According to Order VIII, Rule 6 (3), Illustration (c) of the Code of Civil Procedure, 1908, ‘insure’ means to secure payment of a sum of money in the event of loss or damage to property, or, death or physical injury to a person in consideration of the payment of a premium and observance of certain conditions. ‘Insurance’ is a contract by which a person (insurer) in consideration of a sum of money (the premium), becomes bound to secure a party against the risk of loss occasioning from certain events marked out by the contract. The party deriving security from the contract is called the ‘insured’ and the contract itself is termed as ‘Policy of Insurance’.
‘Policy of Insurance’ is a document containing an undertaking in consideration of premium, to pay a specified amount or part thereof in the event of a specified contingency. According to Section 2(9) (c) of the Insurance Act, 1938, risks covered by an insurance, or, the protection afforded by an insurance is called an ‘insurance cover’.
A contract of insurance like other contracts is concluded by offer and acceptance and if there is a stipulation that the liability will attach itself under the contract only if premium is paid, then, that will be a condition precedent to the policy taking effect.
As per Section 2(d) of the Insurance Act, 1938, the word ‘insurer’ includes: (a) persons actually carrying on insurance business; (b) persons about to commence insurance business; and (c) persons who have stopped insurance business but against whom claims or liabilities might be outstanding. According to Section 65 (58) of the Finance Act, 1994, ‘insurer’ means any person carrying on the general insurance business or life insurance business in India. Tersely, an ‘insurer’ is the person who assures against the loss and according to Section 2 (8) of the Companies Act, 1913, ‘insurance company’ means a company that carries on the business of insurance either solely or in common with any other business or businesses.
According to Section 49 of the Transfer of Property Act, 1882, ‘insured’ is that in respect of which insurance has been obtained, and, the person indemnified by his contract of insurance is called a ‘policy holder’. Lastly, ‘insurable interest’ is a financial or legal interest which an insured must have in the person, object or activity covered by an insurance policy.
‘Health’ is a state of complete physical, mental and social well being and not merely an absence of sickness, disease or infirmity. ‘Health’ is not merely ‘soundness of body’ but is rather freedom from sickness and/or suffering of all kinds (physical, mental and social). Health is a state of being hale, sound or whole in body, mind, soul and well being. ‘Health Cover’ or ‘Health Insurance’ means the effecting of contracts which provide sickness benefits or medical, surgical or hospital expense benefits, whether in-patient or out-patient, on an indemnity, reimbursement, service, prepaid, hospital or other plans basis, including assured benefits and long term care. ‘Good health’ as employed in insurance contract, ordinarily means a reasonably good state of health; it means that the applicant has no grave, important or serious disease, and is free from any ailment that seriously affects the general soundness and healthfulness of the system. Good health does not mean a condition of perfect health. To be ‘healthy’ means to be free from disease or bodily ailment, or any state of the system peculiarly susceptible or liable to disease or bodily ailment. ‘Illness’ in the context of insurance law signifies a disease or ailment of such a character as to affect the general soundness and healthfulness of the system seriously, and not a mere temporary indisposition which does not tend to undermine (weaken) the constitution of the insured. It is important to note that in the context of life insurance, ‘serious illness’ means an illness that permanently or materially impairs, or is likely to permanently or materially impair, the health of the applicant. Not every illness is serious; an illness may be alarming at the time, or thought to be serious by the one afflicted, and yet not be serious in the sense of that term as used in insurance contracts. An illness that is temporary in its duration, and entirely passes away, and is not attended, nor likely to be attended, by a permanent or material impairment of the health or constitution, is not a serious illness. It is not sufficient that the illness was thought serious at the time it occurred, or that it might have resulted in permanently impairing the health. Similarly, ‘infirmity’ in the context of insurance law signifies an ailment or disease of a substantial character, which apparently in some material degree impairs the physical condition and health of the applicant and increases the chance of his death or sickness and which if known would have been likely to deter the insurance company from issuing policy.
Genes are responsible for the various traits that human beings possess, and it is the difference in these traits that make one homosapien different from the other. While the genes pass on several positive traits (characteristics), but they could at times be responsible for some abnormal medical conditions which are passed on from one generation to another; these abnormal medical conditions which are passed on from one generation to another are called genetic disorders. Genetic disorders can be dominant or recessive. If the gene is ‘dominant’ then the disease will surface, but if the gene is ‘recessive’ then the trait will not show up but because the individual is the carrier of the gene, he/she can pass it to the next generation.
According to the National Human Genome Research Institute, there are broadly three types of genetic disorders: (a) Monogenetic disorders; (b) Multi-factorial inheritance disorders; and, (c) Chromosome disorders. There are plethora of medical conditions which can partially be attributable to genetics and partially to the lifestyle and dietary habits of an individual. Therefore, comprehensive ‘genetic testing’ is required in order to determine whether a particular medical condition is an outcome of a possible genetic disorder, or, whether a particular medical condition is a result of the environmental conditions, lifestyle and dietary habits of an individual.
Exclusion of Genetic Disorders from Insurance Claims:
Right to healthcare is an integral part of the right to life guaranteed under Article 21 of the Constitution of India, 1950. Healthcare without health insurance, with the medical costs escalating each year, is a serious challenge. Health insurance cover with the exclusion of ‘genetic disorders’ batters the most basic right of an individual to avail insurance for the prevention, diagnosis, management and cure of diseases. Actions (policy decisions) of the insurers in excluding any particular category of individuals, that is, those with genetic disorders, from obtaining health insurance are not only per se discriminatory in view of Article 14 of the Constitution of India, 1950, but are also violative of a citizen’s right to health enshrined in Article 21 of the Constitution of India, 1950. Covenants, stipulations and/or clauses of an insurance policy must stand the test of reasonableness as ‘insurance’ is a means of social security.
The Hon’ble High Court of Delhi in its report dated: 26.02.2018 in the matter of, M/s. United India Insurance Company Limited v. Jai Prakash Tayal has held that:
Renewal of Insurance Policy: A renewal of insurance policy means repetition of the original policy. When an insurance policy is renewed, the policy is extended and the renewed policy in the identical terms from a different date of its expiration comes into force. Any change in the terms and conditions of an insurance policy which are significantly different from the original policy stipulations must be specifically consented to by the insured at the time of renewal of the policy, and, the insurer is not allowed to slip in new terms and conditions at the time of renewal of the policy without bring them specifically to the knowledge and attention of the insured.
 V.F. & G. Insurance Co. v. Fraser and Ross, AIR 1960 SC 971, 976
 Section 2(6), The Life Insurance Corporation Act, 1956
 An ‘insurance company’ is an institution which undertakes to pay a sum of money on the death of the assured, or at any other fixed time, in consideration of premiums, assessments, or payments made in any other way.
 Kirloskar Brothers Ltd. v. Employees’ State Insurance Corporation, AIR 1996 SC 3261
 CESC Ltd. v. Subhash Chandra Bose, AIR 1992 SC 573
 Section 144 (1), The Criminal Procedure Code, 1973; Article 25 (1) of the Constitution of India, 1950
 Venable v. Gulf Taxi Line, 105 W. Va. 156, 141 S.E. 622, 624
 Regulation 2(f), The Insurance Regulatory and Development Authority (Registration of Indian Insurance Companies) Regulations, 2000
 Kroon v. Travelers’ Insurance Co., 290 Ill. App. 35, 7 N.E. 2d 935, 937
 Mincy v. Washington National Insurance Co., 130 Pa. Super.285, 196 A. 893, 897
 White v. Sovereign Camp, W. O. W., 184 S.C. 215, 192 S.E. 161, 165
 Bell v. Jeffreys, 35 N.C. 356
 Prudential Insurance Co. of America v. Sellers, 54 Ind. App. 326, 102 N.E. 894, 897
 Fishbeck v. New York Life Insurance Company, 179 Wis. 369, 192 N.W. 170, 175; American National Insurance Company v. Hicks, Tex. Civ. App., 198 S.W. 616, 622
 Eastern Dist. Piece Dye Works v. Travelers’ Insurance Co., 234 N.Y. 441, 138 N.E. 401, 404, 26 ALR 1505
 National Human Genome Research Institute, https://www.genome.gov/19016930/faq-about-genetic-disorders/, Last viewed: 17.03.2018
 These are caused by mutation in a single gene, e.g. sickle cell disease.
 These are caused by a combination of genetic and environmental factors, e.g. diabetes, cardiac diseases, and cancer (some forms).
 These are caused due to either deficiencies or excesses of the genes or due to structural changes in the chromosomes, e.g. Down’s syndrome and chronic myeloid leukaemia.
 RFA 610/2016 & CM Nos. 45832/2017, High Court of Delhi, Prathiba M. Singh, J.
 Biman Krishna Bose v. United India Insurance Co. Ltd. & Anr, 2001 (6) SCC 477