A recent case in Mumbai High court led to a judgement that a premature baby is also a new born baby and insurance company cannot deny the insurance claim made by parents.
The woman, Rita Joshi, a legal practitioner, had approached the high court in 2021 after she delivered twin baby boys at 30 weeks’ gestation (Premature) in an emergency Cesarean surgery in 2018.
She had 2 policies worth 20 lakh she renewed periodically after delivering twins they were admitted to life saving treatment In NICU.
Joshi made claim for ₹11 lakh. To her surprise the insurance company said it doesn't cover pre-term babies , then she moved to HC.
A NEW BORN would refer to BOTH a full-term baby and a premature Baby, the Bombay high court observed on Wednesday, as it directed an insurance company to pay ₹11 lakh medical expenses incurred by a woman for treatment of her twin babies born premature in 2018.
In her plea in the high court, the woman said that the insurance company refused her claims on the ground that the policy only covers new born babies who are full-term and not babies born pre-term.
On its part, the insurance firm, represented by advocate D S Joshi, said that as per the relevant cause of the petitioner’s policy, she could claim expenses only for a full-term baby. It also said that the policy did not cover any post-natal care.
PRO TIP : Kindly read your Inusrance Policy very carefully, get clear undestanding of what it clears and what not.
A division bench of justices Gautam Patel and Neela Gokhale also directed the insurance company – New India Assurance – to pay an additional sum of ₹5 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 claims.
The court noted the approach of the insurance company was "unreasonable and contrary to the fundamental utmost good faith ethic of an insurance policy".
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