Bariatric Surgery Claim Rejection Overturned! Court Orders Rs 3.4 Lakh Payout

The patient, a resident of Dabholi, Surat, underwent bariatric surgery for morbid obesity from January 27, 2022, to February 1, 2022, at a private hospital. He paid Rs 3,39,691 for the procedure and subsequently filed a claim under his Rs 5 lakh floater mediclaim policy, which was valid from August 24, 2021, to August 23, 2022. The patient as a policyholder maintained continuous health insurance coverage since 2010.

However, the insurance company- Cholamandalam MS General Insurance Co. Ltd. rejected the claim, citing non-disclosure of obesity at the time of purchasing the policy. The insurer stated; "The insured is suffering from obesity prior to the policy inception date as per the history recorded and documents. This was not declared in the proposal form."

The insurance company’s lawyer further argued that the insured had been obese for three years before the policy’s commencement but did not disclose this in the proposal form. During the investigation, the patient admitted that his weight had fluctuated between 115kg and 136kg over the past three years, and he had undergone surgery based on his doctor’s recommendation.