This case involves a Group Health Insurance (GHI) policy under one of the renowned educational institutions, where a newborn baby sadly passed away a week after birth. The baby’s mother reached out to CoverYou on April 30, 2025, requesting help to recover the hospitalization expenses, which the family had paid out of pocket. However, there were immediate complications; the baby had not been added to the policy by the HR department, and necessary medical documents were missing. Despite the emotional circumstances, our team remained in continuous contact with both the HR and the insurer, ensuring the baby was added to the policy, collecting all required documents, and finally submitting the reimbursement claim. After weeks of follow-up and quick action on every query, the insurance company approved and settled the claim for ₹90,954. CoverYou’s proactive support brought relief to the grieving family during a very difficult time.
Incident Report
On April 8, 2025, a newborn baby was hospitalized in Dehradun but sadly passed away a week later. The family bore all medical costs and later sought reimbursement through their Group Health policy. However, the baby had not been added to the policy by the employer’s HR department, and critical documents were missing, delaying the claim process significantly.
Claim Process Summary
The baby’s father contacted CoverYou on April 30, 2025. We quickly identified the core issue: the baby had not been registered under the group policy. Our team raised a request with the insurer to add the baby post-birth, and simultaneously followed up with the employer’s HR department for medical bills. After persistent reminders and one month of coordination, the documents were finally received, and the claim was formally submitted. When the insurer raised a query, we already had all supporting documents in place and responded immediately. We followed up daily through calls and emails, and finally, on June 13, 2025, the claim was approved and settled.
Challenges Faced
The key hurdles in this case were twofold: the baby was not listed under the insurance policy, and there were prolonged delays in receiving required documents from the HR team. These issues significantly impacted the claim submission timeline.
Actions Taken by CoverYou
Our team sprang into action to get the baby added under the policy coverage. We maintained constant contact with the employer’s HR to collect all necessary hospitalization documents. When the insurer raised a query, we responded on the same day and escalated the matter via email, requesting immediate processing given the emotional sensitivity and delayed timeline. Our continuous follow-up resulted in successful claim approval and closure.
Final Outcome of the case
With the Contentious follow-ups and the case handled by the senior Claim Experts of coverYou, the ₹90,954 claim has been approved on 13 June 2025
Disclaimer: The information in this case study has been anonymized to protect client privacy.
