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My father is suffering from cancer and was critical a few month back so we took consultation from 3 different oncologists all advised for NGS test. and we took that test.ngs is a genetic test which helps in finding the reason of cell multiplication and source of a cancer cell. that test was around 26000 INR we have medical insurance of my father and we are getting cashless and reimbursement for his chemo and other tests but star health has denied to pay for NGS test as genetic tests are not payable under our policy. my argument is that test was crucial for my father's treatment. shall we go to court if we get the amount of this test? please help

( Jaipur, Rajasthan )

7 months ago

Reply

Dear Client,
The terms and conditions of an insurance policy are the most crucial and vital to go through before raising a claim against the policy. Based on the self-declaration of the policy buyer and post-medical tests of the insured wherever required, the risk and coverage are underwritten and the premium is calculated by the Actuaries of the Insurance Company following the guidelines of the regulatory authority IRDAI. Despite non-disclosure of Pre-Existing diseases (PED), some PEDs are covered by continuous renewal of the policy for two or four years from the date of inception of the policy. If any claim is raised before it comes under the coverage on continuous renewal of the policy for prescribed periods, the insurer repudiated/rejected the claim of the insured on the grounds of non-disclosure of PED which is likely to cover under the policy after the waiting period and continuous renewal of the policy. Further, the observations or findings of the treating doctor play a crucial role in the sanction or rejection of any insurance claim by the Insurer. So, if the terms and conditions of the health insurance policy do not support a claim, a complaint before the Consumer Court may not yield an order in favour of the claimant.