When Compassion Meets Persistence – How We Helped a Family Fight for Their Rightful Claim

When Compassion Meets Persistence – How We Helped a Family Fight for Their Rightful Claim

At Expert Claim Solutions India Pvt. Ltd., we’ve seen how a medical emergency can change lives in an instant. But sometimes, the economics of the treatment can be just as exhausting as the process of the medical treatment itself.

In November 2023, our client’s wife, only days after delivering a baby, suffered a sudden intracranial hemorrhage. She was rushed to KIMS Hospital, and over the next few months, endured multiple surgeries, long hospital stays, and rehabilitation.

The total cost? ₹38.84 lakhs.What did the insurer, Care Health Insurance Ltd., pay? Nothing.... Nothing at all.

Despite the policy clearly covering such emergencies, the insurer denied the claim citing irrelevant reasons — a “two-year waiting period for seizures” (even though seizures were only a symptom of the brain bleed) and “pregnancy-related exclusions” (even though childbirth had already concluded without complications).

We first approached the insurer’s Claims Department, presenting detailed facts and evidence. When they refused to act, we escalated to the Grievance Department — which displayed shocking indifference by not responding at all to repeated, well-documented requests. This complete silence, at a time when every day of delay meant more financial and emotional strain for the family, we believe, was both unprofessional and inhuman.

By the time they came to us, our client had received only ₹5.81 lakhs from his employer’s group policy and was left with ₹30+ lakhs out of pocket.

From day one, we:

• Reviewed every policy clause to dismantle the insurer’s faulty reasoning

• Coordinated with doctors to obtain medical clarifications

• Prepared a detailed legal and factual submission to the Insurance Ombudsman

• Followed up relentlessly through every stage of the process

The complaint was registered on 7th November 2024. The hearing was held on 4th June 2025. Finally, on 13th August 2025, nine months after filing, the Ombudsman ruled in our client’s favor, directing the insurer to pay.

This was more than a win — it was a lifeline for a family balancing newborn care, rehabilitation, and mounting bills.

We’re proud to have stood by our client through this fight. And we believe that this case should serve as an  example for the insurers that they must act in good faith always  and for the Policyholders that they must know their rights.

Justice delayed can still be justice delivered — with persistence and the right guidance.

"At Expert Claim Solutions, we don’t just process paperwork — we stand shoulder-to-shoulder with our clients, challenging injustice, dismantling unfair denials, and fighting relentlessly until fairness is not just promised, but delivered."

Santosh Choubey

Technical Head and Director