DECEMBER 13: Can medical insurance companies deny insurance to persons suffering from mental ill-health? The Bombay High Court has admitted a petition challenging the refusal of Oriental Insurance Company Ltd to reimburse a patient's medical expenses for a major case of mental depression, and has placed the matter for hearing in March 2000.Justice A P Shah and Justice S Radhakrishnan on Friday last heard advocate Pradeep Havnur challenge that the refusal of Oriental Insurance Co Ltd - which under the General Insurance Corporation gives insurance coverage for medical, hospitalisation benefits in case of emergency etc - was inter alia in violation of the Persons with Disabilities Act, 1995. Havnur urged that the policy guidelines of the insurance company that exclude all psychatric or psychosomatic disorders is a discrimination that ought to be struck down.The plea has been filed by MAITRI, a forum of social workers, psychiatrists and journalists which had been receiving complaints against these mediclaim insurance companies, from persons suffering from mental illness. These included the New India Assurance Company, the National Insurance Company and the United India Insurance Company, all under the General Insurance Company.Joining MAITRI is Nutan Modi, whose claim for insurance had been rejected by the Oriental Insurance Company. According to the petitioner, she has been a policy-holder under the mediclaim policy for the last many years and has an insurance policy for Rs 55,000 for the current year. She had been hospitalised for mental depression in April 1998 and had sent a letter requesting that the company reimburse her expenses of Rs 7,077.However, she received a reply letter in November 1998 saying the policy was not tenable for mental health clubbing it with other no-nos which included ``convalescence, general debility, run down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxication using drugs or alcohol.''Havnur argued these conditions are outdated and not even ``faintly related to the illness of depression.'' The company's refusal to insure such illnesses has shown a ``total lack of application of mind'' by the company. He also argued that under the Persons with Disabilities Act, 1995, there is a scheme for ``social security for persons with disabilities and schemes for insurance for employees with disability.'' The illness of the petitioner, it has been argued, falls under the category of ``disability'' and hence it is the duty of the companies to cover such illnesses as well.
