在集体医疗政策纠纷中,住宅设施是“医院”。

C Wasilewski
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引用次数: 0

摘要

一所治疗患有功能性神经紊乱的青春期前儿童的住宅设施被认为是一所"医院",以便在集体医疗保险政策的承保范围内,尽管它缺乏内部手术设施,也没有由注册护士提供24小时护理服务。保险公司放弃了对手术设备的要求。此外,由于有关政策没有包含“护理服务”的定义,因此没有要求这些服务必须由注册护士每天24小时提供。因此,被保险人有权报销其儿子在收容设施的治疗费用。但恶意索赔被驳回,因为保险人对其保单的解释没有发现不合理。
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Residential facility is "hospital" in group medical policy dispute.

A residential facility that treated preadolescent children suffering from functional nervous disorders was considered to be a "hospital" for purposes of coverage under a group medical insurance policy, despite the fact that it lacked an on-premises surgical facility and did not provide 24-hour nursing services by registered nurses. The insurance company had waived the surgical facility requirement. Additionally, since the policy in question did not contain a definition of "nursing services," there was no requirement that these services be provided 24 hours a day by registered nurses. Thus the insureds were entitled to coverage of the treatment for their son in the residential facility. But a bad faith claim was denied because the insurer's interpretation of its policy was not found to be unreasonable.

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