Patient with multiple sclerosis sues insurance at HC for denial.

A professor at a college who has multiple sclerosis (MS) filed a lawsuit in Bombay High Court after her family medical coverage was canceled by a private insurance firm and she was rejected payment for an unrelated operation. After learning that she had MS, several insurers refused to provide her with health coverage.

"Being refused health cover by insurance companies on account of MS, a sense of discrimination and of being an outcast is felt by petitioner at the hands and the conduct of insurance companies," according to the appeal submitted by Manita Singh of Bandra.

Manita was given an MS diagnosis in 2015. The chronic illness (see box) affects the brain, spinal cord, optic nerves, and central nervous system and can cause a variety of symptoms. On July 21, 2021, her spouse, advocate Rajesh, accepted the cashless coverage offered by Care (formerly Religare) Health Insurance Ltd. Manita underwent surgery on January 14, 2022, to remove fibroids. The physician attested to the procedure's lack of connection to MS. Care denied a claim for Rs 1.10 lakh on February 16, 2022, stating that it was not paid for "non-disclosure of MS since 2015". The family cover was removed from circulation. Rajesh brought a complaint to the District Consumer Disputes Redressal Commission (a suburb of Mumbai) on July 27, 2022.

Manita approached Care in July 2023 to renew her health insurance, but she was verbally rejected. The response from other insurers was similar. Manita filed a motion with HC on July 27 to enforce her Article 21 rights as a fundamental right (Right to Life).

According to her petition, MS is covered under "critical illness" and was covered by the Mediclaim policy, according to Care's website and ads. Care had access to Manita's medical records during the transfer from New India Assurance. She claimed that in its master circular to insurers on critical illnesses like MS, Care had violated the July 22, 2020, standards set forth by the Insurance Regulatory and Development Authority (IRDA).

Manita's petition also cited research from the Multiple Sclerosis Society of India demonstrating that it "is a rampant practice" to deny insurance coverage to MS patients. "The petitioner submits that it would be unthinkable for her family to spend huge amount at each time she has attack of multiple sclerosis on account of prohibitive costs and if not covered by health insurance plan, her family would be financially drained out," it states.

Manita has pleaded with the HC to rule that Article 21 of the Constitution guarantees the right to health and health care. She has requested that HC order Care to immediately renew or introduce new policies. As an alternative, to give IRDAI instructions on how to revoke, suspend, or cancel Care's license. HC sent notice to the Ministry of Health, Care, and IRDAI on September 27.

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