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Synopsis

While dismissing the writ petition moved by an insurance company, the Kerala High Court recently held that for the purpose of insurance claims, COVID First Line Treatment Centres (CFLTCs) can be termed as a hospital.

The bench of Justice VG Arun said, "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".

The insurance company-Star Health and Allied Insurance Company Ltd had filed the present writ petition assailing the order of the Permanent Lok Adalat allowing the insurance claim of a person who had taken a Corona Rakshak Insurance Policy from the company. 

The Permanent Lok Adalat had rejected the contention raised by the insurance company that since for availing the benefits under the said policy, a positive diagnosis of COVID requiring hospitalisation for a minimum continuous period of 72 hours was essential and the present policyholder had only been admitted at the CFLT Centre, therefore, he could not claim the insurance amount.

Mainly, the argument of the insurance company was that the CFLTC to which the policyholder was sent from the Government Medical College Hospital was an institutional quarantine facility and not a hospital.

The single judge bench of the high court referred to the policy concerned and observed that it stated that 'Hospital' means any institution established for in-patient care and day care treatment of disease/ injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as given. 

Court further noted that in the policy it was also clarified 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.

Furthermore, while deciding whether CFLTCs are designated by the Government for COVID-19 treatment, court referred to the COVID-19 advisory for patient admission to CFLTCs issued by the Government in 2020. 

"Therein, it is specifically stated that 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," court highlighted. 

In view of the same, court held that the contention raised by the petitioner company was not sustainable. 

Case Title: Star Health and Allied Insurance Company Ltd v. Avinash T. and other