COVID First Line Treatment Centre Can Be Termed As Hospital For The Purpose Of Claiming Insurance: Kerala High Court

The Kerala High Court recently observed that COVID First Line Treatment Centre can be termed as a Hospital for the purpose of insurance claims.Justice V G Arun said that as per the COVID-19 advisory for patient admission to CFLTCs issued by the Government, the Centre identified as COVID Health Care Centre should treat all mild and moderate symptomatic persons under surveillance and should be utilised for treating positive cases when need arises. CFLTCs are Primary Level Health Care Centres set up for providing care to less serious cases and referral of serious cases to COVID hospitals, so as to avoid crowding in COVID Hospitals and avoid wastage of resources.It can therefore be unhesitatingly held that CFLTCs are designated as hospitals for the treatment of COVID-19, Court said.The Court made the aforesaid observation while considering a Petition moved by an insurance company. The 1st Respondent had taken a Corona Rakshak Insurance Policy from the Petitioner Company with a coverage of Rs. One lakh for the period of one year and as per the terms of the policy, a lump sum benefit equivalent to 100% of the sum assured was payable to the policyholder on a positive diagnosis of COVID requiring hospitalisation for a minimum continuous period of 72 hours.The 1st Respondent tested positive for COVID-19 and was referred to a COVID First Line Treatment Centre, however, his claim was denied on the ground that the insurance amount was payable only in case of hospitalisation and the 1st respondent had only been under institutional quarantine is frivolous.The matter was referred to the Permanent Lok Adalat, Kozhikode, where the contentions of the Petitioner Company were rejected and the 1st respondent's claim was allowed. The Court after considering the contentions raised by both the parties and after perusing the Policy Schedule and Terms and Conditions of the Corrona Raksha Insurance Policy observed that in Clause 3.6.iv that, for the purpose of the policy any other set-up designated by the Government as hospital for the treatment of COVID-19 shall also be considered as hospital. As per Clause 3.7, admission in a hospital designated for COVID treatment for a period of 72 consecutive 'in-patient care' hours will qualify a policy holder for the insurance coverage. Clause 3.8 makes it clear that 'in-patient care' means treatment for which the insured person has to stay in hospital continuously for more than 72 hours for treatment of COVID.Furthermore, referring to the COVID-19 advisory for patient admission to CFLTCs issued by the Government, the Court observed that CFLTCs are designated as hospitals for the treatment of COVID-19.Regarding the Contention that the petitioner did not have any symptoms of COVID-19 and was not treated for such illness at the CFLTCs, the Court observed that the permanent Lok Adalat relied on the medical records to find that the 1st respondent had received treatment as an outpatient at the Medical College for fever, cough and mialgia. The permanent Lok Adalat having arrived at such a finding based on documentary evidence, I find no reason to come to a different conclusion, the Court said. The Court, therefore, dismissed the Petition. Advocates R. S. Kalkura, M. S. Kalesh and Harish Gopinath appeared for the Petitioner. Advocate Nirmal S and Government Pleader Justine Jacob appeared for the Respondents.Case Title: Star Health Insurance And Allied Insurance Company Ltd v. Avinash T and Anr. Citation: 2023 LiveLaw(Ker) 34Click Here To Read/Download The Order

COVID First Line Treatment Centre Can Be Termed As Hospital For The Purpose Of Claiming Insurance: Kerala High Court

Athira Prasad

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