Newborn Can’t Be Covered Under Existing Health Plan, Rules Consumer Court

Mumbai: A child born after the parents obtain a family health insurance plan won’t be covered under the policy.

The Maharashtra State Consumer Disputes Redressal Commission dismissed a petition filed by Goregaon-based chartered accountant Rishikesh Agarwal claiming reimbursement of expenses he had incurred for treating his second child.

The complainant had purchased a family floater mediclaim policy in 2014 for insurance cover of Rs 7 lakh. It was a group insurance policy for all chartered accountants as members of Institute of Chartered Accountants of India.

Agarwal had taken the policy for himself, his wife and elder son aged about four years.

Ten months after the policy was purchased, the couple’s second child was born on February 16, 2015. The baby boy, who had to be shifted to the neonatal intensive care unit soon after birth, was under treatment for two months before being discharged on April 17, 2015.

The medical bills amounted to Rs 6.28 lakh.

Agarwal approached the insurance company to reimburse the expenses, but his claim was rejected with the company saying that the newborn baby was not covered under the policy.

The complainant then approached the South Mumbai District Consumer Disputes Redressal Commission, contending that children upto 25 years were covered under the group policy.

After the district commission dismissed his complaint in 2018, Agarwal moved the state commission.

Now, the state commission has upheld the district commission’s order.

The argument was that the complainant’s first policy, for the period from April 11, 2014 to April 10, 2015, was renewed for a further period of one year from April 11, 2015. In both policies, insurance cover was given to Agarwal, his wife and four-year-old son Daksh.

“There is no reference in the policy that during pendency of the policy, the newborn child of the complainant would be given insurance cover. In fact, no premium was paid by the complainant for his newly born child,” the state commission explained.