Hold Meeting With Insurance Companies, Ensure Products Are Designed For Persons With Disabilities: Delhi High Court To IRDAI

The Delhi High Court on Tuesday directed the Insurance Regulatory and Development Authority of India (IRDAI) to call a meeting of all insurance companies to ensure that the products are designed for persons with disabilities so as to enable them to obtain health insurance coverage.

Observing that there is no doubt that persons with disabilities would be entitled to health insurance coverage and products may have to be designed for them, Justice Prathiba M Singh said:

"The IRDAI would accordingly call a meeting of all insurance companies to ensure that products are designed for persons with disabilities and other persons in terms of the circular dated 2 June 2020."

In the circular issued by IRDAI on June 2, 2020, it has been stated that companies are required to evolve health insurance policies for persons suffering from disabilities, HIV AIDS, mental illness diseases as also transgenders.

"The process of designing such products shall be supervised by the IRDAI and it shall be ensured that the said products are introduced on an early date," the court said.

The order was passed in a plea moved by one Saurabh Shukla who is suffering from multiple health ailments, including tetraplegia due to an injury suffered in 2012, and is confined to a wheelchair with limited use of his arms.

It is Shukla's case that having never been hospitalised, he approached two insurance companies, Max Bupa Health Insurance Company Limited and Oriental Health Insurance Company Limited, for taking mediclaim or health insurance. However, both the companies refused to give him any health insurance policy.

He thereafter approached the Commissioner for Disabilities who also took up the matter with the IRDAI but to no avail. He thus sought quashing of the communications of rejection by the two insurance companies and also for extending health insurance to him.

While no counsel appeared for Max Bupa Health Insurance Company Limited, the counsel appearing for Oriental Insurance Company Limited submitted that after Shukla's application was received, the matter was examined at the level of the regional office. However his request for health insurance was denied due to his medical history.

On the other hand, the counsel appearing for IRDAI relied upon regulations 8B and 8C of IRDAI Health Insurance Regulations, 2016 which mandate that health insurance coverage shall be provided to disabled persons.

Justice Singh said that a perusal of Sections 3, 25 and 26 of the Rights of Persons with Disabilities Act makes it clear that persons with disabilities cannot be discriminated against insofar as healthcare is concerned.

"It is the settled position in law that the right to life includes the right to health and healthcare is an integral part of the same," the court said.

The court added that Regulations 8B and 8C and circular dated 2 June 2020 clearly provide that insurance companies have to give insurance coverage to persons with disabilities, persons with HIV AIDS and persons affected by mental illnesses.

The court thus observed that the manner in which both the insurance companies simply rejected Shukla's proposals "that too with cryptic rejection letters" is completely unacceptable.

"The petitioner is a person who's working as an investment professional irrespective of the economic standing of a person with disability, insurance coverage cannot be effective of refused," the court said.

The court also said that IRDAI, being the regulator of the sector, has an important function to perform under the law and "cannot be taught" to ensure that its circulars and other policies are duly given effect to by the insurance companies.

"... there is no doubt that persons with disabilities would be entitled to health insurance coverage and products may have to be designed in order to enable them to obtain health insurance coverage," the court said.

The court allowed Shukla to approach the two companies once again, adding that his case shall be considered and the question of extending insurance to him shall be reviewed and a proposal shall be placed on record by the next date of hearing.

Justice Singh also said that a perusal of the IRDAI regulations shows that the term "substandard lives" is being used in respect of persons with disabilities and other categories. The court said it is "not an acceptable terminology."

"Immediate steps should be taken by the IRDAI to modify the terminology "sub standard" from the regulations so as to ensure that such terminology is not used in its regulations or other documents," the court said.

The court asked the IRDAI and the insurance companies to submit a status report before March 17, 2023, the next date of hearing.

Title: Saurabh Shukla v. Max Bupa Insurance & Anr.

Citation: 2022 LiveLaw (Del) 1168