Pre-cancerous growth removal not cosmetic, rules consumer panel

Vadodara: A city consumer forum has directed Oriental Insurance Company Ltd to reimburse a mediclaim of Rs 37,910 to a policyholder after rejecting his claim on the grounds that a mole removal surgery was cosmetic in nature.Sandip Bharadwaj, a resident of New Sama Road, had undergone surgery in May 2023 to remove a large mole under his eye. According to the complaint, Bharadwaj developed a "pigmented mass-like mole" on his face and consulted a doctor, who advised surgical removal as the growth was pre-malignant and could potentially lead to cancer. The mole was also reportedly causing difficulty in vision.
After being admitted to a hospital and undergoing the procedure, Bharadwaj filed a claim of Rs 37,910 with the insurance company towards medical expenses. However, the insurer rejected the claim, stating that the procedure amounted to cosmetic surgery, which was not covered under the policy except in cases involving burns, cancer, or other health hazards. The company contended that the surgery was undertaken to beautify his face.Challenging the rejection, Bharadwaj approached the Vadodara District Consumer Disputes Redressal Commission in Sep 2023. The commission observed that the treating doctor had clearly stated that the mole was large, interfered with Bharadwaj's vision, and was pre-malignant, posing a future cancer risk.Holding that the procedure was medically necessary and not cosmetic, the consumer forum ordered the insurer to pay Rs 37,910 to Bharadwaj along with 9% interest. The commission also awarded Rs 2,000 for mental harassment and Rs 1,000 towards litigation costs.