An additional District Judge has observed that the genetic disease exclusion clause in a mediclaim insurance policy is liable to be struck down as it is violative of the constitutional mandate, and was “arbitrary, discriminatory, and unfair.”

The clause excludes grant of insurance in the case of genetic diseases.

Justice Kamini Lau was disposing of a case against PSU United India Insurance Company for rejecting the claim of one Jai Prakash Tayal who has a heart ailment, citing the genetic disease exclusion clause.

The court was hearing a suit against the insurance firm filed by Mr. Jai Prakash who had sought Rs 5 lakhs spent on his treatment. The firm had denied mediclaim saying “genetic disease is not payable as per policy genetic exclusion clauses”.

Tayal submitted that he had already taken two claims for the same treatment and, therefore, a third claim for the same disease was not liable to be rejected. The court ruled in his favour and said he was entitled to the amount.

The court held that good health is not a privilege but a justiciable fundamental right and said “No person can be discriminated or deprived of state protection in case of an ailment, be it genetic or acquired. The courts of law are required to interpret the provisions of the private contracts in the light of these constitutional obligations”.

Source: http://health.economictimes.com


Guide to approaching a consumer court

India's first practical guide to resolving your complaints by approaching consumer court. Guidance
Customer Complaint

Newsletter

Enter your email address to subscribe to our Newsletter.