New Delhi|HL Correspondent
The Prime Minister Narendra Modi’s motivated project for health insurance cover for each person of our country is yet to be needs more effective push.
‘Good health is a justiciable fundamental right’ said by a trial court examining that PM’s health project however once rolled out properly, it would bring about an evolution in India’s health insurance model.
While, studying the case of United India Insurance Company, a PSU rejected a mediclaim of a Company, a PSU, for rejecting the mediclaim of a person for heart ailment on the ground of genetic disease exclusion clause, the Additional District Judge Kamini Lau made the observation.
“I hold that a genetic disease exclusion clause in a mediclaim insurance policy, which totally excludes the grant of insurance in case of genetic diseases, is liable to be struck down being violative of the constitutional mandate, the fundamental underlying constitutional scheme, policy of the state and public good,” the judge said, adding that the clause was “arbitrary, discriminatory and unfair”.
The court was hearing a suit against the insurance firm filed by one Jai Prakash Tayal who had sought Rs 5 lakh spent on his treatment. The firm had denied mediclaim saying “genetic disease is not payable as per policy genetic exclusion clauses”.
The man had told the court that he has already taken two claims for the same treatment and, therefore, a third claim for the same disease was not liable to be rejected. The court ruled in favour of Tayal and said he was entitled to the amount. It observed that a person suffering from a genetic disease is as much in need of a medical insurance cover as others and in fact the liability qua them is more.
“No person can be discriminated or deprived of state protection in case of an ailment, be it genetic or acquired. The courts of law are required to interpret the provisions of the private contracts in the light of these constitutional obligations,” it said.
The court held that good health is not a privilege but a justiciable fundamental right and lamented that healthcare finances have a poor record as only 4% of the national budget is spent on it. “The time has come that India catches up with this alternative model of allocating resources and funding to its public health programmes,” the judge added.
