Delhi HC issues notice to Insurance Ombudsman and Centre on plea over denial of insurance cover to differently-abled minor

New Delhi [India], February 2 (AN): The Delhi High court recently issued a notice to the office of the Insurance Ombudsman and Ministry of Social Justice and Empowerment on a plea challenging the denial of health insurance to a minor with a disability.
Justice Prathiba M Singh issued the notice and directed them to file an affidavit within six weeks.
The matter was listed on March 17 for further hearing.
The high court asked the IRDAI to consider the manner in which products can be designed for persons with hearing disabilities and persons with implants.
The court also said the IRDAI shall consider the policy and guidelines as may be applicable to a person with a disability.
While passing the order, the bench said the challenges for the differently abled, ought to be mitigated by the society and it has to lend a helping hand and accommodate their needs.
In another matter, earlier, the court had asked the IRDA to convene meetings of all insurance companies to ensure that products related to health insurance coverage are designed for persons with disability.
The petitioner, in the present case, approached the court challenging the denial of a health insurance policy for his minor son who was suffering Bi-Lateral Hearing Loss, which is a hearing disability.
The minor son of the petitioners was prescribed Cochlear Implant and the petitioners got the same implant done for their minor son on July 22, 2020, at their own expense.
Since the petitioners had a family insurance policy, which included their elder daughter, the petitioner applied for renewal on June 15, 2020, with the inclusion of their minor son as a co-insured after disclosing the said pre-existing condition.
The insurance company, however, refused to issue a policy on the ground that such a disability would not be covered by their underwriting policy.
The petitioner argued that it was completely discriminatory against disabled persons, including children.
The counsel for the petitioner relied on the guidelines on the standardisation of exclusions in health insurance contracts issued by the IRDAI on September 27, 2019, for his arguments in support of the plea.
It was argued that the insurance company can have certain exclusions but the same would have to be only on the condition that there could be no insurance given even after levying further loading charges on the policy.
On behalf of the IRDAI, it was submitted that the policy does permit exclusion in the Guidelines on Standardisation of Exclusions in Health Insurance Contracts.
The bench recently considered the insurance policies for persons with disabilities in the case of Saurabh Shukla vs Max Bupa Health Insurance Co. Ltd. and Ors., where the petitioner, suffering from Tetraplegia, was refused a health insurance policy.
After considering the legal position in respect of the rights of persons with disabilities
and certain decisions, the court had passed certain directions.
The IRDAI was asked to call a meeting of all the insurance companies to ensure that products are designed for persons with disabilities in terms of the circular dated June 2, 2020.
The bench noted that In the present case, the counter affidavit of the insurance company shows that it is in a position to issue a policy, but by permanently excluding the pre-existing condition of the minor child.
The court observed, "This would in effect mean that the child of the Petitioner would be unable to obtain a health insurance policy at all in respect of his Bi-Lateral Hearing Loss and any health issues arising out of the same from the Respondent Tata AIG General Insurance."
The court added, "Prima Facie, in the opinion of this Court, this would be contrary to the provisions in favour of Persons with Disabilities under the Rights of Persons with Disabilities Act, 2016."
"Moreover, considering TATA AIG General Insurance Company Ltd. is part of a responsible and respected Corporate group, it is expected that persons with disabilities would be treated compassionately," it added.
The bench said, "Society in general also has a duty towards persons with disabilities and there is a need to consider and provide for specific products covering disabilities, for such persons."
The IRDAI while submitting its position to the court shall consider the existing policies and guidelines as may be applicable to persons with disabilities, the court directed.
It further directed that the present case shall also be escalated to the higher management of Tata AIG General Insurance Company Ltd, including, if required, to the Board of Directors to also consider this matter as to how persons with disabilities ought to be accommodated by insurance companies.
The court has also sought a status report in this regard, with the minutes of the meetings
and proposals for equitable treatment of persons with disabilities shall be filed, both by Tata AIG and IRDAI, on record by the next date of hearing.