Mild Sleep Apnea?

salvnyc wrote: ↑

Thu Apr 16, 2020 3:19 pm

thanks for reply. that is what I am trying to figure out. things are not sometimes black and white and that's why we have courts. I have not been using machine for long time so i forgot to mention mild OSA when taking policy but I did send them email few months later to them with same ID during a different conversation. about 4 years later, i am hospitalized due to illness and bill is 10k. now they are rejecting my claim. I think there are some shades of grey. Policy is in india and the insurance provider do all kind of tricks. I think will have to go to consumer court. I think i have good chance of getting my claim as I sent that email.

Now I am using philips autosv bipap these days. Is all BIpap usage history stored on cards or it's in machine itself? I want to extract info on usage of bipap. How far back does it go on card and on machine hardware?

thanks for helping out.

Sach

No idea what the legal context is like for insurance issued in India (nor the specifics of the policy -- and that matters a great deal). Likely worth a few hundred dollar consult with an appropriate attorney. This is a very very technical part of the law (at least in the US).

That said, arguments I might consider making include:
a) The illness had no linkage to the hospitalization (assuming the illness was not something where untreated apnea is a known risk factor);
b) You completed the health history honestly but had one oversight -- untreated mild apnea. Once you were aware of the oversight, you notified the insurer (likely actual notice) -- and they continued to collect premiums (does that constitute acceptance on their part?). Let them prove it wasn't mild.
c) If the insurer compared your health records to the declaration -- prior to your hospitalization -- and became aware of the apnea, and continued to accept your premiums, (then same as (b)).
d) Argue at the time of the declaration your apnea was mild (even if it is not now -- and I could imagine a current test could work against you as much as for you). But you would likely need to still argue (a) -- just with mild apnea.
e) Would they have declined to issue the policy (or charged a higher rate) if you had declared mild (or not) apnea? If not, what loss has the insurer suffered from your failure to declare at the time of issuance?

By itself, mild or moderate will not resolve the case. Perhaps in the context of a broader argument....