The High Court ordered AAR Insurance to pay Ksh2.1 million in medical bills following a traumatic childbirth that left her with life-threatening complications and financial distress.
The petitioner, Naomi Wangui Mwangi, delivered her baby via caesarean section at The Nairobi Hospital in February 2018.
However, the joyous occasion quickly turned into a nightmare when she developed severe complications, including a colon perforation that required a second surgery.
Her condition worsened with a bout of hospital-acquired pneumonia, forcing her to remain admitted long after her expected discharge.
As the hospital bill accrued to over Ksh2.19 million, Naomi claimed she and her newborn were effectively detained due to the unpaid balance.
Her insurer, AAR, declined to cover the additional costs, insisting it had already paid the Ksh245,000 maternity sub-limit of her plan, despite her overall inpatient cover being Ksh10 million.
The Petitioner depones that they were detained at the 2nd Respondent due to her inability to pay the now outstanding bill of Ksh2,119,585. The Petitioner is aggrieved as she attributes the accrued to the negligent acts of the 1st and 2nd Respondent.
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Court Rules in Favor of Doctor and Hospital
In its judgment, the Court dismissed Naomi’s claims against her doctor, Brigit Monda, and The Nairobi Hospital, finding no evidence of medical negligence or unlawful detention.
“She did not cooperate with us when we were in the hospital. She even gave us the medical report. After surgery, she just disappeared.
“If she did the right thing, I could not have accumulated that Bill. Whatever made me detained in the hospital was the second surgery,” Naomi said on Dr. Brigit Monda’s treatment.
According to Justice Lawrence Mugambi, the hospital’s decision to keep her admitted was due to her critical medical needs and not an attempt to enforce debt payment.
“Considering her overall in-patient medical cover had been not exceeded, that action by 3rd respondent was unconscionable. I consider the maxim “Equity suffers no wrong to be without a remedy” to apply in this case.
“The Petitioner had a right to have this medical bill cleared based on the cover she had in respect of additional hospitalization that followed after prior authorization for admission,” the Judge stated.
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Ruling Against AAR Insurance
However, the Court ruled that AAR Insurance’s refusal to settle the hospital bill was unconscionable, unreasonable, and an act of bad faith insurance practice.
The judge ordered the insurer to clear the Ksh2,192,887 balance, noting that post-delivery emergency complications were covered under Naomi’s overall inpatient limit and should never have been excluded.
A declaration is hereby issued that the 3rd Respondent’s rejection to settle medical bill incurred in respect of additional hospitalization of the Petitioner in the circumstances of this case is unconscionable, unreasonable and a an act of bad faith insurance practice that is unlawful and legally unenforceable.
The 3rd Respondent is hereby ordered to clear the outstanding medical bill of Ksh2,192,887 arising from additional hospitalization of the Petitioner due to post-delivery complications as it falls within the total overall inpatient medical cover limit available to the Petitioner.
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