HC: Do not deny cover for genetic defect

HC: Do not deny cover for genetic defect

Context:

• 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.

Introduction:

• The ill-defined and “all-encompassing” clause about genetic disorders that health insurers regularly cite to deny mediclaim is unconstitutional and arbitrary, Delhi High Court ruled on Monday.
• 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 verdict could open up a large number of ailments as claimable under medical insurance.
• 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.
• The court  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.

Court’s ruling:

• Most health insurance policies have a clause excluding “genetic disorders” as grounds for reimbursement, but the court said this blanket exemption covered several “speculatively genetic” conditions and gave “too much freedom and arbitrary power to the insurance companies to reject genuine claims”.
• It asked the Insurance Regulatory Development Authority to have a “re-look” at such exclusionary clauses and nudged lawmakers to amend the law, saying the right to health care was a fundamental right under Article 21 (life and liberty).
•  “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.
•  “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,” .

What is genetic disorder?

• A genetic disorder is a genetic problem caused by one or more abnormalities in the genome, especially a condition that is present from birth.