Mumbai, November 13, 2026: The South Mumbai District Consumer Disputes Redressal Commission (DCDRC), in one of its recent judgments, has pulled up New India Assurance Company for wrongly repudiating the mediclaim claim of a Nepean Sea Road resident on the ground that she had undergone bariatric surgery for obesity.
The commission, in its order, clarified that bariatric surgery is not a cosmetic procedure but a lifesaving intervention to treat obesity and other associated health complications.
The commission has directed the insurance company to pay ₹5.37 lakh towards the surgery expenses, along with 9 per cent annual interest from the date of filing of the complaint in 2019 until payment.
Further, the commission has directed the insurer to pay ₹25,000 towards compensation for the mental and physical distress caused to the complainant, along with an additional ₹30,000 towards litigation costs.
Insurer Relied On Policy Exclusion Clause
The insurance company had repudiated the claim by relying on a policy exclusion clause that listed several conditions and treatments for which mediclaim benefits could not be claimed.
These included convalescence, general debility, run-down conditions or rest cures, obesity treatment and its complications, congenital external diseases, defects or anomalies, psychiatric and psychosomatic treatment, infertility, sterility, use of intoxicating drugs or alcohol, and tobacco use leading to cancer.
The case dates back to 2017, when the complainant, a 32-year-old doctor, was advised to undergo bariatric surgery after being diagnosed with morbid obesity, hypertension, and knee and back pain.
Certificates dated August 4, 2017, and November 18, 2017, issued by Dr Mahendra Narwaria, a gastrointestinal and bariatric surgeon, recommended the procedure for her medical condition.
However, the insurance company repudiated her mediclaim, following which she approached the consumer commission seeking reimbursement of ₹5,37,250.
Commission Questions Insurer's Failure To Submit Policy
During the proceedings, the commission noted that on October 30, 2025, the insurer had sought time to submit the terms and conditions of the insurance policy. However, even after the lapse of a year, it had failed to produce the policy terms before the commission.
The commission, in its final findings, stressed that bariatric surgery was not a cosmetic procedure but a medically recommended intervention to treat morbid obesity and associated health complications, including Type II diabetes, hypertension, joint pain, sleep apnoea, osteoarthritis and back pain.
It noted that the medical certificates issued by the treating surgeon specifically recommended the surgery for the complainant's condition.
Bariatric Surgery Not A Cosmetic Procedure
“Bariatric surgery is not a cosmetic surgery. It is a lifesaving procedure to cure obesity and other obesity-associated problems like Type II diabetes mellitus, hypertension, joint pain, sleep apnoea, osteoarthritis and back pain. It is even mentioned that according to the World Health Organization, Medical Council of India and Government of India, bariatric surgery is not a cosmetic surgery but a metabolic and gastrointestinal surgery."
“Therefore, with the above observations, discussion, analysis and reasons, this commission has reached the conclusion that the opposite party repudiated the complainant's mediclaim proposal and refused to pay the mediclaim amount payable under the policy by relying solely on technical grounds without any valid reason,” the order stated.
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Concluding that the insurer had rejected the mediclaim on technical grounds without any valid or justifiable reason, the commission held that it amounted to deficiency in service.
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