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Insurance Denies Spine Surgery Claim for Teen Girl
20 Oct
Summary
- Insurer denied claim citing obesity, despite spinal surgery.
- Consumer commission ordered reimbursement and compensation.
- Girl underwent surgery for L5-S1 prolapsed intervertebral disc.
A 13-year-old girl's essential spine surgery claim was initially denied by the Oriental Insurance Company Ltd. The insurer invoked a policy clause excluding obesity treatment, referencing the teenager's weight of 72 kg and a BMI of 26.1. The family sought reimbursement for Rs 1.6 lakh spent on the surgery for a prolapsed intervertebral disc in March 2019.
The hospital and parents argued that the surgery was solely for the spinal condition and not related to weight management. The treating doctor confirmed that neither the surgery nor the patient's pain was caused by obesity. The consumer commission found the insurance company's denial improper and unreasonable, ordering the full reimbursement along with litigation costs and compensation for harassment.
