Health insurance claim rejected citing “substance abuse” – need advice

[User_4bede464]

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User_4bede464
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April 27, 2026 at 6:41 am

Hi, I’m looking for some guidance regarding a health insurance claim dispute in India.

My claim for oral cancer treatment was rejected on the grounds of “substance abuse (areca nut/supari)” being a contributing cause.

However:

* There is no consistent medical record showing addiction
* Treating hospital records do not mention any addiction history
* Only a single preliminary note mentions past use

The insurer is also refusing to share the exact document they are relying on, calling it “confidential evidence.”

I want to understand:

1. Is this a valid ground for claim rejection?
2. Does “past use” qualify as “substance abuse” legally?
3. Has anyone successfully challenged such rejection via IRDAI or Ombudsman?

Any guidance or similar experiences would be really helpful. Thanks!

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