On June 4, 2025, one of the renowned hospitals in Raisen, Madhya Pradesh, received a legal notice related to a patient surgery performed in February. The case stemmed from a patient who was treated for a shoulder injury after a road accident. The hospital had followed all medical protocols, yet the patient later alleged misdiagnosis, poor treatment, and even fabricated details about the accident. CoverYou was immediately informed, and swift legal support was extended. Within a week, a comprehensive reply was drafted, defending the hospital’s name and refuting all claims with documented facts and clarity.
Incident Report
The patient, injured in an accident, first visited the hospital on February 23, 2025, and was prescribed medicine. On February 24, after further evaluation, surgery was advised. The operation clavicle plating of the left shoulder was performed on February 27, 2025. The patient was discharged after a three-day hospital stay and was advised to undergo physiotherapy post-stitch removal. Over two months later, the hospital received a legal notice on June 4, 2025, alleging improper treatment and financial misconduct. CoverYou was informed the same day.
Claim Process Summary
Upon intimation from the insured, CoverYou conducted a detailed review of the legal notice. An experienced advocate was assigned immediately, who worked closely with the hospital’s team to gather complete facts and documents. The advocate held multiple discussions with the doctors involved, reviewed patient records, and drafted a strong legal reply. The response clarified that the surgery was conducted by a qualified team under standard medical protocol and that post-operative follow-ups showed no complications. It was also stated that the treatment was provided under the Ayushman Bharat scheme on a cashless basis. The advocate also pointed out discrepancies in the patient’s claims, suggesting an attempt to malign the hospital and demand undue compensation. The reply was sent within a week of receiving the notice, ensuring timely action and strong representation.
Challenges Faced
- The allegations surfaced over two months after the treatment, despite no reported complications earlier.
- The patient’s accusations included fabricated details about the accident and hospital procedure.
- The situation posed a risk to the hospital’s reputation and legal standing.
Actions Taken by CoverYou
- Immediate review of the legal notice upon receipt.
- Assigned an expert legal professional without delay.
- Multiple rounds of consultation with the insured and medical team.
- Legal response drafted within 7 days, backed with medical facts and documentation.
- Clear, confident defense submitted to refute every false claim made in the notice.
Special Note
This case highlights how timely legal support and proactive case handling can protect healthcare institutions from baseless legal threats. CoverYou ensured the hospital was never alone in facing this pressure and stood by them through every step.
Disclaimer: Client information has been anonymized to protect privacy.
