National Insurance to pay Rs.4 lakh for weight loss surgery

Vadodara: Observing that weight reduction surgery is not always for cosmetic purposes, the consumer court in Vadodara has directed an insurance company to pay the entire treatment cost to a 56-year-old woman who went under the knife for morbid obesity. The Vadodara District Consumer Disputes Redressal Forum ruled that this surgery is often the only recourse to treat multiple ailments resulting out of excessive weight.

The consumer court directed National Insurance Company Ltd to pay 56-year-old Santosh Acharya Rs 4.07 lakh which she incurred for the surgery. Acharya, who weighed around 116kg, was advised to undergo the surgery as she suffered from multiple obesity-related ailments including high blood pressure, thyroid, stiffness of knee joints and gastric problems.

In August 2017, Acharya underwent the treatment at a private hospital in Indore and submitted a claim of Rs 4.07 lakh. However, the company repudiated her claim without citing reasons. Acharya then approached the consumer forum in February 2018 seeking her claims with interest and compensation. The company this time responded that the conditions of the policy make it clear that treatment for obesity and weight control and management treatments are not payable.

Mukesh Shah, who represented Acharya in the court said: “The insurance terms and conditions state that expenses for cosmetic surgery are not payable, but if the weight loss treatment is done to relieve the patient from other related ailments, the claim should be cleared.” Shah further added that after the surgery, Acharya did not have to take any medicine for any of her previous ailments.

The court, refusing to buy the insurer’s argument that this surgery was excluded from the policy, held it deficient and ordered it to clear the entire claim amount along with interest. It also ordered Rs 5,000 to be paid to Shah separately.

The judgement comes as a respite to such patients who are denied their claims by insurers who show them rules of Insurance Regulatory and Development Authority (IRDA) that excluded obesity treatment from being covered under health risks.

Source: The Times of India