Showing posts with label discrimination in insurance. Show all posts
Showing posts with label discrimination in insurance. Show all posts

Saturday, July 11, 2020

National Consumer Court directs LIC Chief to inculcate systemic improvements in future for “apt logical decision-making" for claims of persons with disabilities

New Delhi 11 July 2020

Court: NCDRC Delhi, Case No. RP/1849/2019   

Parties: Life Insurance Corporation of INdia Versus Anil Laxman Matade

The National Consumer Dispute Redressal Commission (NCDRC), has imposed a cost of  Rs 2.5 lakh on Life Insurance Corporation of India (LIC), and has directed it to pay the amount over and above the insured sum of Rs 1 lakh with 9% annual interest to a father and his daughter with intellectual disabilities. The Commission has come down heavily on the LIC for its adamant “mechanical decision-making without application of mind” while refusing to pay the assured amount.

Showing a mirror to LIC, the order said, "the name of the policy is very attractive “Jeevan Adhaar” i.e. “Life Support”, but, at times, this policy makes the consumer, in certain cases, as in the instant case, helpless, i.e. “Niradhar”, “life without support”- “crippled”. Thus, the insured is thrown in vacua..! after 20 years payment of all premiums." 

Background of the case

Mr. Anil Laxman Matade of Sangli in Maharashtra had taken Jeevan Aadhaar policy of LIC for his daughter with Down syndrome. The LIC had refused to pay the assured amount to Matade even years after he made full payment of premiums while citing conditions, which specified that only 20% of the amount would be released after his death and the rest in installments in 15 years.

Both the district consumer forum and Maharashtra State Consumer Commission had ordered in favour of Mr. Matade, but the LIC challenged the order in the NCDRC. The age of Mr. Matade's daughter is 34 and she has 75% mental disability.

Court's Order

The order passed by NCDRC on 10 July 2020  while holding the public sector insurance company responsible for “intransigent mechanical decision-making” and for going for litigation as a matter of routine, a two-member bench comprising Dr S M Kantikar and Dinesh Singh advised its chief executive to inculcate systemic improvements in future for “apt logical decision-making” in such cases of congenital mental disabilities in which the dependent cannot think and act for herself or himself.

The bench observed it was not amending the general terms and conditions of the policy, which specified that the sum assured is to be paid to the handicapped dependents/ nominees on the death of the insured. “However, the policy and its terms and conditions cannot be implemented in an arbitrary and mechanical manner without application of mind and without having regard to the facts and specificities of a particular case,” the order said.

It said the plight of a child and of her father and mother, and especially in the case of a girl-child having Down’s Syndrome, had to be understood and kept in view by the LIC with the due application of mind at the competent level while deciding Matade’s request to release sum assured immediately so that he may make adequate arrangements for his daughter while he is still alive.

“The LIC failed to appreciate that the daughter, a person with Down’s Syndrome would be in no position to apply her brain and to act for herself so as to make appropriate arrangements for her well-being on her own, when her father is no more, and that she would be in no position to pursue her claim with the LIC, far less agitate it in the consumer protection fora/ civil courts,” the order said.

The Court further warned the LIC saying, “Needless to add, in case of failure or omission in timely compliance, the District Forum shall undertake execution, for ‘enforcement’ under section 25(3) and for ‘penalties’ under section 27 of the Consumer Protection Act 1986.”

It is pertinent to mention that in January 2009, Delhi State Consumer Dispute Redressal Commission had fined LIC for rejecting the claim of a Police Constable who suffered 69% disability due to amputation in hand on the ground that he was capable of earning wages, since he was allowed to continue working with Delhi Police for compassionate reasons under the Rights of Persons with Disabilities Act 2016.

Judgement dated 10 July 2020 

Download PDF Here or read below


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 1849 OF 2019

(Against the Order dated 03/04/2019 in Appeal No. 605/2018 of the State Commission Maharashtra)


LIFE INSURANCE CORPORATION OF INDIA
THROUGH ITS ADDITIONAL SECRETARY(LEGAL) 
CENTRAL OFFICE H-39, FIRST FLOOR, 
NEW ASIATIC BUILDING CONNAUGHT CIRCUS,
NEW DELHI-110001                                                                     ...........Petitioner(s)

Versus  

ANIL LAXMAN MATADE
R/O. RAHUL COMPLEX, FLAT NO. 2, GUEST HOUSE,
SANGLI-416416
MAHARASHTRA                                                                        ...........Respondent(s)

BEFORE:  
  HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER
  HON'BLE MR. DINESH SINGH,MEMBER

Dated : 10 Jul 2020

ORDER PRONOUNCED ON: 10th JULY 2020

ORDER PER DR. S. M. KANTIKAR, PRESIDING MEMBER

1.      The present Revision Petition is against the Order dated 03.04.2019 of the State Consumer Disputes Redressal Commission, Maharashtra (hereinafter referred to as the “State Commission”) in First Appeal No. A/18/605.

2.       In the interest of justice, to provide fair opportunity to the Petitioner LIC, to decide the case on merit, the self-admitted delay of 15 days in filing the petition is condoned.

3.       Briefly, the case of the Complainant is that the Petitioner LIC issued a policy under its ‘Jeevan Adhaar Plan– without profits - with accident benefits’ to the Complainant Anil Laxman Matade w.e.f. 25.07.1996 for sum assured Rs. 1,00,000/-. The half yearly premium was Rs. 2,257/-. The Complainant’s wife was the nominee. The policy was for the benefit / welfare of the Complainant’s daughter who was mentally challenged with congenital Down’s Syndrome. The Complainant paid all premiums regularly till the maturity of the policy on 25.01.2015. After the policy matured, the Complainant claimed the sum assured from the Petitioner LIC, but the Petitioner LIC refused. Further, as averred by the Complainant, he was surprised and taken aback to be told that 20% of the sum assured would be paid to his dependent mentally challenged girl-child only after his death and the remaining 80% would be paid to her over a further period of 15 years thence.

4.       Being aggrieved by the refusal of the LIC to pay the sum assured, the Complainant filed a Complaint before the District Forum, Sangli alleging deficiency in service.  

5.       The LIC filed its written version and argued that the policy was for the benefit of only the dependant and would become effective only after the demise of the insured Complainant. The insured Complainant was not entitled for any payment during his lifetime. As per the terms and conditions of the policy only 20% of the sum assured was payable to the mentally challenged dependent daughter after the death of the insured Complainant and the remaining 80% was payable to her over the next 15 years.

6.       The District Forum allowed the Complaint and directed the LIC to pay the sum assured, Rs. 1,00,000/- along with interest @ 9% per annum with effect from 25.01.2016 to the insured Complainant and also awarded Rs. 20,000/- as compensation and Rs.5,000/- as litigation cost.

7.       The LIC preferred an Appeal before the State Commission. The Appeal was dismissed with cost of Rs. 5,000/-.

8.       Both the fora below, the District Forum and the State Commission, have returned concurrent findings in favour of the Complainant.

9.       We find the State Commission’s impugned Order to be well-appraised and well-reasoned. No jurisdictional error or legal principle ignored or miscarriage of justice is evident, as may require interference in the exercise of the revisional jurisdiction of this Commission.

10.     We may but add that, admittedly, the Complainant had paid all premiums for 20 years without any default, the last premium was paid on 25.01.2015, after the period of 20 years was over, he did not receive the sum assured from the LIC despite several requests, he waited for one year and thereafter served a legal notice on the LIC on 26.06.2016, the LIC has not shown any logical application of mind to the peculiarities of this case, but has intransigently adhered to a mechanical straightjacketed application of its terms and conditions by rote.

11.     From the record it is evident that the present age of the Complainant’s daughter is about 34 years, she is having 75% mental disability. No doubt the old parents have to struggle for the welfare and care of their Down’s - adult girl.  They are also concerned for her safety from unforeseen sexual exploitation. She needs to undergo hysterectomy. The Complainant has this only girl, he has no relatives who can look after his such handicapped daughter. 

12.     The LIC has brought this product to the consumers under the clothing of uberrima fide. The name of the policy is very attractive “Jeevan Adhaar” i.e. “Life Support”, but, at times, this policy makes the consumer, in certain cases, as in the instant case, helpless, i.e. “Niradhar”, “life without support”- “crippled”. Thus, the insured is thrown in vacua..! after 20 years payment of all premiums.  

13.     The Act, 1986 is a benevolent social legislation as has been held by the Hon’ble Apex Court in a catena of judgements from time to time, and is aimed at providing for better protection of the interests of the consumers. Given the facts in the present case at hand, the interests of the consumer can be protected only if he is provided a remedy from all angles for the care of his Down’s adult girl. It is a fight between two unequal. The intention of LIC is not to pay a single penny till the death of insured, which makes the father helpless (the whole matter cannot even be understood by the mentally – challenged dependent daughter for whose benefit the father took the policy and paid premiums for 20 years).  It is obvious that to secure the future of his daughter, the father, with good intention, took such policy, but he has been put to trouble and prejudice and made to struggle and face the intransigent arbitrariness of the LIC.  The approach of the LIC in the instant case is contrary to the principle of uberrima fide.

14.     To know about the agony & gravity of “Down’s syndrome and its social effects” we have gone through voluminous medical literature on the subject. Down’s syndrome is caused by triplicate chromosome 21 (Trisomy 21). The syndrome has a variable physical expression, sometimes it is associated with congenital cardiac defects, transient myelodysplasia (acute leukaemias) and duodenal atresia of the new-born. The care of the infant or young child with Down syndrome can be complicated and may involve a myriad of immediate and long-term medical problems, psychomotor and psychosexual development connected with mental retardation and endocrine disorders. Generalized tonic clonic seizures are the most common. IQs range from low normal to profoundly retarded.

15.     When the parents first learn that their baby has Down syndrome, they may feel disappointment, grief, anger, frustration, fear, and anxiety about her future.  The parents may react with shock, denial, anger, grief, fear, acceptance or any combination of these emotions. The Parents often have strong fears about the future of their child with Down’s disabilities. Dealing with the idea of someone else taking care of their child is never easy. As parents, their worry is that child will not be adequately prepared for the world. It is difficult for many to plan for such child. They face and realise their own mortality. There is a feeling always that no one will ever love, care for, and support their child. Thus the parents having Down’s daughter suffer agony and apathy throughout their life. Many parents think that if their child has money, he’ll be safe. Obviously, the financial resources, money, can help to make the child’s life more secure after the death of her parents.

16.     Privacy is important. The sexuality is an intrinsic aspect of human development. Individuals with Down’s syndrome need individualized instruction and education to develop appropriate socio-sexual behaviours. They still require routine and preventive reproductive health services including urological care for men and gynaecological care for women. They also need education and counselling to prevent unplanned pregnancy, abuse, and sexually transmitted disease. The mentally disabled individual is particularly vulnerable to sexual abuse and maltreatment for several reasons: isolation; communication deficits; etc. Other contributing factors include multiple living situations and transient caregivers, some of whom may be paedophiles. [Pedophilia (alternatively spelt paedophilia) is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children] 

17.     The essential crux of the matter is that the Complainant took LIC’s Jeevan Adhaar policy for his daughter, who is mentally challenged with Down’s Syndrome. That all premiums were paid and that the policy had matured is not disputed. The only dispute is that the LIC is intransigent that the benefit will accrue to the beneficiary i.e. the daughter of the Complainant only after his death, as per the terms and conditions of the policy. The Complainant on the other hand, pointing out that his daughter is mentally challenged, wishes to immediately obtain the sum assured and to make adequate arrangements for his daughter in his lifetime, for her future (when he is no longer alive and there is no one else to make the requisite arrangements for his daughter).

18.     We make it clear that we are not amending or adding to or subtracting from the general terms and conditions of the LIC’s subject Jeevan Adhaar policy. It is meant for the benefit of the handicapped dependents / nominees of the insured, the sum assured is to be paid to the handicapped dependents / nominees on the death of the insured. However, the policy and its terms and conditions cannot be implemented in an arbitrary and mechanical manner without application of mind and without having regard to the facts and specificities of a particular case. Making of adequate arrangements during his life time by the father of a mentally handicapped dependent (who would not be able to herself make arrangements or be able to agitate her case after the demise of her father) is nowhere precluded in the terms and conditions, that is to say, payment in such cases, in such facts and specificities, is nowhere precluded. The terms and conditions cannot be implemented in a straightjacketed mechanical arbitrary manner, with total disregard to the facts and specificities.

In this particular case, the handicapped dependent of the insured is an adult girl with Down’s Syndrome, she is not physically challenged, but is mentally challenged, and as such she cannot think and act for herself. The plight of a child and of her father and mother, and especially in the case of a girl-child having Down’s Syndrome, had to be understood and kept in view by the LIC with the due application of mind at the competent level (whichever it may be) while deciding the insured i.e. the girl-child’s father request that after the payment of all the premiums the sum assured may be immediately given so that he may make adequate arrangements for his mentally challenged daughter while he is still alive. The LIC failed to appreciate that a victim of Down’s Syndrome would be in no position to apply her brain and to act for herself so as to make appropriate arrangements for her well-being on her own, when her father is no more, and that she would be in no position to pursue her claim with the LIC, far less agitate it in the consumer protection fora / civil courts. The afore, which is the crux of the case, has been evaded and ignored by the LIC in its decision-making and in its litigation, both.

19.     The intransigent, arbitrary, mechanical decision-making and the intransigent, protracted litigation, in an issue in which straightjacketed mechanical adoption of the terms and conditions by rote was deemed to be inviolable, and understanding the nature of the handicap, that it is mental (repeat mental) challenge caused by Down’s Syndrome, was kept in opacity, overlooked and ignored, is well and truly evident.

20.     We have no hesitation in upholding the impugned Order dated 03.04.2019 of the State Commission and in affirming the award made therein. The award made by the State Commission shall, now, be complied with most immediately, without further delay. In addition, to compensate for the intransigent mechanical decision-making without application of mind and the intransigent protracted litigation by rote and the delay and trouble and prejudice caused to the Complainant and to his mentally challenged daughter, a cost of Rs. 2.50 lakh shall also be paid by the LIC to the Complainant, for the benefit / welfare of his mentally handicapped adult girl within four weeks of the pronouncement of this Order, without fail. The Chief Executive of the LIC shall ensure timely compliance.

Further, the Chief Executive of the LIC is advised to inculcate systemic improvements in future for apt logical decision-making in such cases of congenital mental (repeat mental) disabilities in which the dependent cannot think and act for herself / himself.

21.   Needless to add, in case of failure or omission in timely compliance, the District Forum shall undertake execution, for ‘enforcement’ under section 25(3) and for ‘penalties’ under section 27 of the Act 1986.

22.   A copy each of this Order be sent by the Registry to the Complainant, the Chief Executive of the LIC, the State Commission and the District Forum within three days of its pronouncement.

......................
DR. S.M. KANTIKAR
PRESIDING MEMBER
......................
DINESH SINGH
MEMBER

Wednesday, January 9, 2019

Insurance Company denies health insurance on the basis of disability - Court of Chief Commissioner approached

Dear Colleagues,


A Bengaluru based banker with visual disability has preferred a complaint in the Court of Chief commissioner for Persons with Disabilities against Religare for denying him health insurance policy on the grounds of his blindness. The 63 year-old banker Mr. TR Raghu Kumar has optic nerve atrophy (ONA), a condition of permanent vision loss caused due to damaged optic nerve, in March 1991. 

“I suddenly lost my eyesight; I woke up one morning to know that my vision has been affected. This can happen to anybody,” he said. He bought a health insurance policy from Religare for Rs 5 lakh and paid one-year premium of Rs 16,597 on October 26, 2018. “I had declared my condition in the insurance proposal and submitted a copy of the medical certificate,” he added.

A month later, Raghu received a call from the company stating that his insurance was rejected as he was totally blind and the premium was refunded. Alleging discrimination, Kumar wrote to the commissioner for persons with disabilities on November 29.

Responding to an email query, Religare said Kumar’s insurance proposal was declined due to ONA. “ONA can be caused by multiple reasons and not limited to trauma (including stroke), tumour, decrease in oxygen or blood supply, infections, disorders or hereditary reasons. There was no ascertainment with regard to the cause in his proposal. We cover persons with any kind of disability (physical/visual/hearing), provided there’s no co-existing health condition that’s in contravention with our medical underwriting guidelines,” Religare said.

However, Kumar said the company never asked him anything pertaining to the cause of ONA. “I’ve submitted the disability certificate which is self-explanatory. The company collected money for the premium and rejected my proposal without raising any question. This is nothing but discrimination against a disabled person,” he added.

Source: Times of India 

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







Sunday, April 22, 2012

Extra Premium or Reduced Insurance Cover, both discriminatory against Disabled - Delhi HC [Judgement Included]

Dear Colleagues,

Refer to my earlier posts on 02 Sep 2009, 09 October 2009 and 21 January 2010 on the issue since the matter has been pending before the Delhi High Court. There were several occasions that the Court was about to pronounce judgement however, Union of India bought time on each hearing with a promise that they are amending the rules to remove the discriminatory practices against the persons with disabilities (read employees) in insurance sector and dragged the case to 2012. However, at the end, the court got infuriated the way the Government turned turtle on their own statement before the court and tried to justify the discrimination of extra premium.

The brief background of the case

In the instant case, the petitioner Mr. Vikas Gupta, through a public interest litigation, filed by  Mr. Pankaj Sinha, a lawyer with visual impairment from Human Rights Law Network,  brought to the notice of the court that the Postal Life Insurance Policy issued for the benefit of government employees was inherently discriminatory against employees with disabilities. It allowed the maximum sum insured for employees with disabilities to only Rs. 1 lac while their non-disabled counterparts enjoyed a maximum insurance cover of 5 lacs. Not only this, the employees with disabilities were paying a higher premium than those without disabilities.

Thus through this litigation, the petitioner sought parity in the maximum sum assured and premium charged from the employees with disabilities in comparison to the employees without disabilities. When the matter came up for hearing and notice was issued, Postal Life insurance realizing their follies, issued a notification during pendency of the petition raising the maximum insurance coverage for employees with disabilities to that of non-disabled employees i.e. up to Rs. 5 lakhs. However, they continued to charge extra premium from the employees with disabilities.

The petitioner argued that the extra premium charged was without any scientific justification. When the court sought explanation from PLIC, the Additional Solicitor General stated before the court that they do not discriminate on the basis of disability and there is no extra premium charged.

However, later Union of India turned turtle on their statement and justified the extra premium from the employees on the blanket ground of disabilities and argued that the Insurance Policy was a contract between the insurer and the insured. That in the insurance business a pool was created through contributions made by persons seeking to protect themselves from common risk. Premium was collected by insurance companies which also act as trustee to the pool. Any loss to the insured in case of happening of an uncertain event was paid out of this pool. It worked on the principle of risk sharing. Therefore, prejudice would be caused to the normal insured persons in case of any casualty of the disabled persons. As disabled persons are more prone to accidental risks as compared to normal persons and the amount which is to be paid to the family of the deceased would be paid out of the same pool.  Hence, it is justified to charge extra premium from the employees with disabilities. They also argued that extra premium payable by the disabled person is marginally different from the premium payable by normal persons. Further they justified the extra premium on the ground that the extent of handicap differs from one person to another and that they would continue to charge differential premium decided upon the health profile of the individual proponent.

The petitioner argued that the extra premium clause has no scientific base nor can be justified by any legal enactment or any empirical study. On the contrary, such a standalone stipulation for Persons with Disabilities in form of a special scheme in the Postal Life Insurance for Government employees was discriminatory, non-inclusive, unjust and violates principles of natural justice of equity and fairness and above all it ran against the mandate of the Persons with Disabilities Act 1995 and the UN Convention on the Right of Persons with Disabilities that India is a proud signatory to. Further, it specifically violated Articles 3 and 25(e) of the UN Convention.

The petitioner accepted the rationale of PLI to the extent that any loss to the insured in case of happening of an uncertain event is paid out of this pool and that it worked on the Principle of risk sharing. However the petitioner strongly refuted that disabled persons are more prone to accidental risks as compared to normal persons. On the contrary, the petitioner argued, there was no empirical study or data to support or substantiate such a baseless, false and biased view which only reinforced the stereotypes about persons with disability and their proneness to accident.

Petitioner argued that the right to equality and non-discrimination were inalienable rights which couldn't be taken away by any contract and charging extra premium from employees with disabilities was a direct discrimination with them on the basis of disability which was in direct conflict with Article 2 of UNCRPD.

The petitioner also argued that the justification of health profile put forward by the respondents was faulty for they seem to treat disability as a negative health profile. It was stressed that living with disability was distinct from suffering from a life threatening disease, while the respondent seemed to consider both as synonymous. An employee with visual impairment or with hearing impairment or with neurological impairment also enjoyed good health like anybody else. Therefore, an employee living with a disability would not mean that he / she was suffering from a disease and prone to life risks or susceptible to die prematurely. Such a conclusion on the part of respondent was illogical, arbitrary, had no empirical base and without any understanding of disability, hence, such a conclusion was required to be struck down.


Hon’ble High court in the instant case agreed that charging extra premium from employees with disabilities was indeed a discrimination on the basis of disability and therefore through this remarkable judgement directed the postal life insurance to provide equal insurance coverage and not charge extra premium from the employees with disabilities.
The Road Ahead

I see this judgment  as 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. However, India, its Courts and the persons with disabilities are very progressive on this front and the western countries can follow suit at least on this count.

This is just a beginning. We need a well devised future strategy  to dismantle the entire regime of discrimination that is prevailing in the insurance sector and the immediate challenges are:

(a) The insurance sector still discriminates on the basis of etiology of the disability i.e. causes of disability, whether it is from birth and after birth; neurological or physical and  then rates their lives accordingly,  which in my considered view has again no scientific base.

(b) The persons with neurological disabilities are still not allowed any insurance policy and needs to be challenged.

(c) PLI is an insurance scheme for the benefit of government employees hence, it will cover a very small section of persons with disabilities. Those who are outside the government jobs especially those in rural areas are far away from reaping the benefits of insurance. Though the judgement challenges the principles that have so far formed the basis for denying the  insurance to the disabled.

(d) The Actuaries who are in the business of assessing the life risks are not aware of the real challenges and the lives of the persons with disabilities and they continue to live in their own world and decide on their own whims, the risk calculation of the life of a person with disabilities. They need to be sensitized and made aware not only about the lives of persons with disabilities but also the rights regime that UNCRPD brings.

(e) The entire literature on insurance that I had to read while pursuing this case from outside, I found it reinforced the stereotypes about persons with disabilities and their proneness to accident! Hence, we need new literature for future actuaries to understand that Disability can not be treated always as a negative health profile and that living with disability was distinct from suffering from a life threatening disease.

(f) There is a need to raise awareness that a person with visual impairment or with hearing impairment or with neurological impairment also enjoys good health like anybody else.

(g) The rules of Insurance sector needs to be changed in light of this judgement and applied across the sector. All insurance  issuing companies - be it private or government have to factor in the principles of this judgement and make amends.

(h) The discrimination continues unabated in not just in `life insurance, sector but in health insurance and other insurance products on the offer. This needs to be addressed on priority.

(j) We need to take this awareness to the most marginalized persons with disabilities in rural areas through several means.  

I am sure we all are up for it and would take this to its logical end.

regards

Subhash Chandra Vashishth
Advocate-Disability Rights

Saturday, January 31, 2009

LIC fined for denying insurance claim on acquiring permanent disability on the grounds that Claimant was capable of earning his wages, despite disability

31 Jan 2009 |  SCDRC, Delhi

Consumer Case; Acquired Permanent Disability of 69%  as a result of accident; Claim rejected on grounds that claimant hasn't lost his wage earning capacity; claimant's continue to work in Delhi Police despite disability under proection of Persons with Disabilities Act 1995.

Question of Law: Can LIC deny insurance claim of having acquired disability as a result of accident  on the ground that claimant was capable of earning wages, since he was allowed to continue working with Delhi Police for compassionate reasons.  

The state consumer commission has hit out at Life Insurance Corporation of India (LIC) for rejecting the rightful claim of a poor consumer on a flimsy ground. LIC denied the claim of a disabled police constable on the grounds that he had not suffered permanent disability. Disagreeing with this, the commission has asked LIC to pay Neeraj Kumar his entitled claim that covers permanent disability benefits to the tune of Rs 1.5 lakh and a compensation of Rs 25,000.

Background of the case

Neeraj Kumar, a resident of Burari, suffered an electric shock following which his right arm below the elbow had to be amputated. After obtaining a permanent disability certificate from doctors of Safdarjung Hospital, he filed a claim with the company. Despite the doctors assessing permanent disability to the extent of 69%, LIC rejected his claim on the ground that he was capable of earning wages, since he was allowed to continue working with Delhi Police for compassionate reasons.

Order of the Commission

The commission, headed by Justice J D Kapoor, observed that had the consumer applied for the post of constable now, he would not have got the job. Therefore, to reject such a claim on such a premise was nothing but logic chopping, oppressive and malafide interpretation of beneficial contract, the commission observed.

"Merely because a person with permanent and total disability continues to be employed on compassionate basis does not mean that he has forfeited the benefit of permanent disability arising from the insurance policy,'' Kapoor added.

Justice Kapoor also asked the insurance sector not to adopt such an approach and be consumer friendly. The consumer should not be made to run from pillar to post or else they should be ready for the consequence of recovery of compensation amount from the salary of the officials, he said.

Source: Times of India