Aug.18: SETTLED IN COURT
Denying insurance for genetic conditions violates rights: HC
Jai Prakash Tayal suffered from a heart condition called â€˜hypertrophic obstructive cardiomyopathyâ€™. He took a Rs. 5 lakh health insurance policy from United India Insurance in 2004 and renewed it regularly every year till 2012. He was hospitalized twice in 2004 and 2006 and the insurer honoured his claims both times. However, when he was hospitalized in 2011, the insurance company rejected his claim citing â€œgenetic exclusion clausesâ€ in the renewed contract.
Tayal submitted that the exclusion clause was not part of the initial policy and had been added without informing him. The trial court ruled in his favour ordering the insurance company to pay Rs. 5 lakh to him. It said that a person suffering from a genetic disorder needed medical insurance as much as other people.
Â The Delhi High Court upheld the trial court verdict observing that broadly excluding all people with genetic disorders from obtaining health insurance or denying their claims is â€œdiscriminatory and violativeâ€ of a citizenâ€™s right to health and â€œunconstitutionalâ€. Genetic testing should be done and it should be determined which specific disorders should be excluded.
The High Court also pulled up the Insurance Regulatory and Development Authority of India (IRDAI) for not preventing insurance companies from misusing the term â€˜genetic disordersâ€™ to reject genuine claims.
Point of law
Right to avail medical insurance is an integral part of the right to health as enshrined in Article 21 of the Constitution.
[Source: The order of the Delhi High Court, dated 26 February 2018 on RFA 610/2016 and CM nos. 45832/2017]
School must pay if a student gets injured on its premises
Rahul Joshi, a class IX student of Michael High School in Mumbai, got into a fight in the classroom. There was no teacher present at that time. Rahulâ€™s arm was twisted so badly by another boy that he sustained a fracture. He had to undergo surgery incurring expenses of Rs. 1.5 lakh. A bright student, he also suffered academically as he could not attend school. The school unilaterally sent cheques amounting to Rs. 51,000 which Rahulâ€™s father refused to accept.
Distressed, Rahul filed a complaint against the school through his father in the District Forum. When it dismissed his complaint he appealed to the Maharashtra State Commission. The Commission viewed the CCTV footage and observed that the children were minors in the custody of the school and as such the school was responsible to ensure their safety.Â
The Commission indicted the school for its failure to take proper precautionary measures to prevent the incident and also for its negligence in providing timely medical assistance. It ordered the school to pay the complainant Rs. 1.5 lakh towards medical expenses as well as Rs. 50,000 as compensation for anguish caused to Rahul and his family and Rs. 25,000 towards litigation costs.Â Â
Point of law
A school is liable for any injury due to a fight as it has failed to monitor the students and enforce discipline.
[Source: The order of the State Consumer Disputes Redressal Commission, Maharashtra, Mumbai dated 1 September 2017 on Appeal no. A/15/824]