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Case Studies
Examples of adjudicated MediShield Life claims
Last updated 20 May 2025
Cases are based on real cases, anonymised to protect patient confidentiality. Case notes and supporting documents were requested from the doctor and medical institution. An independent Specialist Panel appointed by the MediShield Life Council reviewed the treatment and adjudicated claims with outcomes.
Case studies of inappropriate claims
Egregious Charging through Multicoding (General Surgery) [PDF, 1.3 MB]
Inappropriate Treatment (Ophthalmology) [PDF, 848 KB]
Cosmetic Procedure Claimed as Therapeutic (Ophthalmology) [PDF, 1.0 MB]
Overservicing (Gynaecology) [PDF, 946 KB]
Overservicing (Otorhinolaryngology) [PDF, 174 KB]
Inappropriate Multicoding (Orthopaedic surgery) [PDF, 118 KB]
Unnecessary Admission (Cardiology) [PDF, 216 KB]
Overservicing (GI Endoscopy) [PDF, 123 KB]
