JUDGMENT :

[Prathiba M. Singh, J.]

1. This hearing has been done through hybrid mode.

2. The challenges posed by nature for persons with disabilities, ought to be mitigated by society as a whole which has to lend a helping hand and accommodate their needs.

3. The Petitioner, in the present case has approached this Court challenging the denial of a health insurance policy for his minor son who was suffering Bi-Lateral Hearing Loss, which is a hearing disability.

4. The minor son of the Petitioners was prescribed Cochlear Implant and the Petitioners got the same implant done for their minor son on 22nd July, 2020, on their own expense.

5. Since the Petitioners had a family insurance policy which included their elder daughter at that stage, renewal was sought by them, vide application dated 15th June 2020, with the inclusion of their minor son as a co-insured after disclosing the said pre-existing condition. The Respondent No.1-Tata AIG General Insurance Company Ltd., however, vide communication dated 19th June, 2020 refused to issue a policy on the ground that such a disability would not be covered by their underwriting policy.

6. The case of the Petitioner is that this would be completely discriminatory of disabled persons including disabled children. Ld. Counsel for the Petitioner relies upon the `Guidelines on standardization of exclusions in health insurance contracts’ issued by the IRDAI dated 27th September, 2019 to argue that the insurance company can have certain exclusions. However, the same would have to be only on the condition that there could be no insurance given even after levying further loading charges on the policy.

7. None appears for the insurance company. On behalf of the IRDAI it is submitted by their Counsel that the policy does permit exclusion in Chapter II of the Guidelines on Standardisation of Exclusions in Health Insurance Contracts.

8. This Court recently had the occasion to consider insurance policies for persons with disabilities in W.P.(C) 6074/2019 titled Saurabh Shukla v. Max Bupa Health Insurance Co. Ltd. and Ors., wherein the Petitioner was suffering from Tetraplegia and was refused a health insurance policy. After considering the legal position in respect of rights of persons with disabilities and certain decisions, This Court had directed as under:

“21. The IRDAI is the sector regulator in the insurance industry in India. Regulation 8 which deals with underwriting reads as under:

“8. Underwriting

b. The underwriting policy shall also cover the approach and aspects relating to offering health insurance coverage not only to standard lives but also to sub-standard lives. It shall have in place various objective underwriting parameters to differentiate the various classes of risks being accepted in accordance with the respective risk categorisation.

c. Any proposal for health insurance may be accepted as proposed or on modified terms or denied wholly based on the Board approved underwriting policy. A denial of a proposal shall be communicated to the prospect in writing, by recording the reasons for denial. Provided, the denial of the coverage shall be the last resort that an insurer may consider.”

22. A perusal of the IRDAI regulations above regulation would show that, unfortunately, the terminology sub-standard lives is used in respect of persons with disabilities which is not an acceptable terminology. Even otherwise, Regulation 8(b) and Regulation 8(c) read with the circular dated 2nd June, 2022 clearly provides that insurance companies have to give insurance coverage to the following three categories three categories of persons:

i. Persons with disabilities

ii. Persons with HIV

iii. Persons affected with mental illness.

23. The IRDAI being the regulator of the sector has important functions to perform under the IRDAI Act of 1999. The IRDAI ought to ensure that its circulars and other policies are duly given effect to by the insurance companies. In the present case, it has been observed the