THE LIABILITY OF THE INSURANCE COMPANY AGAINST THE INSURED FOR ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI) OF COVID-19

Abstract

The Indonesian government stated that the Covid-19 vaccination will be carried out simultaneously since January 13, 2021 in health facilities such as hospitals, clinics, health centers and other health service units. Patients who have been injected with the vaccine are not allowed to leave the health facility immediately and are advised to wait for 30 minutes to deal with Adverse Events Following Immunization (AEFI) of Covid-19 that cause various reactions or side effects to the body, from mild symptoms to serious body reactions  or allergic to the ingredients of the vaccine. The problem is if the insured experiences AEFI, is the insurance company obliged to pay the claim submitted by the insured? To answer this, the research method used is a normative approach by analyzing the applicable laws and regulations. Another method used is empirical-qualitative, namely by analyzing events in the community and conducting interviews. The result of this study that there were several cases of AEFI such as cellulitis, swelling, joint pain, headache, fever, urticaria, anaphylactic reactions, syncope and so on. For patients who experience AEFI and file an insurance claim, the insurance company as the insurer must carefully investigate whether the insurance claim submitted is in accordance with the provisions stipulated in the policy.  In addition, it is also necessary to pay attention to the good faith principle and to see the possibility of malpractice by the doctor or medical staff who carried out the vaccination, so that the insurer can file a claim for compensation to the doctor or related medical staff.