Can’t deny health insurance to those suffering from genetic disorders: HC

NEW DELHI: In a ruling that will benefit hapless claimants, Delhi high court has said that companies cannot deny health insurance to those suffering from genetic disorders.

Justice Pratibha M Singh held that a clause in the insurance policy excluding a person with “genetic disorder” from availing its benefit was “discriminatory” and contrary to public policy, adding that exclusion on the ground of an individual’s genetic heritage can be valid only if it is backed by rigorous and exhaustive tests.

“Right to avail health insurance is an integral part of the right to healthcare and the right to health, as recognised in Article 21 of the Constitution,” Justice Pratibha M Singh noted, upholding the decision of a trial court to decree a suit in favour of a patient who was denied medical claim on the ground of genetic disorder.


HC said exclusion of insurance claims in respect of genetic disorders creates a broad classification “which is writ with ambiguity and vagueness.”
Justice Singh further directed the Insurance Regulatory Development Authority of India to relook this exclusion clause in the insurance contracts and ensure that claims are not rejected on the basis of exclusions relating to “genetic disorders” like cardiac conditions, high blood pressure and diabetes. “The entire purpose of taking medical insurance would be defeated if all genetic disorders are excluded,” the court pointed out.

It further observed that “broad exclusion of genetic disorders is not merely a contractual issue between the insurance company and the insured, but spills into the broader canvas of right to health.” It said that “the exclusionary clause of ‘genetic disorders’ in the insurance policy, is too broad, ambiguous and discriminatory — hence violative of Article 14 of the Constitution”.

The verdict came on an insurance claim by one Jai Prakash Tayal against United India Insurance Company Limited. Tayal, who was suffering from hypertrophic obstructive cardiomyopathy, was suddenly denied his insurance claim on the ground that the said condition was genetic, and genetic diseases were not payable as per the policy.

The trial court had ruled in favour of Tayal, holding that there cannot be a discriminatory clause against persons with genetic disorders and they were entitled to medical insurance. The insurance company had appealed against the trial court’s order in August 2017.
HC took the opportunity to highlight that “citizens require a lot of effort and time to get their claims passed.” It is usual to see claimants running from pillar to post to get medical reimbursement from insurance companies, it underlined.