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2018 Supreme(Mad) 1272

IN THE HIGH COURT OF JUDICATURE AT MADRAS
K. RAVICHANDRABAABU, J.
Dr. Shanthi Rengarajan – Petitioners
Versus
The Oriental Insurance Company Ltd. & Another – Respondents
W.P. No. 43202 of 2016, W.M.P. Nos. 37034, 37035 of 2016
Decided On : 09-03-2018

Advocates Appeared:
For the Petitioner:B. Ravi for M/s. R. Subramanian, Advocates
For the Respondents:G. Guruswaminathan, M/s. Nageswaran & Narichania, Advocates

Headnote:

Constitution of India, 1950 – Article 226 – Medical Insurance Claim – Petitioner is aggrieved against the order of the second respondent in repudiating the medical insurance claim made by the petitioner under two Policy Nos.411200/48/15/03676 and 411200/48/16/03529. – Held, No doubt the said matter before the High Court was arising out of a suit. But that does not matter when the issue is one and the same. – The question raised in the said case was as to whether persons having genetic disorders can be discriminated against in the context of health insurance. – The plaintiff therein suffered from Hypertrophic Obstructive Cardiomyopathy and was hospitalised for some time. – The expenses met out was sought by way of insurance claim, which was rejected by the Insurance Company therein on the reason that expenses met out for genetic diseases are not payable as per the policy which contains genetic exclusion clauses. – When the matter was taken up on 01.03.2018, this Court felt that since the claim of the petitioner is genuine, the decision of the Delhi High Court has come to her rescue at right time, without giving room for any further doubt on the issue. – Thus, based on the above findings rendered by the Delhi High Court, Court is of the firm view that the impugned orders cannot be sustained. – Writ Petition Allowed

JUDGMENT :

1. The petitioner is aggrieved against the order of the second respondent in repudiating the medical insurance claim made by the petitioner under two Policy Nos.411200/48/15/03676 and 411200/48/16/03529.

2. The case of the petitioner is as follows:

She is a Doctor by profession and working as a Paediatrician at a private hospital in Chennai. She took medical claim insurance policy with the first respondent since 2004. This policy is a Happy Family Floater Policy with a total sum insured Rs.3,50,000/-. From the year 2004 till 2015, there was no claim made by the insurer. The policy is running continuously without any break. The petitioner is having two sons. She had lost her husband in 2001 due to colon cancer. As per the medical research and findings, the familial adenomatous polyposis, due to which her husband died, may begin to develop multiple non-cancerous growth in the colon as early as in the teenage years and unless the colon is removed, these polyps will become malignant (cancerous). Therefore, children born to these parents have to undergo genetic study and to detect and rule out polyposis colon. Accordingly, her first son by name Shashank was admitted to Med-India hospitals at Chennai for undergoing genetic study. Unfortunately, he was found to have multiple polyps and further study revealed APC gene is positive. This colonoscopy and genetic study incurred expense of a sum of Rs.70,764/- and it was immediately claimed from the respondent. Doctors in the field advised the petitioner's son to undergo immediate surgery for the removal of portion of the colon, which was affected by polyps. Therefore, it required great amount on counselling on her son. At that time, he was studying in USA. Thereafter, her son underwent a surgery i.e., total colectomy with ileostomy and illeo-anal anastomosis at Gem Hospital and Research Centre, Coimbatore. This resulted in another medical expenses of Rs.4,51,294/- towards hospitalization and surgery. A claim of the same was also made before the respondents. Her son had to undergo reversal of ileostomy during May 11th to 20th 2016 at Gem Hospital Research Centre. The expenses incurred in respect of the surgery was claimed on the respondent immediately. All the three claims were duly received and scrutinised by the second respondent. However to the shock and surprise of the petitioner, the claims were repudiated on the reason that the condition of her son is a genetic disorder. Hence the present writ petition is filed with the relief as stated supra.

3. The first respondent filed a counter affidavit, wherein it is stated as follows:

The writ petition is not maintainable, as the petitioner cannot invoke the writ jurisdiction to enforce a contractual right. The first respondent is a Public Sector Undertaking and however it cannot be interpreted as an instrumentality of a State to maintain the present writ petition. The first respondent had repudiated the claim of the petitioner only after due application of mind and proper appreciation of the documents as per the terms and conditions forming part of the policy of Insurance.

4. Learned counsel for the petitioner submitted that the writ petition is maintainable since the first respondent is discharging a public duty more particularly, when it is admitted that it is a public sector undertaking. He relied on the decision of the Supreme Court reported in 2008 (10) SCC 404, United India Insurance Company Limited vs Manubhai and the decision of the High Court of Delhi reported in 2007 (98) DRJ 246, Hari Om Agarwal vs Oriental Insurance Co. Ltd., in support of the maintainability of the writ petition. On merits, the learned counsel submitted that the reasons assigned in the impugned order to repudiate the claim cannot be sustained in view of the recent decision of the Delhi High Court dated 26.02.2018 in the case of M/s.United India Insurance Company Limited vs. Jai Parkash Tayal. The learned counsel submitted that in the above said decision, th







































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