Abu Dhabi court orders couple to pay hospital Dh180,782 after insurance covers only Dh250,000 of medical bill
The Abu Dhabi Commercial Court ruled the husband's signed payment undertaking made him jointly liable for the balance, even as a medical error investigation was ongoing
Abu Dhabi: The Abu Dhabi Commercial Court of First Instance ruled that a woman and her husband must pay Dh180,782 to a hospital, the remaining value of the cost of emergency medical services and care provided by the hospital to the mother and her two newborns in the intensive care unit, after taking into account the insurance coverage amount of Dh250,000.
In detail, a hospital filed a lawsuit against a woman, her husband, and an insurance company, demanding that they jointly and severally pay it Dh430,782, and compensate it for the material and moral damages it suffered, its losses, and its lost profits in the amount of Dh1 million, with legal interest at a rate of 12% from the date of filing the lawsuit until full payment, and obligating them to pay the fees, expenses, and charges.
The hospital indicated that it provided emergency medical services and care to the first defendant's wife and her two children in the intensive care unit, and the insurance company refused to cover it. The second defendant (the husband) signed an acknowledgment and undertaking guaranteeing the payment of the full cost jointly and severally, in addition to legally obligating the sponsor and employer (the third defendant) to provide health coverage.
This resulted in them being liable for the amount of the lawsuit for the treatment of the mother and newborns, and their refusal to pay it without justification, despite amicable demands.
The first and second defendants (the wife and husband) submitted a response memorandum, in conclusion, insisting on the dismissal of the lawsuit, on the grounds that it was filed prematurely due to a medical error under investigation by the medical liability committees. As a precaution, they requested that the lawsuit be suspended pending a decision on the medical error, the basis of the plaintiff's (the hospital's) liability, which negates any claim regarding medical expenses.
They also requested the dismissal of the lawsuit on the grounds that it was filed in violation of the Medical Liability Law, and alternatively, the appointment of a specialised medical expert to determine the cost of treatment, while dismissing the lawsuit for lack of proof, validity, and entitlement, and obligating the hospital (the plaintiff) to pay the fees, expenses, and charges.
The third defendant (the insurance company) also submitted a response memorandum, requesting the dismissal of the lawsuit against it due to the absence of liability, and the dismissal of the lawsuit against it due to the absence of the employer's liability, while obligating the hospital (the plaintiff) to pay the fees, expenses, and charges.
For its part, the court explained in the reasoning of its ruling that the hospital’s (plaintiff’s) requests are limited to obligating the defendants to pay the hospital the amount of the claim, in return for the emergency medical services for the first defendant and her two children in the intensive care unit. It based its claim on the fact that the wife (first defendant) was the one who received the treatment, and that the second defendant (her husband) signed a customary acknowledgment to pay all treatment costs in the event that they were not settled. The hospital (plaintiff) also based its claim against the insurance company (third defendant), as it is the employer of the second defendant (the husband).
The court noted that it is established from the health insurance policy of the first defendant that it covers the employees of the third defendant, and that the coverage date is effective when she enters the hospital (plaintiff) to receive medical services, pointing out that the maximum insurance coverage in the policy is Dh250,000 per year.
Therefore, the third defendant (the insurance company) has fulfilled its obligation in accordance with what is stipulated in the Health Insurance Law of the Emirate of Abu Dhabi, which obliges the employer to participate in the health insurance system, thus limiting the third defendant's responsibility towards the hospital (plaintiff).
The court also concludes that the responsibility of the first and second defendants only towards the hospital (plaintiff) for the cost of treatment is the first defendant, as the first defendant is the beneficiary of the services, and the second defendant is the one who undertakes to pay any cost according to the attached undertaking.
The court indicated that it is established from the invoices submitted by the hospital (the plaintiff), which have evidentiary weight, especially since nothing was submitted to contradict them, that the value of the medical services provided to the first defendant (the wife) was Dh430,782, and the limit of the insurance coverage was Dh250,000, so what is due to the hospital (the plaintiff) from the first and second defendants (the wife and husband) is Dh180,782.
The court disregarded the defendants’ request to dismiss the case on the grounds that it was filed prematurely due to a medical error under investigation by the medical liability committees, and to suspend the case pending a decision on the medical error as the basis of the hospital’s (plaintiff’s) liability.
The court noted that the issue of medical services provided by the plaintiff is based on a contractual relationship based on the provision of medical services in exchange for money (fees), and that deciding this case does not require determining whether or not a medical error has been investigated, as the financial obligations of the two parties remain independent of any liability for negligence that may result from the error.
The court indicated that the plaintiff was entitled to legal interest as compensation for the disruption and delay, while it rejected the hospital’s (plaintiff’s) request for compensation, and attributed its rejection to its previous ruling that the hospital was entitled to legal interest, on the basis that this ruling is considered sufficient to compensate for its damage without ruling for supplementary compensation, especially since it did not prove that the damage exceeded the value of the interest awarded.
The court ruled that the first and second defendants (the wife and husband) must jointly pay the hospital (the plaintiff) the sum of Dh180,782, and obligate them to pay legal interest at a rate of 5% per annum on the amount awarded until full payment, not exceeding the principal of the debt, and to pay court expenses, and Dh200 for attorney fees, and rejected all other claims.