidence Vault — match 5 items of evidence to the facts and build a verified chronology.
- The Statute Library — choose the governing Act from 5 and the sections that decide the case.
- Decode the Section — sort clauses of IRDAI Master Circular on Health Insurance (2024), moratorium clause; Consumer Protection Act, 2019, ss.34 and 69 and apply them to the facts.
- The Decision Chamber — pick the right next step and justify it.
- The Final Submission — complete the evidence checklist, deadlines and open questions.
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Fictional learning scenario. Names, facts and dates are invented; statutory references are summarised and must be verified before use.