HC: Genetic disorders need cover’

In a significant judgment, the Delhi High Court on Monday termed “unconstitutional” discrimination in health insurance policies of individuals with genetic disorders.

Justice Prathiba M. Singh said a person suffering from a genetic disorder needed medical insurance as much as others. Genetic disorders have been the source of debate in the health insurance sector.

Most policies have exclusionary clauses that deny clients’ claims if they suffer from such disorders. The verdict could open up a large number of ailments as claimable under medical insurance.

“The exclusionary clause of ‘genetic disorders,’ in the insurance policy, is too broad, ambiguous and discriminatory — hence violative of Article 14 of the Constitution,” Justice Singh said. The court directed the Insurance Regulatory Development Authority of India to re-look at the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject claims on the basis of exclusions relating to genetic disorders.

Justice Singh highlighted that there are different types of genetic disorders and even common diseases like diabetes and cardiac diseases could be included in the broad definition.

“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,” she remarked.

The High Court’s verdict came on a petition filed by United India Insurance Company Limited challenging an order passed by a trial court here directing it to honour the medical claim of a person who was suffering from genetic disorder.

The client was suffering from hypertrophic obstructive cardiomyopathy (HOCM).

The court said HOCM is not necessarily genetic in nature and the treatment for the same was primarily to prevent “sudden death”. Unless there is testing, it cannot be conclusively held to be genetic in all cases, the judge said.

In its order, the court noted that in the insurance policy issued to the man, no genetic testing was undertaken before hand.

“Unless and until there is a proper genetic test in accordance with a strict regulatory mechanism, and the cause of the disorder is attributable solely to a genetic condition, the classification is too broad,” the judge said.

The court remarked that 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’.

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Printable version | Nov 22, 2020 2:07:25 AM |

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