Obesity, A Ground for Claim Dismissal at Some Insurers

In a weird, truth is stranger than fictional account, a life insurer in the city refused to compensate a bereaved family stating that the policyholder was "morbidly obese."

Chennai-resident S Shanthi, whose son had died of natural causes, found herself in the unpleasant situation of having to prove her son was thin. The grieving mother found that she had to produce photos of her dead son to convince Shriram Life Insurance Company. When that failed, Shanthi approached the ombudsman in Chennai, who ruled in her favour and asked the insurer to pay up the death claim.

"What was ironic was that the boy worked as an insurance advisor with the same insurer. In his policy documents made him out to be 130 kg, when he was actually about 70 kg," said Sudha Raghunathan, a member of IRDAI.

But the traumatic experience that Shanthi faced is one that many others also face. Insurance companies at times refuse to pay claims if the policyholder was fat or in their view "fat" putting family members in a fix trying to prove their relative healthiness."Chennai largely sees a lot of mediclaim disputes between insurance companies and policyholders. A majority of these disputes arises because of non-disclosure of medical conditions. If one were to have diabetes, hypertension, it is better to disclose and pay a higher premium. If the insurance company were to find out at the time of claim, it would lead to outright rejection," said B N Mishra, current ombudsman of Chennai and Bhubaneshwar. Chennai saw more more than 53% disputes in the general insurance industry arising from non-settlement of individual mediclaim policies. Disputes from non-settlement of group-mediclaims stood at 12%.