HC says new born means full-term & pre-term baby; asks ins firm to pay expenses

A new born would mean both a fullterm baby and a preterm baby the Bombay High Court on Wednesday said while directing an insurance company to pay Rs 11 lakh medical expenses incurred by a woman from Mumbai for the treatment of her twin babies born prematureA division bench of Justices Gautam Patel and Neela Gokhale also directed the New India Assurance company to pay an additional sum of Rs five lakh to the woman for attempting to interpret clauses in its insurance policies contrary to their true spirit only with a view to avoid honouring claimsThe court noted the approach of the insurance company was unreasonable unjust and contrary to the fundamental utmost good faith ethic of an insurance policyThese submissions are the sheerest casuistry They cannot be allowed to succeed the HC saidThe woman a legal practitioner moved the HC in 2021 after the insurance company refused her claims on the ground that the policy only covers new born babies who are born fullterm and not babies born pretermThe woman in her plea said the insurance companys refusal to accept her claims was arbitrary and contrary to the Insurance Regulatory And Development Authority of India IRDAI guidelinesThe petition said there was no rational classification nor intelligible differentia between newborn and premature babiesAlso readLaw cannot be instrument of oppression says Bombay HC while quashing FIRs against man for video on ministerThe insurance company opposed the petition and said the petitioners twins developed complications due to their premature birth and would not have occurred in a baby born fulltermThe bench however refused to accept this argument and said the insurance companys rejection of the petitioners claim was contrary to law unreasonable and arbitrary and liable to be set asideThe distinction between a newborn and a premature baby or a baby born preterm is baseless as a newborn baby can be one that is born full term or preterm A full term baby does not become more newer any more than a preterm baby becomes an earlier born or to make it even more pointed old born the court saidThe bench noted that it has taken the petitioner a young mother and professional considerable trials and tribulations and the roller coaster litigation process to bring the matter to its logical conclusionThe aim of reposing faith in the insurance company is preeminently to guardprovide against dangers which beset human life and dealings by agreeing to pay the consideration in the form of premiums as per the terms of the policy it saidThe court said the petitioner did not even have the time to revel in the birth of her twin babies and nurse them to health when she faced the iquestrude shockiquest of rejection of her legitimate claim by the insurance companyThe insurance company cannot be permitted to play fast and loose with the faith reposed by the insured and that too supported by regular renewals and payments of premium by attempting to interpret clauses in its policies contrary to their true spirit and only with a view to avoid honouring claims it saidThe bench said it deemed it fit and proper in the interests of justice and directed the insurance company to pay the woman an additional Rs five lakh as the cost of litigationAll the amount would have to be paid within a period of four weeks the court saidAs per the plea the woman had in 2007 taken two mediclaim policies for Rs 20 lakhs from the New India Assurance Company which were renewed periodicallyIn September 2018 the woman delivered twin baby boys at 30 weeks gestation in an emergency Caesarean surgery The babies were premature and had to be admitted to the NeoNatal Intensive Care Unit for lifesaving treatmentAfter their discharge the petitioner submitted a claim to the insurance company and claimed Rs 11 lakh for the expenses incurred by herHowever the company repudiated her claimsThis story has been sourced from a third party syndicated feed agencies Midday accepts no responsibility or liability for its dependability trustworthiness reliability and data of the text Midday managementmiddaycom reserves the sole right to alter delete or remove without notice the content in its absolute discretion for any reason whatsoever