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Denying Health Insurance Based on Genetics is Unconstitutional

Hon'ble Justice Pratibha M Singh stated Can't Exclude Genetic Disorders in Insurance Policy
High Court of Delhi on 26 February directed the Insurance Regulatory Development Authority of India (Insurance Regulatory Development Authority of India) to review the exclusion clauses in the insurance contracts. so that medical claims were not rejected on the basis of exclusions relating to "genetic disorders" like cardiac conditions, high blood pressure and diabetes.

Stated that the availing of health insurance was an integral part of the 'Right to Health and healthcare' under the Constitution, Hon'ble Justice Pratibha M. Singh held that the clause in the insurance policy excluding a person with "genetic disorder" from availing its benefit was "discriminatory" and contrary to public policy.

The judge left it to lawmakers to take necessary steps in this regard, saying there was an urgent need for a proper framework against genetic discrimination.

"The Insurance Regulatory Development Authority of India is directed to re-look at the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject medical claims on the basis of exclusions relating to genetic disorders," the verdict stated.

The exclusion of genetic disorders in all forms would be contrary to public policy. Several of the prevalent medical conditions which affect a large mass of population, including cardiac conditions, high blood pressure, diabetes in all forms, could be classified as genetic disorders. High Court of Delhi

"The entire purpose of taking medical insurance would be defeated if all genetic disorders are excluded," the High Court said in the judgement, holding that the law and norms of 'genetic disorders' in the insurance policies in India were "too broad, ambiguous and discriminatory" and hence violated the constitutional provisions.

It said the insurance companies were free to structure their contracts based on reasonable and intelligible factors which should not be arbitrary and in any case cannot be exclusionary.

Discrimination in Health Insurance Based on Genetics is Unconstitutional:
The judge said discrimination in health insurance against individuals based on their genetic disposition or genetic heritage, in the absence of appropriate genetic testing and laying down of intelligible differentia, was unconstitutional.

Hon'ble Justice Pratibha M. Singh stated: “The broad exclusion of genetic disorders is thus not merely a contractual issue between the insurance company and the insured but spills into the broader canvas of Right to Health. There appears to be an urgent need to frame a proper framework to prevent against genetic discrimination as also to protect collection, preservation and confidentiality of genetic data”.

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.

“Such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective or vague factors. It is for lawmakers to take the necessary steps in this regard,” he said.

This verdict in Jai Prakash Tayal v/s United India Insurance Company Limited

the appellant Mr.Jai Prakash Tayal was suffering from Hypertrophic Obstructive Cardiomyopathy, he was denied his medical insurance claim simply on the grounds that it was genetic, Since genetic diseases were not payable as per the policy.

Earlier the trial court had ruled in favour of Jai Prakash Tayal, holding that there cannot be a discriminatory clause against persons who suffered from genetic disorders and they were entitled to medical insurance. United India Insurance Company Limited had appealed against the trial court's order.

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