Mumbai: Bombay High Court, in a recent judgment available on Tuesday, directed insurance companies to pay the cost of PPE (Personal Protection Equipment) kits during hospitalisation in April–May 2020 during COVID-19, holding that the kits comprised essential treatment. The order came in 2 petitions filed in 2021, one by a health worker, challenging the rejection or exclusion of these costs from coverage under the ‘HealthGain’ Insurance Policy.On January 22, Justices Bharati Dangre and R N Laddha said, “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. A cut-off date of 10/07/2020 was applied, and those who were charged for the PPE kits before the cut-off date were not covered in the policy,” said the HC, declaring that “PPE kits/masks/gloves were a very essential part of the medical treatment for Covid 19”.
Noting that the insurance claims “necessarily cover ‘expenses that are medically necessary'”, the court directed both insurance companies, Bajaj Alllianz General Insurance Company Ltd for Modi and Reliance GIC for Yadav, to “reimburse the entire cost of hospitalisation, including PPE kits, masks and glove costs, in 6 weeks”.One petitioner, Jigisha Yadav, is a health worker and contracted the virus while on duty at a suburban hospital. She received treatment at a south Mumbai hospital between April 26, 2020 and May 6, 2020. The PPE kit cost was Rs 7,500 per day and, once, Rs 10,000. Her claim was for Rs 2.6 lakh, and Rs 1.65 lakh was rejected.Hemango Modi, the second petitioner, also claimed under the same policy for her April 2020 hospitalisation. Her Rs 4.4 lakh claim was cleared for only around Rs 70,000, with the balance amount, though mainly consisting of the cost of PPE kits, masks, gloves, and other such items used by the hospital staff for her treatment, deducted.The HC, after hearing senior counsel Fredun Devitre with Kirti Munshi and Chaitanya Mehta for both petitioners, advocate Kalpana Trivedi for Reliance General Insurance Co Ltd, SR Mehta for Bajaj Allianz GIC, and DP Singh for Centre in both, said, “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.”
