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Genetic diseases: Court rules against insurance companies

People with genetic conditions have routinely been excluded from health insurance policies in India. With the law now falling on their side, at least in Delhi, could the situation of those suffering with genetic diseases improve?

The Delhi High Court has ruled that a currently used clause that allowed insurance companies to deny an individual an insurance policy based on their genetic disposition or genetic heritage amounts to discrimination. As a result, the practice was deemed unconstitutional, violating article 14 of the constitution of India under the grounds of discriminatory practices.

The court case involved Jay Parkash Tayal, who had taken out an insurance policy on himself and his family, covering them for Rs 5 lakh per person. Tayal suffers from hypertrophic obstructive cardiomyopathy. The condition involves the heart muscles thickening, making it less efficient at pumping blood. This can lead to lifelong issues.

Tayal had made previous successful claims for the condition in 2004 and 2006. However, in 2011 he was hospitalised due to complications resulting from the condition. He was treated at the Fortis Escorts Heart Institute in Delhi, after which he again made a claim.

The claim was denied by Tayal’s insurance provider, United India. The company claimed “genetic diseases are not payable as per the policy, genetic exclusion clauses” and so refused to cover Tayal. At this point the claim was taken to court.

Justice Pratibha M. Singh stated that the right to health insurance is an integral part of the right to healthcare. She said that, as the definition used by insurance companies to describe a genetic condition is purposely broad, it could be used to deny health insurance to some of the most common conditions in India, such as heart disease or cancers. This often leads to health insurance often only being provided to those who need it the least, negating its purpose.

The wording in the company’s clause for genetic disease is brief and does not explain which diseases are included. The court pointed out that many conditions — as with the examples of cancer and heart disease — can potentially have a genetic component, though they can also be caused by environmental and lifestyle conditions.

The court thus rules that without laboratory testing for genes associated with a condition, it cannot be assumed that the disease is genetic. As such, an insurance company cannot discriminate based on the assumption that a diseases cause is purely genetic.

Such a legal ruling could present positive prospects for those with genetic conditions seeking insurance coverage. However, the court does note that in the instance a disease is linked only to genetic causes, they may be treated differently. This could have a negative impact and deny legal protection for people suffering from conditions such as Huntington’s disease.

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