In a landmark judgment, Justice Pratibha M Singh of the Delhi High Court ruled against clauses in health insurance contract excluding genetic disorders. The judgment also directed sector regulator IRDA (Insurance Regulatory and Development Authority) to review the exclusionary clauses in health insurance contracts.
The judgement is significant as insurance companies cannot now blindly reject claims involving disorders which have genetic origins as well. “The entire purpose of taking medical insurance would be defeated if all genetic disorders are excluded,” the High Court said in the judgement. It said that the clauses of ‘genetic disorders’ in the insurance policies in India were “too broad, ambiguous and discriminatory” and so it violated the constitutional provisions.
The court said that common diseases such as heart attack and diabetes can fall under the ambit of genetic disorders excluding large swathes of the population from health coverage. This would be contrary to the public health policy and to Articles 14 (Right to Equality) and 21 (Right to Life) of the Constitution of India. “The broad exclusion of genetic disorders from insurance contracts/claims is illegal and unconstitutional,” the court ruled.
Article 14 of the Constitution prohibits discrimination based on the genetic heritage of a person. In addition, the right to health and healthcare are part of the right to life under Article 21. The court added that insurance companies are free to structure their contracts as per their discretion but such structuring must be based on empirical testing and data rather than subjective or vague factors.
The court also directed the IRDA to ensure that claims are not rejected on the basis of exclusionary clauses based on genetics. The 2016 IRDA guidelines on standardisation of health insurance exclude ‘congenital anomalies’ but not ‘genetic disorders.’ The case was brought to court by Jay Prakash Tayal who was suffering from Hypertrophic Obstructive Cardiomyopathy.