Prathiba M. Singh, J.

1. The human gene in all its myriad combinations decides the traits of an individual human being. While most genetic traits of human beings have a positive expression, there are certain traits which could cause abnormalities. Such abnormalities are termed as ‘genetic disorders'. Genetic disorders are subject matter of research and development in the search of newer drugs to cure them but are also subject matter of debate, world over, in the context of health insurance. The question raised in the present case is whether persons having genetic disorders can be discriminated against in the context of health insurance.

A. Background Facts

A.1. The Respondent/Plaintiff (hereinafter ‘Plaintiff’) took an insurance policy for himself along with his wife and daughter, from the Appellant/Defendant (hereinafter ‘Defendant’) being Policy No: 041703/48/11/97/00000934 which is valid and subsisting. The said policy is a medi-claim Policy where the sum insured is Rs.5 lakhs per individual. The Plaintiff submits he had first taken a medi-claim on 11th September, 2000 with the National Insurance Co. Ltd. vide policy No. 2000/8100540. The said policy was shifted to Defendant on 10th September, 2004, after which the policy was renewed continuously year to year without break till 10th September, 2012. The Plaintiff suffers from HOCM i.e. Hypertrophic Obstructive Cardiomyopathy (hereinafter ‘HOCM'). He was hospitalised on 23rd January, 2004 and 27th February, 2006 and his claims for the said periods have been honoured and payments were made by the Insurance Company.

A.2 The Plaintiff was again hospitalised for treatment on 27th November, 2011 and was discharged on 30th November, 2011. He made a claim for an amount of Rs.7,78,864/- with the Defendant. The said claim was rejected vide letter dated 6th February, 2012 where the reasons for rejection were mentioned as -

"...We are closing your claim file, on account of the following reasons:-

TPA Vipun Medcorp P Ltd had repudiated your claim. Since genetic diseases are not payable as per the policy, genetic exclusion clauses”.

(extracted verbatim)

A.3. It is the Plaintiff’s case that the exclusion of genetic disorders was not a part of the initial policy which was availed by him but was added as part of the ‘Exclusions' in a later policy document, without specific notice to him and hence the said exclusions do not bind him. However, the stand of the Defendant was that HOCM is a genetic disorder which is clearly excluded and hence the claim is not liable to be entertained.

A.4. The Plaintiff issued a legal notice on 30th March 2012, calling upon the Defendant to pay a sum of Rs.7,78,864/-, the breakup of which is as under: -

“9.That the defendants have committed breach of trust with the plaintiff for which the defendants are liable to face civil and criminal consequences before the competent court of law. It is submitted that the Defendants are liable to pay the amount i.e.:

He received a reply on 24th April, 2012 that the claim cannot be paid as ‘genetic disorders' are excluded in the policy document. The Plaintiff then filed a suit for recovery against the Defendant praying for a decree for the sum of Rs 7,78,864/-. The Prayer clause in the plaint reads:

"It is, therefore most respectfully prayed that the Hon'ble court may please to pass a decree of Rs. 7,78,864=00 (Rs. Seven Lakh Seventy Eight Thousand Eight Hundred Sixty Four Only ) along with interest @ 12% p.a. since the filling of the suit till the realization of decretal amount.

Cost of the suit may also be awarded in favour of the plaintiff and against the defendants."

A.5. The