The Claims Dossier

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Story One -

We won a battle. A battle between Hopes And Fears

A battle of 99% negative vs. 1% positive chances.
Before we move ahead, It's a true story.

Sometimes back, One of our clients' employees got blessed with a baby boy.

Unfortunately, the doctor diagnosed the baby with a hernia after 45 days.

The poor 45-day-old baby suffered immense physical pain. The doctor suggested immediate surgery for the baby. The parents were experiencing mental trauma and all they wanted was for their child to get rid of the pain and illness.

The surgery cost around 50K which was a huge amount for the parents at that time as they were not in sound financial condition to bear this cost.

They approached Ethika Insurance Broking Private Limited. My claims team tried to get the reimbursement but the Insurance company denied the claim saying that 45 days baby "might have" hernia from the birth and it qualifies under external congenital anomaly.

The Point is “externalcongenitalanomaly" is not covered by medical insurance". My client panicked.

After that, I took the call and fought the insurance company for a week.

They stated that 99 percent of such cases fall under external congenital disorders. So the same would apply to this baby. So, the insurance company is not liable to pay a penny.

I ignored their 99% and held on to my 1% chance.

I fought for the remaining 1 percent of hope. The fight lasted for 1 week.

In the end, they said, Prove that it's not congenital external then we'll reimburse the amount.

I said, prove that it's congenital external disorder then we'll take off the claim escalation. hopes won.

Our client received a 100% claim amount. They got it when they needed it most.

Our client simply cried and extended their gratitude to Ethika & Team.

Sometimes, all we need is to hold on to that 1% of hope to win.

Now when people say "why do we need an insurance broker?"

Hold on Man, we have 100 true stories to tell you.