A knee-replacement claim was approved — minus 75%.
A “reasonable and customary” clause — the surgery looked costly next to nearby ones, so they cut the number.
A Modern Treatments clause with no sub-limits — negotiated at placement for procedures like this.
The deduction was reversed in full.
A real claim on a policy Ethika placed and serviced, shared with consent. Past experience; outcomes depend on individual policy terms.




















Member · Insurance Brokers Association of India (IBAI)
