Friday, August 18, 2023

Delhi High Court disposes of petition on Equal Health Insurance for persons with disabilities, after IRDAI and 29 Insurance companies bring out health policies for PwDs [Judgement included]

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:  

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