Khaberni - The Primary Civil Court in Dubai ruled that a "baggage handler" worker, the institution he works for, and a health insurance claims management company, jointly, pay an amount of AED 1,061,500 to a hospital, as the cost of emergency treatment that lasted for months for the first defendant after falling from a two-story height, in addition to AED 10,000 in compensation.
The details of the case date back to the first defendant being admitted to the hospital in December 2024, in critical health condition, due to falling from a two-story height, where he was received by the medical facility through the emergency department and immediately began providing necessary first aid and resuscitation, fulfilling its legal duty to treat emergency cases irrespective of financial capability or insurance coverage.
According to medical reports, the patient suffered from severe injuries, including comminuted fracture of the left femur, and patella fracture, along with complications including pulmonary embolism and other health disorders, necessitating urgent surgical intervention and prolonged admission to the intensive care unit for months until his condition stabilized, and he was discharged from the hospital.
During this period, the cost of medical services provided exceeded one million dirhams, distributed among patient room and intensive care stays, surgical procedures, and medications, without any part being paid by any of the parties.
The medical facility filed its lawsuit demanding the patient, the health insurance claims management company, and the employer, pay the entire amount, based on their joint responsibility for treatment costs, and presented documents including medical reports, bills, and emails proving the company he works for agreed to the treatment.
During the proceedings, the claims management company contended that it was merely an administrative intermediary and not the insurance company, also adhering to their interpretation of the case to refuse coverage, while the employer argued the absence of a direct contractual relationship with the hospital, stating that insurance should be liable for payment.
The court clarified in its ruling reasons that the health insurance claims management company is jointly responsible with the insurance company for performing obligations towards third parties, whenever it undertakes the management of the claim and decides to reject it, which validates the lawsuit against it and holds it accountable for any errors in assessing the coverage.
The court also affirmed that health insurance regulations mandate coverage of emergency cases until medical stabilization, regardless of the causes of injury, considering that protecting human life takes precedence over contractual limitations, thus nullifying the rejection of coverage at this stage.
The court pointed out that the employer's responsibility arises directly from the law, which obligates them to bear the costs of emergency treatment for the sponsored in the absence of effective coverage or its refusal, confirming that their obligation is not limited to contractual relationships but extends to legal responsibilities associated with care for the sponsored.
The court addressed the matter of emails, affirming that an email sent by a company employee, even if not a manager, is considered a legal proof as long as it is issued in the framework of his usual work, especially with the hospital's reliance on it and continuation of the treatment based on it, which constitutes a binding commitment for the company as per 'apparent authority' principle.
After appointing an accounting expert, the court confirmed the validity of the debt and its amount, noting no prior payment, and was reassured by his report based on sound technical grounds.
The court affirmed that the defendants' refusal to pay the costs of emergency treatment constitutes a breach of the legal obligation and constitutes an error necessitating responsibility, especially with the proven damage suffered by the hospital due to the retention of large financial liquidity for a long period.
The court calculated the compensation due for the material and moral damages suffered by the plaintiff at an amount of AED 10,000, noting that the damage consisted of financial burdens, administrative costs, and delays in collecting due amounts, in addition to the moral impact associated with it.
The court concluded by obliging the defendants to jointly pay the full cost of treatment, compensation, and the statutory interest, confirming that the treatment of emergency cases should not become an undue burden on the healthcare provider.
• The sick worker suffered from severe injuries, including a comminuted fracture in the left femur and a fracture in the patella, along with complications consisting of a pulmonary embolism and other health disorders.
