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Insurance Claims For Genetic Disorders Can’t Be Denied

The Delhi High Court ruled that the health insurance companies cannot deny the claim for genetic disorders and it is unconstitutional

  • 28 Feb 2018
  • 2 min read

In a significant ruling, the Delhi High Court has said that insurance companies cannot deny the health insurance claims for genetic disorders. The verdict stated that the clause in the insurance policy, which exclude the person with ‘genetic disorder’ is discriminatory and is in violation of Article 14 and Article 21 of the constitution.

While delivering the judgement, Justice Pratibha M Singh held that, “Right to avail health insurance is an integral part of right to healthcare as recognized in Article 21 of the constitution. The broad exclusion of genetic disorders from insurance claims without any generic testing is illegal and unconstitutional.”

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The court further directed the Insurance Regulatory and Development Authority of India (IRDAI) to re-look at exclusionary clauses in the insurance contracts and ensure that claims are not rejected on the basis of genetic disorders like cardiac condition, diabetes and blood pressure.

However, the court also noted that insurance companies can structure their contract on reasonable and intelligible factors which should not be arbitrary. Such exclusions have to be based on rigorous and empirical tests and cannot be simply based on subjective or vague data.

The verdict came in a case that filed by a customer suffering from Hypertrophic Obstructive Cardiomyopathy, against a leading general insurance company. His insurance claims was rejected on grounds that genetic diseases are not payable under the policy.

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