Some insurers can dismiss claims if the policyholder is 'fat'

Chennai-resident S Shanthi, whose husband had died of natural causes, found herself in the unpleasant situation of having to prove her husband was thin.The grieving widow found that she had to show photos of her dead husband to convince the 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.

But the traumatic experience that Shanthi faced is one that many others also undergo. 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 arise 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%.


So does that mean fat people get penalised by the insurance company? “No. Nothing can be seen in isolation. Just by being fat is no grounds for rejection," said Ganesh Iyer, Senior Vice President, Customer Value Management and Head Underwriting & Claims, Kotak Life Insurance.

For instance, if one were a smoker or imbibed alcohol that would not automatically lead to a rejection of a claim. “If one had disclosed at the time of buying the policy itself, then it would not lead to an outright rejection. The insurance company would investigate the cause of the death," said Ganesh.

Disclosure of pre-existing conditions like diabetes, hypertension is important. “Being fat in isolation is no grounds for dismissal. But the higher the BMI, the more the chances are of increased heart risk, high blood pressure, etc. Unless a person was morbidly obese say for example above 100 kg -normally no insurer rejects anyone for being fat at the underwriting stage. Even if one were morbidly obese, the insurer can still underwrite, if they feel they can cover the risk," said Ganesh.