No insurance cover to persons suffering from congenital anomalies, Delhi HC seeks IRDAI explanation

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New Delhi | October 19, 2018 11:52 AM

The Delhi High Court has asked the Insurance Regulatory and Development Authority (IRDAI) to "explain the reasonableness" of not granting insurance cover to people suffering from congenital anomalies.

Irdai, RBS, RBSF, World Bank, IMF, insurance sector in IndiaCongenital anomalies are also known as birth defects and could be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens and micronutrient deficiencies.

The Delhi High Court has asked the Insurance Regulatory and Development Authority (IRDAI) to “explain the reasonableness” of not granting insurance cover to people suffering from congenital anomalies. “What is the objection to giving insurance cover to them (people suffering from congenital anomalies),” a bench of Chief Justice Rajendra Menon and Justice V K Rao asked the IRDAI and sought its response before the next date of hearing on December 17.

“Give the justification for such exclusion,” the court said to the insurance regulator. The bench also issued notices to the General Insurance Council and the Life Insurance Council, which represent the entities that carry on the business of general and life insurance respectively, and sought their stand on the issue before the next date.

The court was hearing a PIL seeking directions to the Centre, the IRDAI and insurance companies to remove congenital anomalies, like external or internal abnormality in the womb, from the list of general exclusions in the health or life insurance policies. The petition, by Nipun Malhotra, has challenged the “arbitrary” and “illegal” mechanisms adopted by the IRDAI in denying the rights of Persons with Disabilities (PwD) to seek insurance cover for themselves on the ground that their conditions are categorised under the scope of “congenital anomalies”, as defined under a July 29, 2016 circular by the regulator.

Congenital anomalies are also known as birth defects and could be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens and micronutrient deficiencies. Malhotra, a disability rights activist who suffers from locomotor disability from birth, has sought a direction to the IRDAI to remove the phrase ‘congenital anomalies’ from the standardised definition of the 2016 circulars.

He has also sought direction to take a relook at the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject claims on the basis of exclusions related to congenital anomalies.

In his petition filed through advocate Jai Dehadrai, he has said the effect of the circular and regulations was that PwDs found it next to impossible to seek insurance cover, when undergoing any health related complications.

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