The insurance industry Regulator, Insurance Regulatory and Development Authority of India (IRDAI) has directed all the insurance Companies vide its circular dated 19th March 2018 for not including ‘Genetic Disorders’ as one of the exclusions in new health insurance policies issued in respect of all their existing health products and also in the new products launched and/ or filed under the provisions of Guidelines on Product Filing in Health Insurance Business.

The above direction has come from the Regulator post a ruling from the Hon’ble Delhi High Court in the matter of M/s United India Insurance Company Limited Vs Jai Prakash Tayal, wherein the hon’ble court has held that the exclusionary clause of ‘Genetic Disorders’ in the insurance policies is too broad, ambiguous and discriminatory and violates the right to equality and right to healthcare (right to life and liberty) under Article 14 and 21 respectively, accordingly the Hon’ble Delhi High Court directed the insurance Regulator to re-look at the exclusionary clauses in insurance contracts and ensure that the insurance Companies do not reject claims on the basis of exclusions relating to the ‘Genetic Disorders’.

The said direction from the insurance Regulator is a good relief for all the policy holders as the term ‘Genetic Disorders’ is too wide to cover many common diseases like Diabetes, Cardiac Diseases etc. which if included, as exclusions in the health insurance policies and the claims being rejected on that ground will be a great hardship because a person suffering from such genetic disorders need medical insurance as much as others.

Use below hyperlink for the IRDAI cirular referred above:

https://www.irdai.gov.in/ADMINCMS/cms/Circulars_Layout.aspx?page=PageNo3426&flag=1

Use below hyperlink for the detailed judgment by the Hon’ble Delhi High Court in the matter of M/s United India Insurance Company Limited Vs Jai Prakash Tayal:

http://lobis.nic.in/ddir/dhc/PMS/judgement/26-02-2018/PMS26022018RFA6102016.pdf

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2 responses to “Directions by the Insurance Regulator on Genetic Disorders”

  1. Neevrat says:

    Great going Mr. Tripathi. Useful Judgement.

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