Court: High Court of Delhi at New Delhi
Bench: Justice Pratibha M Singh
Case No: W.P.(C) 6074/2019
Case Title: Saurabh Shukla Vs. Max Bupa Health Insurance Co. Ltd. & Ors.
Date of Judgement : 18 August 2023
Brief of the Case:
Please refer to our earlier post updating on the hearing dated 13 December 2022 in the present case titled "Delhi HC: Right to Life includes Right to Health, Referring to persons with disabilities as 'sub-standard lives' is 'unacceptable terminology', directs IRDAI to act."
The matter was further listed before the Court on 17th March, 2023.
On the said date, in compliance with the directions dated 13 Dec 22, IRDAI placed
on record a status report, giving details of the tasks undertaken by IRDAI.
As per the said report, IRDAI had called a meeting of all general and health
insurance companies on 18th January, 2023, where the relevant issues were
discussed and a committee consisting of six senior officials from the various
insurance companies was constituted. The Committee was entrusted with the
following tasks:
“i. Design and develop specific product/s for the
following:
a. Persons with Disabilities (PWD)
b. Persons afflicted with HIV/AIDS
c. Persons having mental illnesses
ii. The design and development of the products shall be
comprehensive enough to meet the insurance needs of
the respective groups.
iii. The complete documentation shall be developed --
Proposal form, Schedule, the Policy wordings
including the various terms and conditions etc., apart
from a Customer Information Sheet (Key Features
Document).”
Thereafter, a model policy was drafted by IRDAI and a circular dated
27th February, 2023 was issued to all general and health insurance providers,
directing them to launch products for persons with disabilities (PWD),
Persons afflicted with HIV/AIDS, and those with Mental Illness, with
immediate effect. IRDAI also complied with the third direction as contained
in paragraph 26 of order dated 13th December, 2022 and the previously used
expression ‘sub-standard lives’ in Regulation 8(b) of the IRDAI (Health
Insurance) Regulations, 2016 was deleted.
The Petitioner was also offered a health insurance policy by Niva
Bupa Health Insurance Company and expressed his willingness to avail of the policy, vide his email dated 1st March, 2023. However, the Petitioner
had certain contentions against the specific details of the policy offered.
Vide order dated 17th March, 2023, this Court directed the Petitioner to avail
the health insurance offered by Niva Bupa, while allowing the Petitioner to
make a representation to IRDAI on the issues of Amount of premium being
charged, Loading charges, Amount of coverage and Period of Exclusion for
Pre-Existing Diseases.
In terms of order dated 17th March, 2023, the following compliances
were to be undertaken by IRDAI:
i. IRDAI was to take a decision on the representation by the
Petitioner and issue directions by 15th April, 2023;
ii. IRDAI was to convey the decision on the representation of the
Petitioner by 30
th April, 2023;
iii. IRDAI was to notify all the insurance companies to submit their
products in terms of circular dated 27th February, 2023 along
with model policy and file a status report.
Pursuant to the said order, an affidavit has been filed by the Deputy
General Manager of the Health Department of IRDAI wherein the deponent
states as under:
“2 That after the issuance of circular dated
27.02.2023, all the general and standalone health
insurance companies have filed their products for
Persons with Disabilities (PWD), Persons afflicted with
HIV/AIDS and those with Mental illness with Answering
Respondent/IRDAI under the “Use and File” procedure
dated 01.06.2022. It is respectfully submitted that as per
Use and File circular insurers are not required to obtain
any prior approval for launching and marketing their insurance product. Copy of the Use and File circular
dated 01.06.2022 is annexed as Annexure A.
3 That in compliance of the Circular dated
27.02.2023, all general and standalone health insurance
companies have also launched their products for Persons
with Disabilities (PWD), Persons afflicted with
HIV/AIDS and those with Mental illness a list containing
the details of products launched in accordance to
Circular dated 27.02.2023 is annexed as Annexure B.”
In terms of the above averments made in the affidavit, the various
general and health insurance companies including the four Government
insurance companies namely New India Assurance Company, United India
Insurance Company Ltd, Oriental Insurance Company Ltd. and National
Insurance Company Ltd. have launched products for persons with
disabilities. The complete list of 29 companies who are stated to have launched
their insurance products for persons with disabilities, has been reproduced in a table in the below judgement.
From the said table, it is clear that several insurance companies have
launched products for PwDs. However, in respect of the products which
have been launched, the Petitioner raises some objection qua the high
insurance premium and the loading charges, that is being charged. The said
consideration of the amount of premium of any company’s specific product
would be beyond the scope of this writ petition. It is, however, observed
that if any person insured is having a grievance on the amount of premium
being charged, remedies in accordance with law are available to such
persons. The Petitioner is given liberty to approach the concerned authority
if he so desires. This Court however, would reiterate the decision of the
Supreme Court in Vikash Kumar v. Union Public Service Commission, 2021 SCC OnLine SC 84, which has also been considered by this Court in
Akshat Baldwa & Ors. v. Yash Raj Films & Ors., 2023:DHC:345 wherein
the principle of reasonable accommodation has been highlighted to ensure
that society and indeed the state, can provide additional support and
facilities that are necessary for persons with disabilities to lead a life of equal worth and dignity.
The court furhter made clear that the merits of each and every product launched
and whether the charges are reasonable or not has not been considered by
the Court and the same was left open for consideration by any appropriate
forum, which may adjudicate a challenge to the same.
The IRDAI, being the
sector regulator would also have an obligation to ensure that PwDs are not
unduly prejudiced and give suitable directions to insurance companies, after
reviewing the products launched.
21. Insofar as the decision of the IRDAI qua the Petitioner is concerned,
the decision is stated to have been taken by the IRDAI on 19th April, 2023.
The said decision of the IRDAI has been placed on record. The challenge to
the decision is on the following aspects:
i. Amount of premium being charged and loading charges
imposed on the Petitioner etc.
ii. Amount of Coverage
iii. Period of exclusion for pre-existing diseases
"The IRDAI’s decision is detailed and reasoned. The Petitioner has
already availed of the policy in terms of the order dated 17th March, 2023.
The Petitioner is free to avail of his remedies in accordance with law in for
any outstanding grievances qua this decision of the IRDAI dated 17th April,
2023." observed the court.
This Court appreciated the assistance given by the parties and their
Counsels, in ensuring that insurance products for persons with disabilities
have been launched in India. The court admitted that the while the said products may not be the most
ideal for persons with disabilities, this would merely be a first step in the
process of achieving Equality for PwDs, which is the solemn intent of
legislations including the Right of Persons with Disabilities Act, 2016.
24. And the court thus disposed of the petition accordingly.
Here is the detailed judgement: