How to contest unjustified claim rejections

My husband was hospitalized from 14th to 22nd July 2024 for the treatment of chronic liver disease (CLD) at areputed hospital. After discharge, we submitted a reimbursement claim with all the required medical and policy documents.

- Shilpa Arora

However, the insurance company rejected the claim, stating that the insured had undergone varicose vein surgery nearly 15 years earlier, which they considered a preexisting disease (PED). The insurer concluded that the current ailment — chronic liver disease —was linked to this past surgery and, therefore, not eligible for coverage under the policy. Is this claim rejection medically and contractually justified? What are the next steps the policyholder should take to challenge this decision?

—Name withheld on request