News Life and Health22 Oct 2018

India:Insurers asked to explain exclusion of congenital defects

22 Oct 2018

The Delhi High Court has asked the 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 hearing on 17 December.

“Give the justification for such exclusion,” the court said to the insurance regulator, according to a report by Press Trust of India.

The bench also issued notices to the General Insurance Council and the Life Insurance Council, which represent general and life insurers respectively, and sought their stand on the issue before the next hearing.

The court was hearing a public interest litigation (PIL) case which sought directions from the court to the central government, the IRDAI and insurance companies to remove congenital anomalies from the list of general exclusions in health or life insurance policies.

The petition, by Mr 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. The regulator based its denial on the grounds that their conditions are categorised under the scope of “congenital anomalies”, as defined under a 29 July 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.

Mr Malhotra, a disability rights activist who suffers from locomotor disability since 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 a direction for a relook at exclusionary clauses in insurance contracts to ensure that insurance companies do not reject claims on the basis of exclusions related to congenital anomalies.


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