Explain basis for approving policies, HC asks insurance body

The Delhi High Court has asked the Insurance Regulatory and Development Authority of India (IRDAI) to explain on what basis it was approving insurance policies that excluded mental conditions from full coverage, noting that “a large number of insured persons would be affected by such an insurance policy”.

Justice Prathiba M. Singh said that a perusal of the Mental Healthcare Act of 2017, makes its clear that “there can be no discrimination between mental illnesses and physical illnesses and the insurance provided in respect thereof”.

“This matter requires consideration, in as much as the Insurance Regulatory and Development Authority of India ought to place on record the basis on which approval has been granted for such insurance policies,” the judge ordered. The court’s direction came on a petition by one Subhash Khandelwal, who has an insurance policy from Max Bupa Health Insurance Company Limited. Mr. Khandelwal’s case is that he has regularly been paying the insurance premium for the sum assured of ₹35 lakh.

Recently, when he raised a claim with the insurance company in respect of his mental illness, he realised that there is a clause in the policy restricting the sum assured to ₹50,000, with a few conditions, in case of mental illnesses.

His counsel argued that if one peruses the conditions imposed in fine print, almost all prevalent mental conditions, such as severe depression, schizophrenia, bipolar disorder, post-traumatic stress disorder, eating disorder, generalised anxiety disorder, obsessive compulsive disorders, panic disorders, personality disorders, conversion disorders, dissociative disorders, are restricted to a sum assured of ₹50,000.

This, the counsel argued was contrary to the provisions of the Mental Healthcare Act, 2017. As per Section 21(4) of the Act, every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.

“The clauses pointed out in the policy clearly show that a large number of mental conditions are excluded from full coverage of the policy and only a sum of ₹50,000 is reimbursable for these mental conditions,” the court said.

The court has posted the case for further hearing on June 2.

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Printable version | May 19, 2021 6:20:59 AM |

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