Dr.

Shanthi Rengarajan VS
The Oriental Insurance
Company
Background Information
About the petitioner i.e. Shanthi Rengarajan.
She is a Paediatrician at a private hospital in Chennai.
She lost her husband in 2001 due to colon cancer.
She is having two sons.
About The Insurance policy taken by her
Happy Family Floater Policy
Sum Insured- Rs. 3,50,000
2004 to 2015, still Continuing
 Colon Cancer
Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract.Colon cancer
typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called
polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.
The types of Hereditary Colon Cancer are

Familial Adenomatous Polyposis Lynch Syndrome,

MYH-Associated Polyposis, Hyperplastic Polyposis Syndrome

There is a probability of 5% to 10% chance of the inheritors getting genetic colon cancer.

In the case,......

The familial adenomatous polyposis, due to which her husband died, may begin to develop multiple non-cancerous growth in the colon
as early as in the teenage years and unless the colon is removed, these polyps will become cancerous. The children born to these parents
have to undergo genetic study and to detect and rule out polyposis colon.

https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-genetics/genetic-counseling/inherited-risk-colorectal
Happy Family Floater Policy
Oriental Insurance Happy Family Floater plan is an exclusive health policy designed to protect an entire family under a single plan with
extensive coverage. The broad range of features and benefits of the Oriental Insurance Happy Family Floater policy gives one enough
security from any unforeseen emergencies and complications arising out of health related issues.

It usually covers the policyholder, spouse, and up to 4 children. There are plans in which parents, siblings, and extended family members
(such as in-laws) are also covered for an additional premium.

Cost savings: New member additions:

Sum insured is larger: Streamlined policy/premium:

Tax savings: Restoration of coverage:

Cashless hospitalisation: No claim bonus: Flexibility in policy terms:

Newborn and maternity cover:

https://orientalinsurance.org.in/happy-family-floater-policy
3 Claims Rejected
Her first son by name Shashank was admitted to Med-India hospitals at Chennai for undergoing genetic study.
● To detect Colon Cancer
Med India Hospital Chennai
Colonyscopy & Genetic Study- Rs. 70,764
Unfortunately, he was found to have multiple polyps and further study revealed APC gene is positive.

● Removal Of portion of polyps Colons

Gem Hospital and Research Centre, Coimbatore
Colectomy & Ileostomy & Illeoanal & Anastomosis- Rs.4,51,294

● Expenses Incurred in respect of the surgery was claimed on respondent immediately

Writ Petition- The writ petition is not maintainable, as the petitioner cannot invoke the writ jurisdiction to
enforce a contractual right.
Writ is a form of written command in the name of a court or other legal authority to act, or abstain from acting, in a particular way.

You can file a petition in High courts (Article 226) or Supreme Courts (Section 32) of India when your fundamental rights are violated.

Types of Writ

Writ of Habeas Corpus Writ of Mandamus

Writ of Prohibition Writ of Certiorari

Quo Warranto

In the case of enforcement of contractual rights and liabilities the normal remedy of filing a civil suit being available to the aggrieved
party, this Court may not exercise its prerogative writ jurisdiction to enforce such contractual obligations.
Maintainability of Writ Petition
Since the first respondent is discharging a public duty more particularly, when it is admitted that it is a public sector undertaking.

Law Cases referred to with the respect to supporting the decision of maintainability of writ petition

● United India Insurance Company Limited vs Manubhai

Renewal of insurance policy refused by the petitioner due to high claim amount.

● Hari Om Agarwal vs Oriental Insurance Co. Ltd

Disclosed all the information while filing medical insurance but afterwards the insured got to know about the cardiac disease.

● M/s.United India Insurance Company Limited vs. Jai Parkash Tayal.

The genetic disorders will automatically be included in insurance claim.
Non Maintainability of writ petition
The excuses made by learned counsel appearing for the respondent Insurance claim:

Life Insurance Corporation of India vs Asha Goel, 13th Dec 2000

To contend that the writ petition is not maintainable.

He further submitted that

● since the genetic disorders are excluded in the terms of the agreement entered between the parties.
● the claim made by the petitioner was rightly repudiated as such genetic disorders are not covered under the Insurance policy.
The decision of the court after hearing both sides
1. Whether is it maintainable or not?
2. If maintainable, impugned orders are liable to be interfered with?

Maintainability of writ petition

The business of the first respondent Company in dealing with the insurance of various kinds is undoubtedly a duty aiming at the
general public and thus, the functioning and responsibilities of the first respondent Company are to be treated as the one
discharging public duty. Therefore, when an element of public duty and responsibility is traceable to the activities of the
respondent Insurance Company, there is no point in saying they are not amenable to the writ jurisdiction. When a complaint is
made that an instrumentality of the State, who is party to a contract, is acting unfairly, unjustly and unreasonably in violation of
its constitutional obligation as enshrined under Article 14 of the Constitution of India, such instrumentality is certainly amenable
to the writ jurisdiction and consequently answerable to the complaint made against it.
United India Insurance Co. Lmtd Vs Manubhai Dharma Sinhbhai Gajera

Under Article 226, the basic facts are admitted. The High Court was concerned with the interpretation of statute and interpretation of the
contract. Judicial Review of the impugned action on the part of the appellant was, therefore, permissible.

Law cases referred to:

Hari Om Agarwal vs. Oriental Insurance Co. Ltd.

ABL International Ltd. v. Export Credit Guarantee Corporation of India Ltd

LIC v. Consumer Education & Research Centre

1. In an appropriate case, a writ petition as against a State or an instrumentality of a State arising out of a contractual
obligation is maintainable.
2. Merely because some disputed questions of fact arise for consideration, same cannot be a ground to refuse to entertain a writ
petition in all cases as a matter of rule.
3. A writ petition involving a consequential relief of monetary claim is also maintainable
4. Public law remedy, through judicial review under Article 226 was defined as intervention where the actions of State or
its agencies, bearing the imprint of public interest, can be examined. Fairness and non-arbitrariness are considered as
two immutable pillars supporting the equality principle, an unshakeable threshold of state and public behaviour.
Life Insurance Corporation of India vs. Asha Goel.

The High Court can entertain the writ petition under Article 226 of the Constitution of India to enforce a claim under a life
insurance policy. It is further observed therein that while the jurisdiction of the High Court to entertain a writ petition under
Article 226 of the Constitution cannot be denied altogether, Court must bear in mind the self-imposed restriction in not
entertaining writ petitions for enforcement of purely contractual rights and obligations which involve disputed questions of
facts.

M/s.United India Insurance Company Limited vs. Jai Parkash Tayal

The plaintiff therein suffered from Hypertrophic Obstructive Cardiomyopathy and was hospitalised for some time. The
expenses met out was sought by way of insurance claim, which was rejected by the Insurance Company therein on the reason
that expenses met out for genetic diseases are not payable as per the policy which contains genetic exclusion clauses.
Objections raised by Delhi High Court
D4- Right To Healthcare

D5- Reasonableness/ social security

D6- The Insurance Act, 1938 and IRDAI to provide exclusions

D12- Illegal and Unconstitutional if Genetic disorder are excluded

E15- Medical Insurance Policy taken for unforeseen medical conditions

E16- prevention, diagnosis & management, cure, palliative care in non-curable diseases.

E17- exclusion of genetic disorders by itself would be unconstitutional

F1- Concluding all the points...