Irdai asks insurers not reject claims on grounds of genetic disorder

In a major relief to policy holders, insurance regulator Irdai today directed insurers not to reject any health insurance claim based on exclusions related to 'genetic disorder'.

The regulator also asked health insurance companies not to include 'genetic disorders' as one of the exclusions in new health insurance policies.

The decision comes in the wake of Delhi High Court ruling that held that exclusionary clause of 'genetic disorders' in insurance policies is too broad, ambiguous and discriminatory, violative Article 14 of the Constitution dealing with right to equality.

"... in pursuance to the directions of Hon'ble High Court all insurance companies offering contracts of Health Insurance are hereby directed that no claim in respect of any existing health insurance policy shall be rejected based on exclusions related to Genetic Disorder'," the Irdai said in a communication to insurers.

The Delhi High Court last month had directed the Insurance Regulatory Development Authority of India (Irdai) to have a re-look at the exclusion clauses in the insurance contracts to ensure that claims are not rejected on the basis of exclusions relating to genetic disorders like cardiac conditions, high blood pressure and diabetes.

Irdai also directed insurers "not to include" genetic disorders as one of the exclusions in new health insurance policies issued in respect of all their existing health insurance products and also in the new products.

Observing that the availing of health insurance was an integral part of the 'Right to Health and healthcare' under the Constitution, Justice Pratibha Maninder Singh had held that the clause in the insurance policy excluding a person with "genetic disorder" from availing its benefit was "discriminatory" and contrary to public policy.

"The IRDA is directed 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 47-page verdict said.

"The exclusion of genetic disorders in all forms 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 judgement said.