Need Legal Advice: STAR Health Asking for Claim Refund

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 Actuaries of the Insurance Company calculate the premium following the guidelines of the regulatory authority IRDAI. Despite non-disclosure of Pre-Existing disease (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 the prescribed periods, the insurer repudiated/rejected the claim of the insured on the grounds of non-disclosure of PED, which is likely to be covered 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, even if it is detected after the approval of the hospital charges by default. 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.