Disgusting after sales service from Essential Med - false information given

When I took out this policy I specifically asked if I was covered for operations and any other procedures. I was told I was. I requested authorisation now for knee surgery for my son and after the whole day of filling out different forms - I was told out of the R60k they would only pay R16k as I was not covered for any sports injury's and had not told them of any accident within 24 hours! Nicolene Williams took it upon herself to decide that the torn minuscus was an illness, not an accident! Please advise how I can report this if you have to wait WEEKS to see a surgeon?!?!