Insurance can’t exclude genetic disorders: Court

NEWDELHI: The Delhi high court on Monday held that it was illegal for health insurance policies to exclude genetic disorders from their scope of coverage.

Such exclusionary clauses were held to be in violation of Article 14 (Right to Equality) and Article 21 (Right to Life) of the Constitution for being “too broad, ambiguous and discriminatory”.

“The fact (is) that there are different

types of genetic disorders and even common diseases like diabetes and cardiac diseases could be included in the broad definition, and makes the 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... The broad exclusion of genetic disorders from insurance contracts/claims is illegal and unconstitutional,” the court said.

The judgment affirms two things — that the Constitution prohibits discrimination based on the genetic heritage of an individual, and that the “right to health” as well as the ‘right to healthcare’ is a part of right to life. The court, however, noted that 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”.

The court said such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective or vague factors.

The court further observed that the Insurance Regulatory Development Authority (IRDA) ought to have supervised the manner in which the term genetic disorders were being misused by companies.

It said genuine claims were rejected by companies that took advantage of the ambiguity in the IRDA guidelines with respect to genetic conditions.