News Life and Health28 Feb 2018

India:High Court orders review of insurance policies that exclude genetic disposition

28 Feb 2018

The Delhi High Court has directed the IRDAI to review insurance contracts to ensure that claims are not rejected on the basis of exclusion clauses relating to "genetic disorders" like cardiac conditions, high blood pressure and diabetes.

Observing that health insurance is an integral part of the “right to health and healthcare” under the Constitution, Justice Pratibha Maninder Singh said that discrimination in health insurance against individuals based on their genetic disposition or genetic heritage, in the absence of appropriate genetic testing and laying down of intelligible differentia, was unconstitutional.

"The entire purpose of taking medical insurance would be defeated if all genetic disorders are excluded," the High Court said in the judgement, holding that the law and norms of 'genetic disorders' in the insurance policies in India were "too broad, ambiguous and discriminatory" and hence violated constitutional provisions.

The judge also said that there is an urgent need for a proper framework against genetic discrimination and to protect the collection, preservation and confidentiality of genetic data, reported Times of India.

The 47-page verdict read: “The exclusion of genetic disorders in all forms would be contrary to public policy. Several of the prevalent medical conditions which affect a large mass of population, including cardiac conditions, high blood pressure, diabetes in all forms, could be classified as genetic disorders.”

It said insurance companies are free to structure their contracts based on reasonable and intelligible factors which should not be arbitrary and "in any case cannot be exclusionary".

“Such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective or vague factors. It is for lawmakers to take the necessary steps in this regard," Justice Singh said in the order.

The verdict was rendered in an insurance claim by one Jai Prakash Tayal against United India Insurance. Tayal, who was suffering from hypertrophic obstructive cardiomyopathy, was denied his insurance claim on the ground that the said condition was genetic, and genetic diseases were not payable as per the policy.


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If there are genetic disorders pre-existing prior to commencement of insurance & if pre-existing diseases are not covered in the policy then same would not be covered as per policy condition for predetermined period mentioned in the policy. However same may be covered after expiry of that period on payment of additional premium in advance.

28 February 2018

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