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Monday, June 25, 2018

Denying health insurance for genetic conditions violates rights, says Dehi High Court

The High Court upheld a trial court order of 2017, which directed United India Insurance to pay Rs 5 lakh to the insured.

Written by Abhishek Angad | New Delhi | Updated: February 27, 2018 5:00:55 am
 Delhi High Court, genetic disorders, health insurance, health insurance guidelines, medical insurance, United India Insurance, Insurance Regulatory and Development Authority, IRDA, health news The High Court also pulled up the Insurance Regulatory and Development Authority of India (IRDA) and said that IRDA’s primary duties was the “settlement of insurance claims” and “governing and regulating” exclusions in insurance contracts. (Source: Thinkstock Images)

The Delhi High Court Monday held that excluding people with genetic disorders from obtaining health insurance or denying their claims is “discriminatory and violative” of a citizen’s right to health and “unconstitutional”.

The High Court upheld a trial court order of 2017, which directed United India Insurance to pay Rs 5 lakh to the insured. The trial court had said, “… Suffering from a genetic disorder needs medical insurance as much as others.”

Justice Pratibha M Singh on Monday 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 order pertains to Jai Prakash Tayal, who suffers from 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, which was renewed every year till 2012 since 2004. The plaintiff was hospitalised twice between 2004 and 2006, for which claims were honoured and payments made 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.

Tayal had submitted that the exclusion of genetic disorders was not part of the initial policy, which he had availed, and was added in a later policy document without giving him notice. Tayal first approached the trial court, which ordered relief of Rs 5 lakh to Tayal.

On exclusion based on genetic disposition, the High Court said there were different types of genetic disorders and “even common diseases” like diabetes and cardiac diseases which could be included in the broad definition, making “exclusion vulnerable”.

“In effect, it would mean that large swathes of population would be excluded from availing health insurance which could have a negative impact on the health of a country. Thus it is necessary to determine the legality of such an exclusion in insurance policies… Without doing genetic testing and prescribing what is the kind of genetic disorder which is excluded, applying a general exclusion would lead to arbitrariness,” observed the High Court.

The High Court also pulled up the Insurance Regulatory and Development Authority of India (IRDA) and said that IRDA’s primary duties 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.

The High Court also said that insurance companies were free to structure their contracts based on “reasonable and intelligible” factors which should not be arbitrary. “Such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective and vague factors . It is for the lawmaker to take necessary steps in this regard. However, the broad exclusion of genetic disorders from insurance contracts/claims is illegal and unconstitutional.

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