Denying health insurance for genetic conditions violates rights: Delhi High Court
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IAPG
Feb 27, 2018, 10:45:46 AM2/27/18
to Rare Diseases PAG
The Delhi High Court yesterday held that excluding people with genetic disorders from obtaining health insurance or denying their claims is “discriminatory and violative” of a citizen’s right to health and “unconstitutional”.
Background:
The High Court order pertains to Jai Prakash Tayal, who suffers from Hypertrophic Obstructive Cardiomyopathy. He had taken a medical policy of Rs 5 lakh, which was renewed every year till 2012 since 2004. The complainant was hospitalised twice between 2004 and 2006, for which claims were honoured and payments made by United India Insurance.
However, when Tayal was hospitalised again in 2011, the insurance company rejected his claim citing “genetic exclusion clauses” in the renewed contract.Tayal had submitted that the exclusion of genetic disorders was not part of the initial policy, which he had availed, and was added in a later policy document without giving him notice. Tayal first approached the trial court, which ordered relief of Rs 5 lakh to Tayal. The trial court had said, “… Suffering from a genetic disorder needs medical insurance as much as others.”
Justice Pratibha M Singh of the High Court upheld the trial court order of 2017, which directed United India Insurance to pay Rs 5 lakh to the insured.
Key excerpts from the High Court order:
- There are several medical conditions which could be partially attributable to genetics, but could also be attributable to several other factors, such as lifestyle, environmental conditions, dietary habits, etc.
- Detailed genetic testing is required in order to determine the nature of the genetic disorder, in the absence of which, it would be medically impossible to determine whether a broad medical condition is a pure genetic disorder i.e, solely attributable to a gene or to the several other factors which could
contribute
- Moreover, in order to exclude genetic disorders from insurance claims, there has to be genetic testing, which is itself a complex and expensive process
- Right to avail health insurance is an integral part of the Right to Healthcare and the Right to Health, as recognised in Art. 21 of the Constitution
- Discrimination in health insurance against individuals based on their genetic disposition or genetic heritage, in the absence of appropriate genetic testing and laying down of intelligible differentia, is Unconstitutional
- The broad exclusion of "genetic disorders‟ is thus not merely a contractual issue between the insurance company and the insured but spills into the broader canvas of Right to Health. There appears to be an urgent need to frame a proper framework to prevent against 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‟. Such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective or vague factors. It is for lawmakers to take the necessary steps in this regard.
- The Exclusionary clause of `genetic disorders', in the insurance policy, is too broad, ambiguous and discriminatory - hence violative of Art. 14 of the Constitution of India
- Insurance Regulatory Development Authority of India (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
Read the full order here (https://goo.gl/AA2UqL).
Background:
The High Court order pertains to Jai Prakash Tayal, who suffers from Hypertrophic Obstructive Cardiomyopathy. He had taken a medical policy of Rs 5 lakh, which was renewed every year till 2012 since 2004. The complainant was hospitalised twice between 2004 and 2006, for which claims were honoured and payments made by United India Insurance.
However, when Tayal was hospitalised again in 2011, the insurance company rejected his claim citing “genetic exclusion clauses” in the renewed contract.Tayal had submitted that the exclusion of genetic disorders was not part of the initial policy, which he had availed, and was added in a later policy document without giving him notice. Tayal first approached the trial court, which ordered relief of Rs 5 lakh to Tayal. The trial court had said, “… Suffering from a genetic disorder needs medical insurance as much as others.”
Justice Pratibha M Singh of the High Court upheld the trial court order of 2017, which directed United India Insurance to pay Rs 5 lakh to the insured.
Key excerpts from the High Court order:
- There are several medical conditions which could be partially attributable to genetics, but could also be attributable to several other factors, such as lifestyle, environmental conditions, dietary habits, etc.
- Detailed genetic testing is required in order to determine the nature of the genetic disorder, in the absence of which, it would be medically impossible to determine whether a broad medical condition is a pure genetic disorder i.e, solely attributable to a gene or to the several other factors which could
contribute
- Moreover, in order to exclude genetic disorders from insurance claims, there has to be genetic testing, which is itself a complex and expensive process
- Right to avail health insurance is an integral part of the Right to Healthcare and the Right to Health, as recognised in Art. 21 of the Constitution
- Discrimination in health insurance against individuals based on their genetic disposition or genetic heritage, in the absence of appropriate genetic testing and laying down of intelligible differentia, is Unconstitutional
- The broad exclusion of "genetic disorders‟ is thus not merely a contractual issue between the insurance company and the insured but spills into the broader canvas of Right to Health. There appears to be an urgent need to frame a proper framework to prevent against 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‟. Such contracts have to be based on empirical testing and data and cannot be simply on the basis of subjective or vague factors. It is for lawmakers to take the necessary steps in this regard.
- The Exclusionary clause of `genetic disorders', in the insurance policy, is too broad, ambiguous and discriminatory - hence violative of Art. 14 of the Constitution of India
- Insurance Regulatory Development Authority of India (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
Read the full order here (https://goo.gl/AA2UqL).
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