A new order from IRDA to medical insurance companies
Posted on: 21/Mar/2018 6:05:10 PM
IRDA (The Insurance Regulatory and Development Authority of India) has issued a new order to the medical insurance companies that insurance cover for generic disorders must not be refused.
IRDA has specified that coverage or reclaims for generic disorders must not be rejected by the medical insurance companies on the basis of explanation that this section related to genes-based diseases is removed from the policy list.
In this connection, a case between an individual Jayaprakash Dayal and the United India Insurance was being enquired in the Delhi High Court. It was mentioned the section on generic disorders has been removed from the Claims section in the insurance coverage policy. Generic disorders are quite widespread. It is still a gray area and a lot of controversies and hence claims made on this and paying the same would not be allowed. However, it was also mentioned by the court that such an explanation and action would be a violation of the Indian Constitution Act Section – 14.
Further, the Delhi High Court has emphasized to IRDA that it should undertake another scrutiny of the rules and regulations in the section of ‘removals/rejections’ and do not cite the instance of generic disorder and reject the claims of the policyholder.
So, the medical insurance companies, with the basic requirement to implement the points raised by the High Court, should not reject the claims of the policy holder citing the reason of genetic disorder.
