Claim Forms

Doctor's Statement Cancer 

Doctor's Statement Heart Related Conditions

Doctor’s Statement Bone, Joint, Muscle and Connective Tissue Related Conditions

• Cancer

• Early Stage Cancer (Prostate/Thyroid/

• Bladder/CLL/Melanoma)

• Carcinoma-in-situ (Breast/ Cervix Uteri/ Uterus/ Ovary/ Fallopian Tube/ Vagina)

• Mastectomy For Carcinoma-In-Situ Breast

• Prostatectomy For Stage 1 Prostate Cancer

• Hysterectomy (surgical Uterus Removal)

• Salpingectomy (surgical Fallopian Tube Removal)

• Oopherectomy (surgical Ovary(ies) Removal)

• Partial Colectomy/Gastrectomy with End-to-end Anastomosis

• Cystectomy For Carcinoma-In-Situ Urinary Bladder/ Papillary Carcinoma Of The Bladder

   

•  Coronary Artery Disease Requiring Surgery/ By-Pass Surgery

• Other Serious Coronary Artery Disease

• Angioplasty & Other Invasive Treatments

• Keyhole Coronary By-Pass Surgery

• Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB)

• Enhanced External Counterpulsation Procedure

• Transmyocardial Laser Therapy

• Heart Attack/ Acute Myocardial Infarction

• Heart Valve Replacement/ Surgery

• Percutaneous Heart Valve Surgery

• Surgery of AortaMinimally invasive surgery to Aorta

• Large Asymptomatic Aortic Aneurysm/ Dissection

• (Hypertrophic) Cardiomyopathy

• Pericardiectomy (with Surgery)

• Insertion of Pacemaker

• Insertion of Cardiac Defibrillator

• Infective Endocarditis (Early/Late)

• Eisenmenger's Syndrome (Early/Late)

   

• Paralysis/ Paralysis of Limbs/Loss of Use of One Limb

• Loss Of Limbs/Fingers

• Surgical Reattachment Of Amputated Limb

• Loss Of A Single Hand/ Foot By Amputation

• Limb Amputation Due To Type 2 Diabetic Complications

• Muscular Dystrophy (Moderate / Severe)

• Rheumatoid Arthritis (Moderate / Severe / Chronic)

• Joint Replacement Due to Severe Osteoarthritis

• Total Knee/ Hip Replacement

• Osteoporotic Fracture Requiring Surgery

• Osteoporotic Fracture Of The Hip/ Vertebra

• Osteogenesis Imperfecta

• Poliomyelitis (Moderate / Severe)

• Progressive Scleroderma (Early / Late)

• Progressive Scleroderma With CREST Syndrome

• Major Burns/ Third Degree Burns

• Mild/ Moderately Severe Burns

• Grafting Due To Burn

Doctor's Statement Kidney, Liver, Lung & Gastrointestinal Related Conditions

Doctor's Statement Brain and Nerve Related Conditions

• End Stage Kidney Failure

• Chronic Severe Renal Impairment

• Severe Diabetic Nephropathy resulting in Kidney Failure

• Systemic Lupus Erythematosus (SLE) with with Lupus Nephritis or Severe Kidney Complications

• Medulla Cystic Disease

• Nephrectomy/ Removal of one Kidney

• End Stage Liver Failure

• Fulminant Viral Hepatitis

• Cirrhosis of the Liver

• Autoimmune Hepatitis (Early / Chronic)

• Partial Hepatectomy

• Portal Vein Thrombosis

• End Stage Lung Disease

• Primary Pulmonary Arterial Hypertension

• Surgical Removal of the Lungs (whole lung or lobes)

• Status Asthmaticus

• Surgical Insertion of a Vena-cava Filter

• Heart Failure due to Chronic Lung Disease

• Acute Necrotizing / Chronic Relapsing Pancreatitis

• Biliary Tract Reconstruction Surgery

• Chronic Primary Sclerosing Cholangitis

• Chronic Crohn's Disease

• Chronic Ulcerative Colitis

• Adrenalectomy For Adrenal Adenoma

• Chronic Adrenal Insufficiency

• Apallic Syndrome

• Akinetic Mutism / Locked In Syndrome

• Encephalitis (With Recovery)

• Meningitis (With Recovery / Reversible Neurological Deficits)

• Tuberculous Myelitis / Meningeal Tuberculosis

• Brain (Aneurysm) Surgery

• Surgical Removal Of Pituitary Tumour

• Insertion of Cerebral Shunt

• Insertion of Ventriculoperitoneal Shunt

• Endovascular Treatment of Cerebral AVM

• Craniotomy for Treatment of Aneurysm/ AVM

• Benign Brain Tumour

• Surgical Excision of a Spinal Meningioma

• Surgery for Drug Resistant (Severe) Epilepsy

• Major Head Trauma (Mild / Severe)

• Cervical Spinal Cord Injury (Accident)

• Head Trauma (Accident) Requiring Re-constructive Surgery / Open Craniotomy

• Surgical Repair of Depressed Skull Fracture

• Motor Neuron Disease (Early / Severe)

• Peripheral Neuropathy

• Myasthenia Gravis (Less Severe / Severe)

• Spinal Cord Disease/Injury Cause Bowel & Bladder Dysfunction

• Multiple Sclerosis (Early / Severe)

• Guillain-Barre Syndrome

• Parkinson's Disease (Early / Moderate / Severe)

• Progressive Supranuclear Palsy (Early / Late)

• Diagnosis of Alzheimer's Disease or Dementia

• Alzheimer's Disease or Dementia (Moderate / Severe)

• Stroke

• Stroke Treatment By Carotid Angioplasty & Stent

• Carotid Artery Surgery

• Surgery For Subdural Haematoma Due To Accident

• Coma

Doctor's Statement Eyes and Ears Related Conditions

Doctor's Statement Other Illnesses

• Blindness/ Loss of Sight (Both Eyes)

• Corneal Transplant

• Loss of Sight in One Eye

• Bilateral Severe Low Vision

• Deafness/ Loss of Hearing

• Cochlea Implant

• Bilateral Severe Hearing Loss

• Surgical Drainage for Cavernous Sinus Thrombosis

• HIV Infection due to Blood Transfusion / Organ Transplant

• HIV Infection due to Assault

• Full Blown AIDS

• Occupationally Acquired HIV / Hepatitis B or C Infection

• Aplastic Anaemia (Acute or Chronic)

• Myelodysplastic Syndrome or Myelofibrosis

• Loss of Independent Existence

• Loss of Speech

• Tracheostomy

• Facial Reconstructive Surgery

• Type 2 Diabetic Retinopathy

• Limb Amputation due to Type 2 Diabetic Complications

• Major Organ Transplant or Bone Marrow Transplant

• Pending Major Organ Transplant

• Small Bowel Transplant

• Terminal Illness