Health insurance policy terms and conditions

From what I understand, the BP was taken when the Dr. checked it after the accident and, accordingly, prescribed the medication. High blood pressure is a medical condition and, with relevance to the medical insurance policy, it is considered to be a pre-existing ailment. Although you mentioned he did not have health issues, please clarify - did your father ever have high BP prior to the accident? Has he ever undergone regular checkups during which this was discovered and hence he has been taking prescribed medication for it? If it was an already existing condition, then, yes, it is important for it to be disclosed to the insurance service provider and should have been mentioned at the time of taking the policy.

Now if the high BP showed after the accident, then it will be indicated in the Dr.'s note and there will be a written prescription of the medicines to take. In that case, you will be submitting the prescription to the service provider in any case to support a claim for the pharmacy bill for the amount paid. What you need to check is the policy's terms and conditions yourself, and not rely wholly on what the service provider tells you verbally. There are certain aspects you should be aware of, such as whether the insurance claim can be made only for hospitalization for a certain number of hours, pre- and post-hospitalization expenses, OPD charges (such as for a follow-up), etc. Find out what all is covered and to what extent (5%, 10%, etc).

The bottom line in my personal opinion is that you should be totally honest with the insurance company. If the BP itself is not really the issue, that is, that it may not be factored in as a cause of the accident, then I don't think they would reject the claim as such and you can clearly tell them that the high BP was detected during treatment for the accident and was not a pre-existing condition.

This is my personal opinion and you could consult some family friend or relative who may have knowledge about this.

One last thing to note- You also need to consider that you took the policy just three months ago and the accident happened within a few months of it. So it would be the first claim application that you are making in the year 2022-23. Hence, you would also need to find out if, God forbid, you are required to again apply for a claim again within the same period, would that be covered, too, and, if so, how much percentage of what is spent is covered by the policy.

The following points are necessary to be included prior to drafting an application to the health insurance provider. The relevant points are as it follows-
1) Did your health insurance provider put any conditions in which going through this health condition was essential? If not, you should be relaxed and there was not the point of any deviation from your side.
2) Please go through the booklet provided by the health insurance company and see if there is the inclusion of this element for which you are entitled to get relief in course of treatment if pointed by the competent doctors attached to a recognised hospital. If such is case, your father's case will be entertained without your undue worry.
3) Please go through the prescription of the doctor and see if other ailments are also indicated to be tested apart from BP measurements such as recording of heart functioning by going through ECG or the accompanying conditions such Echo or Halter test to assess the conditions of the hearts apart from its medications as suggested by the doctors. If such is the case, these conditions are to be intimated to the health provider to get due compensation by way of undertaking this health insurance policy.
4) Full or part payments might be availed depending upon the their rules and you would be benefited accordingly.

A policy applicant is supposed to divulge all the facts related to his health condition as at the time of applying for medical insurance. He has to answer honestly to any question posed in the application related to the health and ailments listed there. The premium is fixed considering these factors also. In certain policies. there will be a specific period during which the person is not insured for health issues caused by pre-existing diseases. The list of these conditions are given by the Insurance companies. The agent should have apprised this to the policy applicant.

In the present case as it is an accident and if the same is covered by the policy, there should not be any problem for allowing the insurance claim.

You have stated "My father didn't have any health issues at that time. ". In case your father did not have the BP issue at the time of taking the policy, there is no question, of declaring it, arises. The insurance claim will no be affected by the present BP problem.

However if your father had been diagnosed with high BP and he was regularly taking medicines for that prescribed by a doctor after proper examination and prescribed medicine for long term regular use, then not declaring that fact at the time of taking policy can cause problem, if the insurance company takes a stand that the policy holder has consciously suppressed facts. It can also take a stand that the accident was also caused by the pre-existing high BP conditions. But I do not se such a rigid situation in the case quoted in the question, unless the company is adamant to deny the claim.

Hence you may proceed with the insurance claim, without worrying about the present BP rise , subject to the other policy conditions and limits.

I am not making the policy takers to afraid or to get back from enrolling themselves. But the major thing before entering into any health policy the following points are to be clearly get clarified from the person with whom the health policy is going to undertake. It is not bad omen that we are talking negatively before entering into one agreement as this policy itself for our health related issues.
1.What must be the exact quantum of amount reimbursement available - This is most important aspect as many people got disappointed when getting discharged from hospital after treatment even though informed earlier about the insurance etc.,
2.Period for which the premium to be paid
3.After what period the benefit can be availed
4.What are the ailments for which the claim is applicable - as many Insurance companies later disallow certain ailments from the policy after coverage
5.What are the hospitals covered under the policy

Generally, when a policy is taken by a person who is above 45 years old, the insurance company asks for the clinical testing report as per the format given by the insurance company. Some companies prescribe the doctor also to whom you have to contact for conducting these tests.
You took insurance to your father 3 months back. Did this clinical testing was performed or not? At that time they might have seen BP of the person and if it is not normal there is no issue. Based on the health condition and age of the person only the premium value will be decided.
When you took policy for your father, was he using BP tablets. As you said that he is having no heath issue, his BP is normal only. I think. If he is using tablets for BP at that time, you should have informed the insurance person.
Now after the accident only the doctor observed that he is having high BP. This finding is not going effect you reimbursement of medical expenses after thenaccident. You can claim them and they will be paid. All the reports given by the doctor will be submitted to the insurance company when you are asking for reimbursement. Those papers will contain information about BP also and the insurance company will get the information through these documents. So your telling about BP to them will not create any problems. It is always better to be honest with the insurance company and hence informing them is good and in no way it will harm you. When you go for the renewal, there may be a revision in the premium.
I suggest you to visit the insurance company and discuss with the concerned person through whom you took the insurance policy. As per his advise you can inform the company.

When we take a health insurance policy then at the time of taking it we have to specify the ailments that the person is having or had been under them earlier. The insurance company will enter in the insurance contract as per that information and if we have given any wrong information then insurance company would take all excuses under that in the future whenever we are making a claim for treatment. So the thing is that we have to read the terms and conditions of the insurance that we have bought from the insurance company and go trough the fine print in details. If they have mentioned that any new ailment emerging in a person is to be brought in their notice through a claim within so many days of the incident or otherwise just to inform them about it without claiming anything then it becomes our prime duty to inform them so that they can incorporate that in the insurance policy for any future reference. Please remember that such endorsements are in the favour of the person who has taken insurance from that company.
Another important thing is to lodge the claims as early as possible so that the present ailments are simultaneously reported in the claim. The doctors diagnosis and prescriptions should be clearly visible so that there is no confusion in reading and decoding them by the insurance company. Many people are not careful in the paper work that is to be done during a claim making and then it creates a lot of confusion in the company and claim settlement is delayed. A clarity in the claim is a very important aspect and that has to given full attention by the person making the claim.
The insurance companies are making a profit based on the facts that only a few people make claim for insurance benefits and that also after a good gap after which they sometimes get some health problems. So the company would settle the cases at an earliest if the documents are in order.