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2014 DIGILAW 4568 (MAD)

Regional Director, Employees State Insurance Corporation v. D. Rajendran

2014-12-10

S.VAIDYANATHAN

body2014
JUDGMENT : S. Vaidyanathan, J. 1. These appeals arise out of the orders passed by the learned II Addl. District Judge-Cum-Employees Insurance Court, Pondicherry in E.S.I. Appeal Nos. 1 of 2009, 2 of 2010 and 1 of 2008, dated 20.6.2012, 19.6.2012 and 22.6.2012 respectively, in and by which, the Employees State Insurance Corporation, the appellant herein has been directed to pay the permanent disablement benefit to the injured employees as per the assessment made by the Medical Board of JIPMER, against the decision of the Medical Board of the Employees' State Insurance Corporation (in short, 'ESI Corporation'). The respondents 1, 3 and 4 herein are the employees, covered under ESI Scheme and during the course of employment, they sustained injuries, which resulted in permanent disability. On examination, the Medical Board of the ESI Corporation has determined the permanent disability in respect of respondents 3 and 4 is at 10% and 22.5% respectively and in respect of respondent No. 1, 'no permanent disability' and issued Certificates. The employees were paid with temporary disablement benefit. However, not being satisfied with the assessment made by the Medical Board, the employees preferred the above said appeals before the ESI Court, praying to set aside the report of the Medical Board and grant the permanent disablement benefit throughout their life. 2. While exercising the power conferred upon it under Section to be referred to a Medical Board other than the Medical Board of ESI Corporation. While exercising the power conferred under Section 54-A(1) of the Employees' State Insurance Act (in short, 'ESI Act'), the Tribunal has referred the injured employees to the Medical Board of JIPMER, which in turn, on examination of the injured/respondents 1, 3 and 4, assessed the disability to 12%, 28% and 29.15% respectively and accordingly issued reports. Based on the said reports and on evaluation of the evidence available before it, the Tribunal has awarded compensation, directing the appellant to pay the permanent disablement benefit to the injured employees as per the respective assessment of disablement determined by the Medical Board of JIPMER. Aggrieved by the same, the Regional Director, ESI Corporation has come forward with the present appeals. 3. Challenging the orders of the Tribunal, Mr. Aggrieved by the same, the Regional Director, ESI Corporation has come forward with the present appeals. 3. Challenging the orders of the Tribunal, Mr. G. Bharadwaj, learned counsel appearing for the appellant, would contend that the Medical Board of the ESI Corporation has been constituted under Section 54 of the E.S.I. Act, to probe into the question of disablement of the insured employee, its nature; temporary or permanent and the extent of loss of earning capacity and Employees State Insurance Court ought not to have interfered with the conclusions arrived at by the Medical Board of the ESI Corporation and without giving any reasons for not accepting the disability certificate issued by the Medical Board of the Corporation, the Insurance Court ought not have accepted the disability certificate produced by the insured employee issued by JIPMER. He also contended that it is not safe to overrule the opinion of the Medical Board since the members of the Board are technically qualified to assess the disablement and no purpose would be served in continuing the Medical Board if its reports are not accepted. He also contended that if the reports other than the Medical Board are allowed and accepted, it will open a flood-gate for diverse reports and it will be difficult for the Insurance Court to decide the matter. He pointed out that in respect of the insured employee/respondent No. 1 in CMA 2855 of 2012, though the Medical Board gave the report assessing the disability 'Nil' since the employee has not suffered any permanent disability, however, the Insurance Court has accepted the report of the JIPMER, without taking into consideration the fact that the injury sustained by him is not the one included in the list of injuries in Part I of the Second Schedule. 4. In support of his contentions, the learned counsel for the appellant relied upon the decisions, viz., (a) E.S.I.C. Vs. K.K. Pushkaran, (1994) ACJ 492, Wherein, the Kerala High Court, while dealing with similar matter, has held in para 5 and 8 as under: "5. As provided under Section 54-A, the Employees' Insurance Court will have to determine the extent of loss of earning capacity of the insured person. The circumstance that the employer is refusing employment even though the Medical Board determined the employee's disablement at 20 percent, can only be one of the factors to be taken into account. As provided under Section 54-A, the Employees' Insurance Court will have to determine the extent of loss of earning capacity of the insured person. The circumstance that the employer is refusing employment even though the Medical Board determined the employee's disablement at 20 percent, can only be one of the factors to be taken into account. But, it is not safe to overrule the opinion of the Medical Board, members of which are technically qualified to assess the disablement, without further evidence. If the party is unable to produce such evidence before the Court, normally the Court should hold that there is no material to interfere with the finding of the Medical Board. Here, the employee is challenging the decision of the Medical Board. The burden of establishing that the finding of the Medical Board was not proper is on the employee. There is very little scope for the Court, which is not technically equipped, to assess the quantum of disablement or to interfere with the finding of the Medical Board on grounds which are not established before it or on compassionate grounds which cannot be tested by the superior court. .................. "8. In cases where the claim is on the basis that the employee has suffered permanent total disablement as defined under Section 2(15-B) of the Act, if the injury is not one included in the list of injuries in Part I of the Second Schedule, whether the employee has suffered permanent total disablement will be a question of fact to be proved before the Court. The Court has to examine whether the disablement is of such a character that the person concerned is unable to do any work and not only the work which he was doing at the time of the accident...." (b) Employees State Insurance Corporation Vs. Lallan (Ins. No. 21/1138932), (2006) 3 LLJ 595 , wherein, the High Court of Allahabad has held in para 9 as under: "9. The 'Act' does not provide for an examination of the injured person to decide the Disablement benefit by any other doctor or hospital except the Medical Board constituted under the Act. If reports from a private doctor or of hospital are allowed, it will open a flood-gate for diverse reports and there will be chaos and confusion and it will be difficult for the Court to decide the matter. If reports from a private doctor or of hospital are allowed, it will open a flood-gate for diverse reports and there will be chaos and confusion and it will be difficult for the Court to decide the matter. Since the 'Act' has provided for a Medical Board and also for an appeal before the Medical Appellate Tribunal, it is these two only which have the authority to give Reports, with regard to the injury of an employee. (c) Vasudevan Nair Vs. Regional Director, ESIC, (1992) 1 LLJ 359, wherein, the High Court of Kerala has held as under: "9. We say all these, since we feel that in this case, the Employees' Insurance Court has forgotten to decide the correctness of the determination of the disability by the medical board. In fact, the focus of the appeal is the question of the correctness of the determination of disability by the medical board. Section 54-A of the Act is the power source of the Employees' Insurance Court to decide the question of disability. "10. In this case, the Employees' Insurance Court has not considered the question whether the determination of the Medical Board as to the disability of the insured is correct or not. It directed its attention to find out whether there is any economic loss sustained by the insured worker, and came to the conclusion that when the matter was decided, the insured worker was getting a higher remuneration. Why he was able to get a higher remuneration and what are the circumstances which made it possible for the insured worker to get a higher remuneration were not adverted to by the Employees' Insurance Court. The Employees' Insurance Court has not discussed the evidence regarding the disability." 5. Why he was able to get a higher remuneration and what are the circumstances which made it possible for the insured worker to get a higher remuneration were not adverted to by the Employees' Insurance Court. The Employees' Insurance Court has not discussed the evidence regarding the disability." 5. On the other hand, the learned counsel appearing for the insured employees would contend that there is no irregularity in the order of the Employees Insurance Court in accepting the medical report other than that of the Medical Board of the ESI Corporation while exercising its discretionary power under Section 54-A of the Act in case of it is not satisfied and more over, having allowed the preliminary order of the ESI Court in referring the matter to JIPMER and having participated in the proceedings and after the final outcome of the ESI Court, the appellant cannot now take U turn and contend that the ESI Court ought not to have accepted the said report of the other hospital. He also contended that there is no substantial question of law is involved in these appeals in order to interfere with the same. Hence, the learned counsel sought for dismissal of the appeals. 6. Heard the learned counsel on either side and perused the entire materials on record. 7. The preliminary contention raised by the learned counsel for the insured employees that having accepted the preliminary order in referring the matter to JIPMER by the ESI Court for assessing disability and having participated in the proceedings without raising any objections, after final orders accepting the medical reports of the said JIPMER by the ESI Court, the appellant cannot take U turn and contest the same, is not acceptable for the reason that the appellant cannot approach this Court based on the preliminary order of the ESI Court in referring the matter to JIPMER since it was a premature stage and there is every likelihood of accepting or rejecting the report of the JIPMER by the ESI Court and therefore, the appellant is right now in questioning the same in these appeals. 8. 8. The only ground of attack in these present appeals urged by the learned counsel for the ESI Corporation is that de-horsing the report of the Medical Board of the ESI Corporation, the ESI Court ought not to have accepted the medical reports of JIPMER and it should not normally interfere with the conclusions arrived at by the Medical Board except those are based on no valid material or they are perverse or otherwise vitiated by reason of any mistake of law or of fact. 9. Section 54 of the Act enables the Medical Board constituted in accordance with the provisions of the Regulations to determine the question of disablement referred to it by the Corporation and to assess the loss of earning capacity of the insured person. 10. It is relevant to refer the proviso to Section 54(A) which reads as under: "54(A). References to Medical Boards and appeals to Medical Appeal Tribunals and Employees' Insurance Courts - (1) The case of any insured person for permanent disablement benefit shall be referred by the Corporation to a Medical Board for determination of the disablement question and if, on that or any subsequent reference, the extent of loss of earning capacity of the insured person is provisionally assessed, it shall again be so referred to the Medical Board not later than the end of the period taken into account by the provisional assessment. (2) If the insured person or the Corporation is not satisfied with the decision of the Medical Board, the insured person or the Corporation may appeal in the prescribed manner and within the prescribed time to- (i) the Medical Appeal Tribunal constituted in accordance with the provisions of the regulations with a further right of appeal in the prescribed manner and within the prescribed time to the Employees' Insurance Court, or (ii) the Employees' Insurance Court directly; Provided that no appeal by an insured person shall lie under this sub-section if such person has applied for commutation of disablement benefit on the basis of the decision of the Medical Board and received the commuted value of such benefit; Provided further that no appeal by the Corporation shall lie under this sub-section if the Corporation paid the commuted value of the disablement benefit on the basis of the decision of the Medical Board." 11. A reading of the above, it is clear that sub-section (1) of Section 54-A of the Act requires the Corporation to refer the case of an insured person seeking permanent disablement benefit to Medical Board to decide the disablement question and assess the loss of earning capacity of such person. Sub-section (2)(i) thereof enables the insured person or the Corporation, as the case may be, if not satisfied with the decision of the Medical Board, to go up in appeal to the Medical Appeal Tribunal constituted in accordance with the provisions of the Regulations and similarly to go up in further appeal to the ESI Court. However, sub-section (2)(ii) thereof also enables the insured person or the Corporation, as the case may be, if dissatisfied with the decision of the Medical Board, to go up in appeal directly to the ESI Court. 12. Section 55 of the Act, thereafter, provides for review of the decision by the Medical Board or Medical Appeal Tribunal, if there are circumstances warranting such review. 13. It is no doubt true that the Medical Board is the original forum constituted under the Act to decide the question whether the employment injury suffered by the injured person has resulted in permanent disablement of such person and if so, what is the extent of loss of his earning capacity. However, it is to be noted that nowhere in the Act, it is envisaged that the decision of the said Medical Board is final and binding upon the parties. Sub-section (2)(i) thereof enables the insured person or the Corporation, as the case may be, if not satisfied with the decision of the Medical Board, to go up in appeal to the Medical Appeal Tribunal constituted in accordance with the provisions of the Regulations and similarly to go up in further appeal to the ESI Court. However, sub-section (2)(ii) thereof also enables the insured person or the Corporation, as the case may be, if dissatisfied with the decision of the Medical Board, to go up in appeal directly to the ESI Court. 14. Further, Section 75 of the Act provides the ESI Court to decide the matters as listed therein and Sub-section 2 of it, is relevant and it is extracted as under: "75(2-A). 14. Further, Section 75 of the Act provides the ESI Court to decide the matters as listed therein and Sub-section 2 of it, is relevant and it is extracted as under: "75(2-A). If in any proceedings before the Employees' Insurance Court a disablement question arises and the decision of a medical board or a medical appeal tribunal has not been obtained on the same and the decision of such question is necessary for the determination of the claim or question before the Employees' Insurance Court, that Court shall direct the Corporation to have the question decided by this Act and shall thereafter proceed with the determination of the claim or question before it in accordance with the decision of the medical board or the medical appeal tribunal, as the case may be, except where an appeal has been filed before the Employees' Insurance Court under sub-section (2) of Section 54-A in which case the Employees' Insurance Court may itself determine all the issues arising before it." 15. Therefore, the ESI Court, for the purpose of deciding the quantum of disablement, is not barred from estimating and fixing its own percentage of loss of earning capacity of an insured person resulting from an employment injury suffered by him for arriving at just extent of disablement benefit to which he is entitled to under the Act. Further, the ESI Court may itself determine all the issues arising before it, de-horsing the decision taken by the medial Board or medical appeal Tribunal and even in the absence of any report, it can independently render a decision regarding the percentage of disability based on which, loss of earning capacity. Having regard to the same, I am not in agreement with the decisions referred to by the learned counsel for the appellant. In fact, the Act itself is a beneficial one and it is settled law that the Courts should always give liberal and purposive interpretation without resorting to technical and constructive interpretation. In the present case, the ESI Court, on application made by the insured employees being dissatisfied with the assessment of the Medical Board, referred them to the JIPMER for getting opinion on disablement of the injured. In the present case, the ESI Court, on application made by the insured employees being dissatisfied with the assessment of the Medical Board, referred them to the JIPMER for getting opinion on disablement of the injured. It is not in dispute that the insured employees had sustained permanent disability during their employment and the JIPMER has given its reports assessing permanent disability of the respective employees which was proved by the evidence of the Doctor. Based on the said material and having regard to the evidence and the nature of injury and pain undergone by the injured, the ESI Court has fixed the quantum of permanent disablement, which in my opinion, is a finding of fact rendered after appreciation of evidence and in view of the categorical pronouncement of the Hon'ble Apex Court in Syed Yakoob Vs. K.S. Radhakrishnan and Others, AIR 1964 SC 477 , requires no interference of this Court. Therefore, I do not find any question of law much-less substantial question of law in these appeals in order to entertain the same. For the reasons stated supra, these appeals fail and they are dismissed. No costs.