Observing that bariatric surgery performed to save a life doesn’t come under the category of cosmetic surgeries, a consumer forum directed ICICI Lombard General Insurance Company to pay a customer Rs 5 lakh spent on surgery for his wife who was diagnosed as morbidly obese.
“The evidence produced by the complainant (woman’s husband) is sufficient to show that it was life threatening.Therefore, surgery was conducted to save her life. Surgery to save life is not excluded in the policy,“ the forum said.
The woman’s husband was working as a general manager in a company that had a group insurance policy for its employees. The woman, who was suffering from pain in both knees and could not walk, failed to lose weight through conventional means and was advised to undergo bariatric surgery . The woman was admitted to hospital on April 9, 2014.The following day , the surgery was performed in which part of the stomach was excised.
The insurance company , however, refused the cashless claim on the ground that it was a cosmetic surgery . The husband’s claim for reimbursement was rejected on the ground that treatment or charges incurred towards change of life or cosmetic or aesthetic treatment of any description was not payable. In the complaint filed before the Central Consumer Disputes Redressal Forum, the man alleged that the surgery was not only to help relieve his wife’s pain in the knees and back, but also help prevent a heart attack.
The insurance company did not file its reply in the forum following which the order was passed ex parte. The husband produced a certificate from the doctor whoperformed the surgery . The doctor opined that the woman was suffering from a life-threatening situation.
Source : The Times of India
Date : 14-09-2016