New Delhi, Sept. 13 -- In a significant ruling for health insurance policyholders, a consumer forum has held that insurers cannot mechanically invoke a waiting-period clause to reject a claim unless they can establish that the illness was pre-existing.

The Mumbai Suburban District Consumer Disputes Redressal Commission passed the order in a case involving a Rs.5 lakh health insurance claim for pancreatitis. The commission directed Max Bupa Health Insurance Co. Ltd., now known as Niva Bupa Health Insurance Co. Ltd., to pay the policyholder's claim after the insurer rejected it by citing a 24-month specific waiting period applicable to pancreatitis.

The ruling highlights an important point for health insurance customers: the presence of a...