Newborn can mean full and pre-term babies: HC on insurance

The woman, Rita Joshi, a legal practitioner, had approached the high court in 2021 after she delivered twin baby boys at 30 weeks’ gestation in an emergency Cesarean surgery in 2018.

A new born would refer to both a full-term baby and a pre-term 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. (Getty Images/iStockphoto)

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 woman, Rita Joshi, a legal practitioner, had approached the high court in 2021 after she delivered twin baby boys at 30 weeks’ gestation in an emergency Cesarean surgery in 2018. The babies were premature and had to be admitted to the NeoNatal Intensive Care Unit for life-saving treatment.

“The distinction between a ‘new-born’ and a ‘premature baby’ or a baby born ‘pre-term’ is baseless as a new-born baby can be one that is born ‘full term’ or ‘pre-term’. A full term baby does not become more ‘newer’ any more than a ‘pre-term’ baby becomes an ‘earlier born’ or, to make it even more pointed, ‘old born’. The approach is unreasonable, unjust and contrary to the fundamental utmost good faith ethic of an insurance policy. These submissions are the sheerest casuistry,” the bench said.

“The 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 added.

The woman was represented by advocates Ashok Shetty and Swapnil Kamble in the court.

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.

The bench said: “An argument is sought to be made between ‘expenses relating to illness or injury to the new born’ as distinct from ‘expenses relating to postnatal care, pre-term or premature’. This is a distinction without a difference.”