Denial Of Medical Insurance Claim Amounts To Violation Of Right To Life Under Article 21 : Kerala High Court

Justice P.M. Manoj, delivering the judgment in a writ petition, ruled that once an insured person has undergone treatment or surgery based on the expert opinion of a qualified medical professional, the insurer cannot arbitrarily reject the claim. Such rejection, the Court said, amounts to denial of treatment and infringes upon the citizen's fundamental right to life and health.

“The right to medical treatment is a right identified under fundamental rights. In fact, once the insured has undergone treatment or a surgical procedure on the expert opinion of the concerned doctor, the insurer cannot deny the claim. Rejection of the claim for the expenses incurred for such treatment availed by the insured amounts to denial of treatment,” the Court observed.

The petitioner had approached the Court after the Life Insurance Corporation of India (LIC) rejected and restricted his medical insurance claims under the LIC policy. Despite paying premiums regularly since 2008, LIC limited his first claim to ₹5,600 against an expenditure of Rs. 60,093 and rejected a subsequent claim of Rs.1,80,000 on the ground of a “pre-existing illness”.

Referring to the Supreme Court's decisions in Paschim Banga Khet Mazdoor Samithi v. State of West Bengal [1996 (4) SCC 37], Consumer Education and Research Centre v. Union of India [1995 (3) SCC 42], and State of Punjab v. Mohinder Singh Chawla [1997 (2) SCC 83], the Court reiterated that the right to medical treatment is an integral component of the right to life.

“Declining the claim in respect of the treatment undergone amounts to denial of treatment itself. Thereby, there is violation of the right to life provided under Article 21 of the Constitution of India.” the Court added.

The Court has also noted that insurers often take advantage of the insured's vulnerability during medical crises and cautioned that such conduct “defeats the very purpose of health insurance and erodes public trust.”

“The object of life insurance is to provide security against unforeseen contingencies, which are defeated when claims are rejected for reasons neither substantial nor material. Insurance is a contract of utmost good faith, and the duty of fairness lies equally on the insurer, as contracts of adhesion policies must be construed in favour of the insured and repudiation for consequential inaccuracies or ambiguities cannot be justified.” the court observed.

The Court thus quashed LIC's rejection orders and directed the corporation to allow the petitioner's claim without delay, underscoring that the policy remained valid until March 31, 2024.

Case Title: Dr. A M Muraleedharan v The Senior Divisional Manager, LIC and Another and connected case

Case No: WP(C) 4088/ 2017 and connected case

Citation: 2025 LiveLaw (Ker) 620

Counsel for Petitioner: R Parthasarathy, B Krishnan

Counsel for Respondents: L Lakshmy