Bombay High Court Mandates Insurance Coverage for COVID-19 PPE Kit Expenses
In a landmark judgment that brings significant relief to COVID-19 patients and healthcare workers, the Bombay High Court has directed insurance companies to cover the costs of Personal Protection Equipment (PPE) kits used during hospitalizations in April and May 2020. The court declared these protective items as essential components of medical treatment during the pandemic, overturning previous claim rejections by insurers.
Essential Treatment Ruling on Protective Gear
The division bench comprising Justices Bharati Dangre and R N Laddha delivered this crucial verdict on January 22, addressing two petitions filed in 2021 that challenged insurance companies' refusal to cover PPE kit expenses. The court emphatically stated that "PPE kits, masks, and gloves were a very essential part of the medical treatment for COVID-19" during the peak pandemic period.
Justice Dangre observed, "The most essential feature of the system and lifesaver for the community is doctors and health care workers, and we find absolutely no justification in creating discrimination between the patients who were admitted and, during their treatment, the PPE kits were used." The bench rejected the insurance companies' classification of PPE kits as non-clinical items, noting their critical role in preventing infection transmission.
Case Details and Petitioner Experiences
The judgment specifically addressed the claims of two petitioners who had purchased the 'HealthGain' Insurance Policy. Jigisha Yadav, a healthcare worker who contracted COVID-19 while on duty at a suburban hospital, received treatment at a south Mumbai facility between April 26 and May 6, 2020. Her hospital bills included PPE kit charges ranging from Rs 7,500 to Rs 10,000 per day.
Despite submitting a claim for Rs 2.6 lakh, the insurance company rejected Rs 1.65 lakh, primarily comprising PPE kit expenses. The second petitioner, Hemango Modi, who was hospitalized in April 2020, faced similar challenges with her Rs 4.4 lakh claim, receiving only approximately Rs 70,000 in reimbursement.
Court's Reasoning and Directives
The Bombay High Court meticulously examined the insurance policy provisions and the extraordinary circumstances of the COVID-19 pandemic. The bench noted, "We find it extremely difficult to accept that PPE kits are non-clinical items. In ordinary circumstances, it may be, but for the Covid pandemic, which was considered to spread through droplets of saliva or any particles coming out from sneezing or coughing by a Covid-positive patient, it was the PPE kit which acted as a barrier and prevented the user from being infected."
The court highlighted that insurance claims "necessarily cover 'expenses that are medically necessary'" and found the insurers' application of a July 10, 2020 cut-off date for coverage arbitrary. The bench directed both insurance companies involved—Bajaj Allianz General Insurance Company Ltd for Modi and Reliance General Insurance Company for Yadav—to reimburse the entire hospitalization costs, including PPE kits, masks, and gloves, within six weeks.
Legal Representation and Broader Implications
The case saw representation from senior counsel Fredun Devitre along with Kirti Munshi and Chaitanya Mehta for the petitioners, while advocate Kalpana Trivedi appeared for Reliance General Insurance Company Ltd, SR Mehta represented Bajaj Allianz General Insurance Company, and DP Singh represented the Central Government. The comprehensive hearing examined the medical necessity of protective equipment during a public health emergency.
This judgment establishes an important precedent for insurance coverage during health emergencies and recognizes the extraordinary medical requirements during the COVID-19 pandemic's initial devastating wave. The ruling emphasizes that insurance policies must adapt to exceptional circumstances and cover genuinely medically necessary expenses, regardless of their classification during normal times.
