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Case Studies

Real claim disputes — what went wrong, the legal position, and how to fight back.

Case Studies7 min read

The COVID Claim That Took Three Years — And Still Wasn't Paid

FairClaims Case Review Team
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Procedural Bad FaithDocument CyclingCOVIDConsumer Forum
Case Studies7 min read

When a Dental Abscess Becomes an Insurance Battle

FairClaims Case Review Team
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Exclusion MisappliedDentalAbscessConsumer Forum
Case Studies7 min read

The Group Policy That Disappeared — When Your Employer's Lapse Becomes Your Crisis

FairClaims Case Review Team
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Group PolicyCorporate InsurancePolicy CancellationEmployer Lapse
Case Studies7 min read

Malaria Hospitalisation Rejected as "Could Have Been Managed as Outpatient"

FairClaims Case Review Team
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OPD-ManageableMalariaMedical NecessityNon-Registration
Case Studies7 min read

"Newly Detected" — How an Insurer Used an Unknown Condition to Cancel a Policy

FairClaims Case Review Team
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PEDNon-DisclosurePolicy CancellationOmbudsman
Case Studies7 min read

"Your Hospital Is Not in Our Network" — What Happens to Your Claim?

FairClaims Case Review Team
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Cashless DenialNon-Network HospitalReimbursementCo-Payment
Case Studies6 min read

"We Found Discrepancies" — When Insurers Reject Without Explaining Why

FairClaims Case Review Team
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Vague DiscrepancyProcedural ViolationIRDAIConsumer Forum