Insurers cannot reject health claims based on genetic disorders, says IRDAI

In a major relief to patients suffering from genetic disorders, the Insurance Regulatory and Development Authority of India (IRDAI) has barred insurers from rejecting claims on the basis of genetic disorders.

Published: 22nd March 2018 02:52 AM  |   Last Updated: 22nd March 2018 05:28 AM   |  A+A-

Express News Service

BENGALURU:In a major relief to patients suffering from genetic disorders, the Insurance Regulatory and Development Authority of India (IRDAI) has barred insurers from rejecting claims on the basis of genetic disorders.In a letter issued to all life, general and health insurers on Monday, a copy of which is with The New Indian Express, it cited a Delhi HC judgment in United India Insurance versus Jai Parkash Tayal case which held that “the exclusionary clause of ‘Genetic Disorders’, in the insurance policy is too broad, ambiguous and discriminatory – hence violative of Article 14 of the Constitution of India.”

IRDAI is an autonomous, statutory agency tasked with regulating and promoting insurance and re-insurance industries in the country.Gagandeep Chandok (34) has been a thalassemia major all his life. A member of Thalassemia & Sickle Cell Society of Bangalore, he told TNIE, “According to IRDAI, all genetic conditions — be it Thalassemia, Haemophilia, blood disorders or muscular disorders — any genetic disorder from now can be covered under life insurance policy or health policy. The point the court made was that if a person is born with a condition, you cannot deny him insurance cover as he/she is born that way.”

The reason why life insurance companies and health insurance companies introduced the “existing condition/genetic condition” clause for exclusion previously was to prevent fraud, he said. “The IRDAI hasn’t checked if the insurance companies are following the rule or not. I called LIC enquiring if I can get coverage for a genetic condition and nobody knew what to say,” Chandok said.

Prasanna Shirol, founder, Organisation of Rare Diseases of India, told TNIE, “For a child weighing 10 kg suffering from a rare disease, the drugs will cost `30 lakh. This can go up to a crore. Will the premium be increased proportionately? Will it be affordable then? It needs to be discussed with all stakeholders.”



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