A consumer court in Ahmedabad has dismissed an insurance company’s argument that breast- reduction surgery is invariably cosmetic. The court ordered the insurance company, which had denied a 55-year-old woman’s claim, to pay all costs for the mammoplasty she had undergone. The woman had incurred medical costs amounting to Rs 1.64 lakh, and the court ordered the amount be paid in full, along with Rs 5,000 towards mental harassment and legal costs.
After going through the summary of the medical case of the petitioner, the court learnt that she was advised to get a breast-reduction surgery done as she suffered constant back and shoulder pain due to abnormally sagging breasts. On the other hand, 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 held that in this particular case the insurers had misinterpreted the exception clause and committed serious lapse in service and also engaged in unfair trade practice.