Monday, May 2, 2016

Private Insurance Contracts can't override fundamental rights of equality & health through exclusion clauses

Dear Colleagues,

Please refer to my earlier blog entry titled "Extra Premium or reduced insurance amount, both discriminatory against employees with disabilities- Delhi HC" wherein the Hon'ble Delhi High Court had categorically come to a conclusion that charging extra premium from employees with disabilities was indeed a discrimination on the basis of disability and the court in its remarkable judgement directed the postal life insurance to provide equal insurance coverage and not charge extra premium from the employees with disabilities.

I had called that judgement  a milestone in the disability rights movement with far reaching implications not only in India but also beyond India and especially in European countries where the actuaries continue to discriminate against persons with disabilities by under-valuing their lives. 

In the instant case, the plaintiff  Jai Prakash Tayal, holding a mediclaim policy had filed a suit seeking payment of Rs. 5 lakh spent on his treatment while the Insurance firm had denied mediclaim saying “genetic disease is not payable as per policy genetic exclusion clauses".

The trial court presided by Hon'ble Additional District Judge, Delhi Dr. (Ms.) Kamini Lau lambasted the United India Insurance Company, a Public Sector Undertaking (PSU) of Govt. of India, for rejecting the mediclaim of a person for heart ailment on the ground of genetic disease exclusion clause. 
News Clipping from Times of India Delhi Edition 02 May 2016

Adding that the clause was "arbitrary , discriminatory and unfair" the Judge said, “I hold that a genetic disease exclusion clause in a mediclaim insurance policy, which totally excludes the grant of insurance in case of genetic diseases, is liable to be struck down being violative of the constitutional mandate, the fundamental underlying constitutional scheme, policy of the state and public good.

The plaintiff had told the court that he had already taken two claims for the same treatment and, therefore, a third claim for the same disease was not liable to be rejected. The court ruled in favour of the plaintiff and said he was entitled to the amount. It observed that a person suffering from a genetic disease is as much in need of a medical insurance cover as others and in fact the liability qua them is more.

“No person can be discriminated or deprived of state protection in case of an ailment, be it genetic or acquired. The courts of law are required to interpret the provisions of the private contracts in the light of these constitutional obligations,“ the court said.

The court held that good health is not a privilege but a justiciable fundamental right and lamented that healthcare finances have a poor record as only 4% of the national budget is spent on it. “The time has come that India catches up with this alternative model of allocating resources and funding to its public health programmes,“ the judge said. 

Related News from Times of India :  Court pulls up insurer, cites right to health







2 comments:

Sood- sumit said...

I strongly need a copy of this judgement please. I have a similar case, rejected by insurance ombudsman recently. Please forward me a copy if you have it on my e-mail id: cool2sumit@gmail.com

Vinodh said...

Hi

I too need a copy of the judgement. I searched in the Delhi courts Tis Hazari judgements...but couldn't find. I am facing similar problem in my family. Would greatly appreciate if you can kindly send the copy of judgement to vinodh.mewani@gmail.com