Insurance is meant to be a safety net — not a gatekeeper. Yet across India, many consumers are being denied health and life insurance coverage, or charged steep premium surcharges, purely on the basis of their Body Mass Index (BMI). I discussed this issue on ET Now Swadesh, and the underlying legal question deserves a closer look.

"A single anthropometric metric cannot and should not determine a citizen's right to affordable healthcare coverage. This is not just a health policy failure — it can amount to an unfair trade practice under the Consumer Protection Act, 2019."

The problem: when BMI becomes a "fat tax"

Insurance companies increasingly use BMI as a primary risk-screening tool. On the surface, it appears scientific. In practice, it is a considerably blunter instrument than it's often treated as:

• BMI was never designed as a health diagnostic tool. It is a population-level statistical measure developed in the 19th century, not an individual health predictor.
• It ignores critical health factors — muscle mass, age, gender, ethnicity, metabolic health, and chronic conditions — all of which are more accurate predictors of risk.
• It disproportionately affects women, older adults, and certain ethnic groups, creating a systemic bias baked into premium calculations.
• It can result in financial exclusion of people who are otherwise healthy by every clinical measure except one arbitrary number.

The legal position: consumer forums are taking note

• Consumer commissions in several states have ruled against arbitrary premium loading without adequate medical evidence, treating such practices as unfair trade practices under the Consumer Protection Act, 2019.
• The principle of utmost good faith (uberrimae fidei) in insurance law cuts both ways — the insurer also carries a duty of fair dealing toward the insured.
• A notable Madhya Pradesh State Commission ruling held that an insurer could not deny a claim by citing pre-existing conditions that were undisclosed but irrelevant to the actual claim.
• The Insurance Regulatory and Development Authority of India (IRDAI) has issued guidance requiring insurers to provide reasoned, individualised decisions — a blanket BMI-based rejection may not meet that standard.
• BMI-based denial also sits within the ambit of the right to health under Article 21 of the Constitution, a right the Supreme Court has read expansively.

What you can do as a consumer

• Demand a written, reasoned rejection. Insurers are required to give specific reasons — "high BMI" alone is not sufficient.
• Provide comprehensive medical records. Blood pressure, lipid profile, HbA1c, and clinical assessments carry more weight than BMI in a consumer forum.
• File a complaint with the Insurance Ombudsman — it's free, relatively fast, and covers insurance disputes up to ₹50 lakh.
• Approach the District Consumer Commission if the Ombudsman's order is unsatisfactory. Relief can include policy reinstatement, premium refund, and compensation.

Practical takeaway

Access to affordable insurance is not a privilege granted at an insurer's discretion — it engages a fundamental component of the right to health under the Constitution. A BMI-based rejection or premium loading, on its own, is rarely the end of the road; it is often the starting point for a legitimate consumer grievance.