An experienced gynecologist from Karnataka never expected that a routine pregnancy scan would one day land him in trouble. Everything seemed normal until the baby was born with a cleft lip. The family was shocked and angry.
They claimed the doctor should have spotted it during the anomaly scan and came back to his hospital demanding compensation. What started as a peaceful pregnancy turned into a serious allegation. That’s when the doctor called CoverYou for help.
Case Background
The doctor had done both the NT scan and the anomaly scan for the patient. The scans were done at 12 weeks and 24 weeks, and both showed a healthy baby with no visible problems. On 24th September 2024, the baby was delivered at a government hospital. Unfortunately, the newborn had a cleft lip and possibly a cleft palate. The family believed this could have been detected earlier and blamed the doctor for missing it.
On 28th September, just four days after delivery, the family came back to the doctor, showed a photo of the baby, and demanded ₹2.5 lakhs as compensation.
Incident Report
1: Scan Dates: 30 March 2024 (NT scan), 5 June 2024 (Anomaly scan)
2: Delivery Date: 24 September 2024
3: Dispute Date: 28 September 2024
4: Allegation: The Doctor didn’t detect the cleft lip/palate during the anomaly scan
Doctor’s Response:
1: All standard checks were done
2: No signs of cleft lip were visible during the scan
3: Baby’s brain, heart, face, spine, and limbs were all scanned properly
4: Fetal position can sometimes make facial defects hard to see
5: No earlier scan reports were shared by the patient
What Happened Next
To avoid arguments or legal fights, the hospital and the family agreed to settle the matter out of court. The hospital paid ₹2.5 lakhs as compensation. But when the doctor informed the insurance company, ICICI Lombard was hesitant. Since there was no formal court case, they wanted more documents and weren’t sure if they could approve the claim.
How CoverYou Helped
1: We took charge immediately after the doctor contacted us on 28 September 2024, and we helped prepare all the documents, scan reports, explanation letters, and a medical note showing that cleft lip detection can be difficult in some cases.
2: We explained the situation clearly to ICICI Lombard: the settlement was made to avoid tension and protect the hospital’s name, not because of any mistake. After follow-ups and clarification, ICICI agreed to pay the full ₹2.5 lakhs.
3: We stayed connected with the doctor through the whole process, making sure he never felt alone.
Outcome
The claim was successfully settled with full support from the insurer. ICICI Lombard approved and paid the entire requested amount of ₹2,50,000 on 02 March 2025, ensuring the doctor did not face any financial burden in resolving the sensitive case.
Conclusion
The doctor followed all the rules. He did his job well. But sometimes, things don’t go as expected, and doctors get blamed. With CoverYou, he was able to handle the situation smoothly, protect his reputation, and get full support from his insurance.
Special Note:
The doctor thanked the CoverYou team for staying with him from start to finish. Our quick action, simple guidance, and strong support helped him settle a tough situation without letting it harm his career.
Disclaimer: All names and patient details have been changed to protect privacy.
