NEW DELHI: In a landmark ruling that will benefit people who are denied health insurance cover on grounds of genetic disorder, the Delhi High Court on Monday ruled that the right to health insurance is an integral part of the right to health and healthcare under Article 21 of the Constitution.Justice Pratibha M Singh, while delivering the verdict, held that discrimination in health insurance against individuals based on their genetic heritage, in the absence of appropriate genetic testing and laying down of intelligible differentia, is unconstitutional.
The order came while deciding an insurance claim by Jai Prakash Tayal against United India Assurance. Tayal, who was suffering from Hypertrophic Obstructive Cardiomyopathy, was denied his insurance claim on the ground that his condition was genetic, and genetic diseases were not payable as per the policy.
The court observed that the “exclusion of genetic disorders in all forms from health insurance 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. The entire purpose of taking medical insurance would be defeated if all genetic disorders are excluded.”
“With spiraling medical costs, health insurance has to be an integral part of medical care and health facilities. Thus, healthcare without health insurance is a challenge. Health insurance with the exclusion of genetic disorders hits at the basic right of an individual to avail of insurance for prevention, diagnosis, management and cure of diseases,” the court said.
The court sought a proper framework to prevent 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.”The court asked the Insurance Regulatory Development Authority of India to revisit the exclusionary clauses and ensure insurance companies do not reject claims on the basis of exclusions relating to genetic disorders.
‘Can’t expect laymen to read each & every clause’
“Insurance documents are standard form contracts and usually the insured person signs on the dotted line. It would be extremely tenuous to expect a layman to read each and every clause of an insurance document before signing it,” the judge said