Thu. Mar 28th, 2024

The Delhi HC declared that it was illegal to not include genetic disorders under the cover of health insurances. Denying these claims was considered ‘unconstitutional’ and violative of people’s right to health.

The laws it violates to not include genetic defects under the cover are, Article 14 (right to equality), and Article 21 (right to life), the bracket of ‘genetic disorders’ was too broad and ambiguous which makes not covering them discriminatory. With this established, the court directed the Insurance Regulatory Development Authority of India to review the cases of exclusion and to ensure that claims were not rejected on the basis of being ‘genetic disorders’. Genetic disorders, the court clarified could also include ailments like Diabetes, Cardiac arrests and blood pressure.

The decision was delivered by Justice Pratibha Maninder Singh. The court also said that the insurance companies were allowed to frame their policies the way they wanted. But it had to be based on reasonable factors based on empirical data which can’t be arbitrary and exclusionary. It also insisted that IRDA should have observed how companies were misusing the term ‘genetic disorders’. Genuine claims were rejected because of the unfair usage of ‘genetic disorders’.

The order was passed in relation to Jai Prakash Tayal, he suffers from Hypertrophic Obstructive Cardiomyopathy and his insurance claim was rejected on the basis of being a ‘genetic disorder’. He had taken a policy with United Insurance Co. Ltd.. Tayal was covered by the company when he was hospitalised in 2004 and 2006. But in 2011, according to his renewed contract, the insurance company rejected his claim citing ‘genetic disorders’ when he was hospitalised. Tayal said that the ‘genetic disorders’ clause wasn’t in his initial contract and was added to his contract later on without giving him prior notice. The ruling in the trial court was delivered in his favour and the court ordered that a relief of 5 lakh rupees be given to Tayal. If ‘genetic disorders’ is taken into considerations, the court said that it would defeat the whole purpose of taking a health insurance policy in the first place.

By Sahitya