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Research Paper | Law | Volume 15 Issue 4, April 2026 | Pages: 550 - 555 | India
Insurers' Contractual Discretion and Public Interest: A Critical Study of Health Insurance Contracts in India
Abstract: This study examines the scope and implications of insurer contractual discretion in Indian health insurance law, with particular focus on exclusion clauses, waiting periods, sub-limits, and claims processing practices. The research adopts a doctrinal and comparative methodology, analysing statutory provisions including the Insurance Act, 1938, regulatory instruments issued by the IRDAI, and judicial precedents, alongside comparative insights from the United Kingdom and the United States. The findings reveal a structural imbalance arising from standard-form contracts that disproportionately favour insurers, reinforced by limited regulatory oversight and inconsistent judicial intervention. The study demonstrates that existing legal mechanisms inadequately constrain discretionary practices that undermine policyholder protection and access to healthcare. It argues for reconceptualising health insurance as a quasi-public service requiring enhanced legal safeguards grounded in principles of fairness, transparency, and social welfare. The paper concludes by proposing legislative, regulatory, and judicial reforms aimed at aligning contractual practices with constitutional values and public interest considerations.
Keywords: Health Insurance, Contractual Discretion, IRDAI, Exclusion Clauses, Consumer Protection, Bad Faith, India, Standard Form Contracts, Insurance Regulation, Health Law, Comparative Insurance Law
How to Cite?: Kaustubh Mishra, Dr. Ekta Gupta, "Insurers' Contractual Discretion and Public Interest: A Critical Study of Health Insurance Contracts in India", Volume 15 Issue 4, April 2026, International Journal of Science and Research (IJSR), Pages: 550-555, https://www.ijsr.net/getabstract.php?paperid=SR26405162039, DOI: https://dx.dx.doi.org/10.21275/SR26405162039