A consumer court rejected all arguments of insurance companies stating that all forms of breast reduction surgery are not cosmetic. This happened when a 55-year-old woman, in need for a breast reduction surgery was refused a claim for her surgery.
Court says breast reduction surgery is not always cosmetic
HIGHLIGHTS
- Court stated that the lady is in need of the breast reduction surgery
- The insurance companies were ordered to pay all the costs for mammoplasty
- The court stated that insurers misinterpreted the exception clause
Ahmedabad: A consumer court rejected all arguments of insurance companies stating that all forms of breast reduction surgery are not cosmetic. This happened when a 55-year-old woman, in need for a breast reduction surgery was refused a claim for her surgery. The insurance companies were ordered to pay all the costs for mammoplasty the lady had to go through. This included a medical cost of Rs 1.64 lakh along with Rs 5000 for mental harassment and legal costs. Court stated that the lady is in need of the surgery and not for enhancement of beauty. Therefore, it is not cosmetic.
After the court was submitted a summary of her case by the petitioner saying that she suffered constant pain due to huge and sagging breasts, the surgery suggestion was accepted. She stated that due to the large breasts, she suffered back and shoulder pain since a few years. When consulted, she was advised to get a breast reduction surgery done.
Whereas, the insurers pointed out an exception clause in the policy saying, "Circumcision, cosmetic aesthetic treatment, plastic surgery unless required to treat any injury or illness" are not insured.
The court stated that insurers happened to misunderstand the exception clause and committed lapse in service and also engaged in unfair trade practice.
This case is of a 55-year-old woman from Vasna, who underwent a breast reduction surgery in a private hospital to reduce the size of her huge and sagging breasts in May last year. She claimed an amount of Rs 7 lakh from Medi Assist TPA Pvt Ltd and New India Assurance Co Ltd. which was rejected straightaway.
The insurers gave their take on this by saying that breast reduction through a mammoplasty is cosmetic surgery for her because there were no other reason behind the same other than the fact that her breasts were too huge. Doctors explained that the surgery took place because the patient suffered great discomfort due to the size of her breast, and claims for such cases are not covered under the insurance.
When denied the claim, the woman sought help in the Consumer Dispute Redressal Forum in Ahmedabad.
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