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2022 DIGILAW 767 (JHR)

Monika Kumari v. Union of India

2022-06-30

RAJESH SHANKAR

body2022
JUDGMENT : 1. The present writ petition has been filed for issuance of direction upon the respondents to pay a sum of Rs.50,00,000/- (rupees fifty lacs) to the petitioner under Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting Covid-19 (hereinafter to be referred as “the Scheme”) issued by the Ministry of Health and Family Welfare, Government of India vide order dated 28.03.2020 and circulated to all Chief Secretaries of the State/Administrators of Union Territories vide D.O. No. Z-21020/16/2020-PH dated 30.03.2020. Further prayer has been made for quashing and setting aside the decision communicated through E-mail dated 04.09.2020 to the Nodal Officer, Jharkhand Pradhan Mantri Garib Kalyan Package Insurance Scheme, whereby it has been decided that the deceased husband of the petitioner does not fall under the category of insured persons envisaged to be covered under the aforesaid scheme and hence found ineligible for the benefit. The petitioner has also prayed for issuance of direction upon the respondents to pay her interest at the rate of 9% per annum with effect from the date the same was payable till the date of actual payment. 2. The learned counsel for the petitioner submits that the husband of the petitioner was appointed as District Accounts Manager on contract basis. At the time of death, he was posted at Garhwa. In view of Covid-19 pandemic, an order contained in memo no.850 dated 24.03.2020 was issued by Civil Surgeon-cum-Chief Medical Officer, Garhwa- respondent no.6, whereby the husband of the petitioner was deployed as Nodal Officer to take timely action with respect to payments towards expenditure incurred in operation of isolation ward and quarantine centre at Garhwa as well as for making arrangement of articles as per requirement after taking approval of the said respondent. The Union of India floated the said Scheme and circulated it to the Chief Secretaries of all the State/Administrators of Union Territories vide D.O. dated 30.03.2020. Unfortunately, the husband of the petitioner died in harness on 27.05.2020 due to cardiac failure, while providing health care services to Covid-19 patients, and the death certificate was also issued to that effect. The petitioner raised claim for compensation on account of death of her husband under the said Scheme on 04.06.2020 in a prescribed format before the New India Assurance Company Limited-respondent no.7. The petitioner raised claim for compensation on account of death of her husband under the said Scheme on 04.06.2020 in a prescribed format before the New India Assurance Company Limited-respondent no.7. On perusal of the details relating to “the scheme” available in the form of frequently asked questions (FAQ’s) on the website of Ministry of Health and Family Welfare Department of health and Family Welfare, Government of India, it appears that the Scheme covers loss of life due to Covid-19 and an accidental death on account of Covid-19 related duty. Further, the term of “accident” has also been defined as question no.2, according to which an accident is sudden unforeseen and involuntary event caused by external, visible and violent means. 3. It is further submitted that since the husband of the petitioner died on duty while he was providing health care services to Covid-19 patients, his case is fully covered under the said Scheme. The petitioner being the widow of the deceased contractual employee approached different authorities of the Government seeking redressal of grievance with respect to payment of insurance claimed under the said Scheme however, vide communication made through e-mail dated 04.09.2020 addressed to the Nodal Officer, Jharkhand, PMGKP Insurance Scheme, the petitioner was found ineligible for the benefit under the aforesaid insurance scheme on the ground that her husband died due to cardiac arrest, which was not an accident to be treated under coverage of the comprehensive personal accident insurance scheme. It was thus observed that the deceased- husband of the petitioner did not fall in the category of insured person envisaged to be covered under the said scheme. 4. It is also submitted that as per the said Scheme all persons who were deployed to fight Covid-19 pandemic including private hospital staff and contractual/daily wages/ad hoc workers were covered under the scheme. Since the petitioner’s husband was appointed on contractual basis and was deployed to fight Covid-19 pandemic, the petitioner is entitled to be compensated under the said Scheme and the decision not to pay the claim amount to her is absolutely arbitrary and illegal. The petitioner’s husband died at the age of 45 years while taking care of Covid-19 patients in the quarantine centre leaving behind his wife, three minor children and old parents. Hence, the respondents by rejecting the petitioner’s claim for insurance amount has forced her and the dependents to lead a miserable life. The petitioner’s husband died at the age of 45 years while taking care of Covid-19 patients in the quarantine centre leaving behind his wife, three minor children and old parents. Hence, the respondents by rejecting the petitioner’s claim for insurance amount has forced her and the dependents to lead a miserable life. 5. Learned counsel for the respondent-State submits that after the death of the petitioner’s husband, the Director-in-Chief, Health Services, along with Deputy Director, Health Services-cum-Claim Certifying Authority, Health Services, Government of Jharkhand issued certificate vide memo no.1501 (RCH) dated 22.06.2020 on the basis of the report of the respondent no.6 and sent the recommendation for payment of insurance claim under the scheme to the respondent no.7 for needful. The Administrative Officer of the respondent no.7 vide e-mail dated 04.09.2020 informed the respondent no.8 that the deceased did not fall under the category of insured persons as envisaged to be covered under the Scheme in terms with the order dated 28.03.2020 issued by the Ministry of health and Family Welfare, Government of India as also the cause of death was connected to cardiac arrest which was not an accident as defined in question no.2 of the FAQ’s related to the said Scheme. 6. Learned counsel for the respondent no.7 submits that the present writ petition is not maintainable in the eyes of law, as the petitioner has alternative remedy of invoking jurisdiction of consumer forum or civil court as disputed questions of facts are involved in the same. It is further submitted that the petitioner’s husband died between 10:00 a.m. of 27.05.2020 and 8:00 a.m. of 28.05.2020 inside his house and his body was recovered by his father who went to there in the morning of 28.05.2020 where the deceased was staying alone. Since it was an unnatural death, inquest report was prepared on 28.05.2020 at about 8.15 a.m. wherein as per the statements of the witnesses it was mentioned that the death was caused due to medicine reaction. Post mortem of the body was also conducted and as per the opinion of the doctors, the death was due to cardiac failure. The viscera was, however, persevered and sent for further chemical examination. It is also submitted that death of the deceased was due to cardiac arrest while he was at rest in his residence, which is not covered under the said Scheme. The viscera was, however, persevered and sent for further chemical examination. It is also submitted that death of the deceased was due to cardiac arrest while he was at rest in his residence, which is not covered under the said Scheme. It is clear that the death of the petitioner’s husband was not on account of Covid-19 related duty and unless it is established that it was an accidental death on account of Covid-19 related duty, the respondent no.7 is not liable to pay the insured amount to the claimant. 7. The learned counsel for the respondent-Union of India submits that the policy of the said Scheme was purchased from the respondent no.7, having personal accident cover of Rs.50 Lakhs for about 22.12 Lakh public healthcare providers including community health workers who might have to be in direct contact and care of Covid-19 patients pelting them at the risk of being infected by this. The said Scheme was launched initially for 90 days with effect from 30.03.2020 and was subsequently extended from time to time. It is further submitted that the said Scheme is applicable to those; (a) Who had been requisitioned by the States/Central hospitals/autonomous hospitals of Central/States/UTs, AIIMS & INIs/hospitals of Central Ministries on account of unprecedented situation and entrusted with Covid-19 related responsibilities. (b) Who were working as front-line health workers and might have come in direct contact of Covid-19 patients and who might be at risk of being impacted by this. (c) Whose loss of life occurred due to Covid-19 or accidental death on account of Covid-19 related duty. 8. It is thus submitted that death due to cardiac arrest cannot be termed as death due to an accident on account of Covid-19 related duty as defined under the said scheme and as such the claim of the petitioner is not admissible. Only those claimants who meet the criteria of being eligible under the Scheme can only be given benefit of the said Package. 9. Heard learned counsel for the parties and perused the materials available on record. The contention of the petitioner is that her husband was District Accounts Manager, working under respondent no.6 as one of the workers fighting Covid-19 pandemic who died on duty due to cardiac failure and as such she is entitled to get the benefit of insurance claim under the said Scheme. 10. The contention of the petitioner is that her husband was District Accounts Manager, working under respondent no.6 as one of the workers fighting Covid-19 pandemic who died on duty due to cardiac failure and as such she is entitled to get the benefit of insurance claim under the said Scheme. 10. The respondents have refuted the claim of the petitioner on the ground that the deceased was not covered under the said Scheme since he died in home due to cardiac arrest which cannot be termed as accidental loss of life on account of Covid-19 related duty. 11. To appreciate the rival contentions of the parties, it would be appropraite to refer the said Scheme, which reads as under:- “As per the announcement made under the Pradhan Mantrl Garib Kalyan Package, the competent authority has approved the launch of 'Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19' with the following conditions:- i. It will be a comprehensive personal accident cover of Rs. 50 fakh for ninety (90) days to a total of around 22.12 lakh public healthcare providers, including community health workers, who may have to be in direct contact and care of COVlD-19 patients and who may be at risk of being impacted by this. It will also include accidental loss of life on account of contracting COVID-19.; ii. On account of the unprecedented situation; private hospital staff retired/volunteer/local urban bodies/contract/daily wage/ad-hoc/outsourced staff requisitioned by States/Central hospitals/autonomous hospitals of Central/States/UTs, AIIMS & INls/hospitals of Central Ministries can also be drafted for COVID-19 related responsibilities. These cases will also be covered subject to numbers indicated by MoHFW; iii. The scheme will be funded through the NDRF Budget operated by the Health Ministry for this purpose; iv. Actual payment by the Insurance Company to the beneficiary will be under certification of the authorised Central/State Government Officials and v. The insurance provided under this scheme would be over and above any other insurance cover being availed by the beneficiary.” 12. The Government of India, Ministry of Health and Family Welfare, Department of health and Family Welfare in the form of FAQ’s has explained that the said Scheme covers; Loss of life due to COVID-19, and accidental death on account of COVID-19 related duty. The Government of India, Ministry of Health and Family Welfare, Department of health and Family Welfare in the form of FAQ’s has explained that the said Scheme covers; Loss of life due to COVID-19, and accidental death on account of COVID-19 related duty. The term “accident” has also been defined in question no.2 of FAQs according to which “accident is sudden, unforeseen and involuntary event caused by external, visible and violent means.” The persons who are covered under the said Scheme are “Public healthcare providers including community health workers, who may have to be in direct contact and care of COVID-19 patients and who may be at risk of being impacted by this. Private hospital staff and retired/volunteer/local urban bodies/contracted/daily wage/ad-hoc/outsourced staff requisitioned by States/Central hospitals/autonomous hospitals of Central/States/UTs, AIIMS and INIs/hospital of Central Ministries can also be entrusted with COVID 19 related responsibilities in the unprecedented situation. 13. In the present case the deceased was a contractual employee, who was deployed in Isolation Ward and Quarantine Centre at Garhwa as Nodal Officer to take timely action with respect to payments towards expenditure incurred in operation of isolation ward and quarantine centre at Garhwa as well as for making arrangement of articles as per requirement after taking approval of the said respondent and thus was not in direct contact and care of Covid-19 patients. The claim of the petitioner is that her husband died while discharging Covid-19 related duty, whereas the respondents have contended that the deceased died due to cardiac arrest at home and as such at the relevant point of time he was not on duty. The petitioner has failed to bring on record sufficient evidence before to substantiate that her deceased husband lost his life either due to Covid-19 infection or met accidental death due to Covid-19 related duty. This court is of the view that mere death during subsistence of the said Scheme is not sufficient to make the dependent of the deceased entitled to claim insurance amount unless it is shown with sufficient evidence that the death was due to Covid-19 related duty which is a mandatory condition for payment of insurance amount under the said scheme. This court is of the view that mere death during subsistence of the said Scheme is not sufficient to make the dependent of the deceased entitled to claim insurance amount unless it is shown with sufficient evidence that the death was due to Covid-19 related duty which is a mandatory condition for payment of insurance amount under the said scheme. Since both the parties have their own factual plea on the point of death of the petitioner’s husband and there is no sufficient evidence before this court to come to a conclusive finding that he died due to Covid-19 related duty, the relief claimed by the petitioner cannot be granted under the extraordinary writ jurisdiction. Moreover, if the petitioner’s husband died due to cardiac arrest, the same has not been considered as an accidental death as defined in the FAQ’s uploaded by the Ministry of Health and Family Welfare, Department of Health and Family Welfare, Government of India. It further appears that the father of the deceased himself had expressed his apprehension that his son might have died due to medicine reaction consumed by him. That apart, the inquest report of the deceased indicated unnatural death due to reaction of medicine and not an accidental death as claimed by the petitioner. 14. Under the facts and circumstances of the case, I am of the view that in absence of the sufficient evidence on record to suggest that the petitioner’s husband lost his life due to COVID-19 infection or due to accident on account of COVID-19 related duty, no writ of mandamus can be issued to the respondents as prayed by the petitioner. 15. The writ petition is, accordingly, dismissed.