Delhi HC: Denying health insurance on the grounds of genetic conditions is "unconstitutional"

Team SoOLEGAL 27 Feb 2018 6:22pm

Delhi HC: Denying health insurance on the grounds of genetic conditions is

New Delhi: Justice Pratibha M Singh of Delhi High Court upheld a trial court order of 2017 by which it had directed United India Insurance to pay Rs 5 lakh to the insured.

The case relates to Jai Prakash Tayal, who suffers from a genetic disorder by the name of Hypertrophic Obstructive Cardiomyopathy — a condition where a portion of heart thickens without an obvious cause resulting in the heart being less able to pump blood effectively. He had taken a medical policy of Rs 5 lakh in 2004 which he renewed every year till 2012. He was hospitalised twice between 2004 and 2006, for which claims were honoured by United India Insurance. However, when Tayal was hospitalised again in 2011, the insurance company rejected his claim citing “genetic exclusion clauses” in the renewed contract.

He filed the case against the insurance company and won it in the lower court. The lower court gave him a relief of 5 lakh rupees. But it was contested by United India Insurance in High Court. The High Court has also ruled in favour of the insured. Terming the exclusion of genetic disorder as unconstitutional, the High Court said the right to avail health insurance was an “integral part” of right to health as recognised under Article 21 (right to life and personal liberty) of the Constitution.

The High Court observed there were multiple types of genetic disorders and “even common diseases” like diabetes and cardiac diseases which could be included in the broad definition, making “exclusion vulnerable”. On this basis, a large section of the population can be excluded from the health insurance which will have disastrous effect for the health of the country. The court further observed that insurance companies need to list the genetic disorders which they are excluding as this will check arbitrariness. 

The High Court also came hard on Insurance Regulatory and Development Authority of India (IRDA) and said that IRDA’s primary duty was the “settlement of insurance claims” and “governing and regulating” exclusions in insurance contracts.

“Thus, IRDA ought to have supervised the manner in which the term genetic disorders is being misused by insurance companies to reject genuine claims. Obviously the IRDA turned a blind eye to the functioning of insurance companies,” the High Court said.

Tagged: United India Insurance   Delhi HC   IRDA  
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