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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

infographic thumbnail for Egregious Charging through Multicoding (General Surgery)

Egregious Charging through Multicoding (General Surgery) [PDF, 1.3 MB]

infographic thumbnail for Inappropriate Treatment (Ophthalmology)

Inappropriate Treatment (Ophthalmology) [PDF, 848 KB]

infographic thumbnail for Cosmetic Procedure Claimed as Therapeutic (Ophthalmology)

Cosmetic Procedure Claimed as Therapeutic (Ophthalmology) [PDF, 1.0 MB]

infographic thumbnail for Overservicing (Gynaecology)

Overservicing (Gynaecology) [PDF, 946 KB]

infographic thumbnail for Overservicing (Otorhinolaryngology)

Overservicing (Otorhinolaryngology) [PDF, 174 KB]

infographic thumbnail for Inappropriate Multicoding (Orthopaedic surgery)

Inappropriate Multicoding (Orthopaedic surgery) [PDF, 118 KB]

infographic thumbnail for Unnecessary Admission (Cardiology)

Unnecessary Admission (Cardiology) [PDF, 216 KB]

infographic thumbnail for Overservicing (GI Endoscopy)

Overservicing (GI Endoscopy) [PDF, 123 KB]

infographic thumbnail for Inappropriate Multicoding (Urology)

Inappropriate Multicoding (Urology) [PDF, 188 KB]