Through Judgment No. 68001-23-33-000-2016-00649-0 of February 3rd, 2025, the Third Section, Subsection C, of the Administrative Litigation Chamber of the Council of State (hereinafter, the “CE”) ruled on an appeal filed by a regional hospital, insured under a civil liability insurance, and the relevant insurance company.
In terms of insurance law, the case addressed two key issues: (i) the statute of limitations for the third-party claim against the insurer, and (ii) the coverage of the civil liability insurance, particularly whether it covered damages arising from an alleged failure in the provision of healthcare services.
Facts:
The dispute arose from the medical care provided to a minor who visited the regional hospital on February 13, 2014, due to symptoms affecting his health. Initially, he was discharged, but as his condition worsened, he returned to the hospital, where a transfer to a higher-level facility was ordered. However, the delayed transfer resulted in complications that ultimately led to the amputation of an organ.
On November 30, 2015, the minor’s mother filed an extrajudicial claim against the hospital through an extrajudicial conciliation hearing. However, there was no willingness to settle the dispute between the parties.
In March 2016, the minor’s mother filed a lawsuit against the hospital, seeking to establish its liability for the damages caused by the lack of timely medical care.
Subsequently, on December 17, 2017, the hospital filed a third-party claim against the insurer, asserting that the loss at issue was covered under its civil liability insurance.
Procedural History:
In the first instance, the Administrative Tribunal of Santander held the hospital liable for the damages caused by the delayed referral of the patient and ordered compensation for the victim. It also found the insurer liable for payment under the civil liability insurance.
On appeal, the CE upheld the hospital’s liability but overturned the ruling against the insurer, concluding that the insurance did not cover medical liability and that the legal action arising from the insurance contract was time-barred based on the following:
Considerations:
- The damage resulted from the doctor-patient relationship, not non-contractual civil liability:
The CE applied the presumption of fault in the provision of medical services, determining that the harm resulted from medical malpractice arising from the doctor-patient relationship. It concluded that the delay in the patient referral and the failure to provide timely treatment constituted a deficiency in medical care, thereby excluding the case from the scope of non-contractual civil liability. The harm did not originate from an external event but rather from the inadequate provision of healthcare services.
"(...) in cases of damages caused in the provision of medical and hospital care services, the Third Section of the Council of State, after applying evidentiary rules on the presumption of medical fault and the distribution of evidentiary burdens, established the general rule of proven service failure. In this framework, the plaintiff must prove the involvement of medical action, the existence of errors, omissions, or negligence in such action, and that it was the adequate cause of the alleged damage."
(...)
"The presumption of service failure removes from the evidentiary debate very relevant issues, such as the distinction between facts that may be classified as omissions, delays, or deficiencies and those that are mere consequences of the patient’s pre-existing condition."
- The non-contractual civil liability insurance did not cover professional liability:
The CE analyzed the terms of the hospital’s insurance and determined that it did not include coverage for professional liability. The insurance solely covered risks typically associated with non-contractual civil liability and did not explicitly extend to medical or administrative failures in the provision of healthcare services.
"The third-party claimant (...) also appealed the first-instance ruling. It argued that the policy entered into between the Hospital (...) and [the insurer] did not cover potential medical non-contractual liability or failures related to administrative actions or procedures within the healthcare system, which was the reason for the IPS’s liability. Indeed, according to the appellant, Policy No. 1001200—which served as the basis for the third-party claim and was submitted as an annex—lacked coverage because the contractual object only covered what was described in the policy’s specific and general conditions, meaning it was not a universal policy."
- Statute of limitations for the third-party claim:
The CE upheld the insurer’s statute of limitations defense, applying a strict interpretation of Article 1131 of the Colombian Commercial Code. This provision establishes that the statute of limitations for claims brought by the insured— in this case, the hospital—begins to run from the moment the victim or beneficiary files a judicial or extrajudicial claim.
In this case, the minor’s mother filed an extrajudicial claim (settlement hearing) on November 30, 2015. However, the hospital filed the third-party claim on December 17, 2017, exceeding the two-year limitation period established in Article 1081 of the Colombian Commercial Code.
"Furthermore, the Tribunal misinterpreted the statute of limitations for actions, rights, and obligations under the insurance contract as provided in Article 1081 of the Commercial Code. In this regard, the appeal stated:
Moreover, inexplicably and contradictorily, the lower court, when resolving the controversy regarding the phenomenon of the statute of limitations on actions, rights, and obligations under the insurance contract, despite acknowledging that in this case the ordinary two-year (2) statute of limitations set forth in Article 1081 of the Commercial Code applied and clearly indicating the starting date of the limitation period (November 30, 2015) along with the expiration date (November 30, 2017), irrationally held that despite the third-party claim being filed on December 17, 2017—undeniably beyond the two-year (2) period—(...)."
If you wish to consult Judgment No. 68001-23-33-000-2016-00649-0 of February 3, 2025, click here.