New Delhi: “Good health is a justiciable fundamental right”, a Delhi court has said while observing that Prime Minister Narendra Modi’s ambitious project for health insurance cover for everyone would bring about an “evolution” in India’s health insurance model.
The court’s observations came while pulling up the United India Insurance Company Ltd, a Public Sector Unit (PSU), for rejecting the mediclaim of a person for heart ailment on the ground of genetic disease exclusion clause. Additional District Judge Kamini Lau said,
“I hold that a genetic disease exclusion clause in a mediclaim insurance policy which is a contract between the insurer and the insured and 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.“Such clauses are arbitrary, discriminatory and unfair as they discriminate persons suffering from genetic disorders/ diseases from state assistance.”
The court said, “The ambitious project of Prime Minister Narendra Modi i.e. National Health Assurance Mission (NHAM) envisioning a scheme for health insurance cover for everyone is yet to effectively put in place and rolled out before it can be offered to everyone and this would bring about an evolution of the health insurance model in India as promised.”
The court, while deciding the suit against the insurance firm, said plaintiff Jai Prakash Tayal was entitled to recover from the company Rs. five lakh which he had spent for his treatment at the hospital.
The firm had denied mediclaim saying “genetic disease is not payable as per policy genetic exclusion clauses”.
The man had told the court that he has 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 observed that a person suffering from a genetic disease, is as much in need of a medical insurance cover as others and the liability qua them is more.
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