Executive Director/Nodal Officer, Comprehensive Health Insurance Agency of Kerala v. Devarajan
2025-08-25
AMIT RAWAL, P.V.BALAKRISHNAN
body2025
DigiLaw.ai
JUDGMENT : AMIT RAWAL, J. JUDGMENT [WA Nos. 9/2025, 13/2025, 17/2025, 32/2025, 38/2025] 1. This order shall dispose of four intra court appeals preferred by the appellant - Executive Director/Nodal Officer of an Agency established under the Comprehensive Health Insurance Agency of Kerala (CHIAK) against the judgment dated 13.12.2024 arising out of four writ petitions bearing Nos.19989 of 2019, 19990 of 2019, 19993 of 2019 and 20002 of 2019. 2. All the respondents in the writ petitions as well as present writ appeals are the legal heirs of various persons who were categorized under the Rashtriya Swasthya Bhima Yojana (RSBY) health insurance scheme, which was implemented by the State of Kerala vide order dated 04.07.2008 on the basis of its launch by the Central Government. It is an insurance scheme providing an annual medical insurance cover for maximum amount of Rs.30,000/- (Rupees Thirty thousand only) for a family of five members, which can be taken from the empanelled Government/ESI/Private Hospitals based on the package rates, with the liberty to the Government to verify the eligibility of the beneficiary, BPL workers and their family members. A comprehensive health insurance scheme was also ordered to be implemented jointly by the labour and rehabilitation department (labour), health and family welfare department(health), and for the comprehensive health insurance company, by a committee consisting of five persons. 3. Subsequently, on 10.01.2014 Government of Kerala, Labour and Skills (J) Department issued an order specifying that the high Power Supervising Council meeting of CHIAK held on 26.08.2013 had decided to disburse the Personal Accident Death Claim amounting to Rs.2,00,000/- (Rupees Two lakh only) from the administrative fund of CHIAK for the financial year 2013-14 to the legal heirs in the case of the accidental death of the head of family or spouse of RSBY/CHIS families and Assistant District Co-ordinators was directed to verify the claims of the beneficiaries. Contents of the Government Order dated 10.01.2014 reads as under: “The High Powered Supervisory Council meeting CHIAK read as 1 st paper above has decided to disburse the Personal Accident Death Claim amounting to Rs.2,00,000/- (Rupees Two Lakhs Only) from the administrative fund of CHIAK for this financial year to the legal heirs in the case of Accidental death of Head of family or Spouse of RSBY/CHIS families.
It was also decided to authorise the Assistant District Co- ordinators of CHIAK to verify the Personal Accident Death Claims to the beneficiaries in the meeting read as 2 nd paper above. CHIAK by its letter read as 3 rd paper above has requested the Government to validate the above decision. Government have examined the matter in detail and are pleased to accord sanction to disburse the amount of Rs.2,00,000/- (Rupees Two Lakhs only) from the administrative fund of CHIAK for the current financial year (2013-14) to the legal heirs in the case of Accidental death of Head of family or Spouse of RSBY/CHIS Scheme. The following instructions regarding verification and disbursement of Personal accident Death claims are also issued.:- (i) The Assistant District Co-ordinators will invariably verify the respective Personal Accident Death Claims of RSBY/CHIS card beneficiaries with the original of the documents detailed below and to forward the attested copies of the same to CHIAK for release of claims with their report. 1. FIR 2.Post-mortem Certificate 3. Death Certificate 4. Legal Hiership Certificate issued by the concerned tahsildar 5. RSBY Card 6. Ration Card (ii) CHIAK will release the amounts only after verifying the details of the deceased person available inteh database of CHIAK and verifying the required documents forwarded to CHIAK by the Assistant District Co-ordinators. (iii) The details will be placed in the Executive Committee for ratification after releasing of claims and will be intimated to Government in due course. (iv) The President, CHIAK will monitor the process of releasing Personal Accident Death claims without delay.” 4. The benefit of the aforementioned scheme was extended vide order dated 10.02.2016 till 2015-16. In all these cases, the earning members of the family had died either in accidents/road accidents or falls but were deprived of the benefit of the RSBY Scheme or CHIS Scheme, though as per the aforementioned order applications were required to be submitted to the CHIAK. As per the pleadings before the Government, were constrained to approach the Lok Adalath under Section 22C of the Kerala Legal Services Authorities Act , 1989. 5.
As per the pleadings before the Government, were constrained to approach the Lok Adalath under Section 22C of the Kerala Legal Services Authorities Act , 1989. 5. The aforementioned claims were resisted by the appellants – writ petitioners on various grounds, including jurisdiction in view of the contents of the letter dated 12.05.2017 whereby the department of Labour and Skill had informed the Executive Director that Financial Assistance on Accidental Death do not include in the RSBY Scheme or CHIS Scheme on the premise that the financial assistance on accidental death benefit was provided by some insurance companies as additional benefit to RSBY or CHIS card holders. 6. Learned Lok Adalat overruling the objections, accorded the benefits to the applicants by noticing that even during the cross examination of the witnesses of the writ petitioner who were arrayed as respondents admitted to have received the application in their department. Another objection taken was that the applications were belated much less after 2017 and in view of the letter dated 15.05.2017, could not have been entertained, therefore Lok Adalat was having no jurisdiction to entertain and decide the lis. Negating the aforementioned argument Lok Adalath awarded the compensation in all the cases to the tune of Rs.2,00,000/- (Rupees Two lakhs only) as the accidents in all these cases had occurred in the year 2014-15 and as per the extension of the RSBY Scheme and CHIS Scheme was extended vide order dated 10.02.2016 till financial year 2015-16. The contents of the aforesaid order reads as under: “Read:- 1) G.O. (Rt) No. 43/2014/LBR dated 10/1/2014 2) Minutes of the meeting held on 14/12/2015 3) Letter No. 011/CH6/2016/CHIAK/HPSC dated 06/01/2016 As per the G. O, read as first paper above Government invited orders to disburse the amount of Rs. 2,00,000/- from the administrative fund of CHIAK for the financial year 2013-14 to the legai heirs in the case of accidental death of the Head of the family or spouse of RSBY/CHIS families. The High Powered Supervisory Council meeting of CHIAK read as second paper above has suggested for continuance of the above scheme during 2015-16 also. The meeting also suggested to incorporate the following additional guidelines regarding the schemes. 1.
The High Powered Supervisory Council meeting of CHIAK read as second paper above has suggested for continuance of the above scheme during 2015-16 also. The meeting also suggested to incorporate the following additional guidelines regarding the schemes. 1. The accident death includes any unnatural death which means death due to injuries by machines, vehicles, animals including reptiles and due to occupations, fall from height-accidentally and during occupation, accidental drowning, accidental hanging, accidental poisoning, accidental burns and accidental trauma and asphyxia due to occupational and accidental choking with exception of suicide and murder. 2. The accidental death has to be evidenced by necessary documents as and when needed. 3. The personal accident death claim can be claimed only for the accidental death of the head of the family or spouse of the RSBY/CHIS family as per RSBY/CHIS registered data submitted at the time of registration. Only one claim will be entertained per financial year for a smart card. In the circumstances, Government are pleased to accord sanction for continuance of the scheme for personal accident death claim for RSBY/CHIS card holders during 2015-16 incorporating the above suggested additional guidelines while the other conditions as per G.O. read as first paper will remain unaltered.” 7. The Nodal Agency i.e., CHIAK through its Executive Director/Nodal Officer challenged the award of the Lok Adalat before the Single Bench resulting into dismissal and hence present intra court appeals. 8. Mr.A.Velappan Nair, learned counsel appearing on behalf of the appellant in support of the intra court appeals laying challenge to the judgment of the learned Single Bench and the order of the Permanent Lok Adalat, raised the following submissions: (i) In view of the letter dated 12.05.2017, the benefit of RSBY/CHIS has not been extended in respect of the personal accident death of the persons falling under the BPL category or defined under the RSBY as per the scheme launched by the Central Government and adopted by the State Government on the premise that those benefits are being entertained and extended by various insurance companies. (ii) Lok Adalath cannot entertain such application in view of the findings of the Lok Adalat of Kozhikode rendered in O.P.No.42/2017 . (iii) The applications were never submitted to the Department, but directly approached the permanent Lok Adalath. 9. We have heard learned counsel for the parties and appraised the paper books. 10.
(ii) Lok Adalath cannot entertain such application in view of the findings of the Lok Adalat of Kozhikode rendered in O.P.No.42/2017 . (iii) The applications were never submitted to the Department, but directly approached the permanent Lok Adalath. 9. We have heard learned counsel for the parties and appraised the paper books. 10. Contents of the letter dated 12.05.2017 is also worth extraction: “Attention is sought to the reference. Financial assistance on Accidental Death is not included in the RSBY scheme or the CHIS Scheme. Financial Assistance on Accidental Death Accidental death benefit was provided by some insurance companies as an additional benefit to RSBY/CHIS card holders. Therefore, it is informed that applications for the said assistance cannot be considered.” 11. Cumulative fact of the order of 04.07.2008, extending the benefit of the RSBY Scheme to the people belonging to the BPL Category defined and described under the Act as promulgated by the Central Government and adopted by the State Government, and extended in 2010 by increasing the amount from Rs.30,000 to Rs.2,00,000/- for the financial year 2013-14 and thereafter, by letter dated 10.02.2016 to financial year 2015-16, are not in dispute. The only point agitated is that in view of the letter dated 15.05.2017, the appellant - writ petitioner was denuded, not to entertain and disburse the claims. Therefore the order of the permanent Lok Adalat is liable to be set aside. 12. Such argument does not merit acceptance for the simple reason that the accident had taken place in the year 2014-15 and at that time the insurance scheme adopted by the State Government was in vogue. It stopped only in the year 2017 that too, on the premise that certain insurance companies had been extending the benefits. However, the appellants miserably failed to place on record any material to belie the claim on the premise that any benefits of insurance having been taken by the deceased or the family members except that a health card on payment of Rs.30,000/- as per the RSBY Scheme was issued. This is precisely the import of judgment of the Single Bench.
However, the appellants miserably failed to place on record any material to belie the claim on the premise that any benefits of insurance having been taken by the deceased or the family members except that a health card on payment of Rs.30,000/- as per the RSBY Scheme was issued. This is precisely the import of judgment of the Single Bench. Once the Government had sanctioned a sum of Rs.2,00,000/- (Rupees Two lakh only) the role of appellant is only to comply with the same and could not have contested for the reason that letter dated 15.05.2017, which came only in 2017 whereas the accident had taken place in the year 2014-15, for the sake of repetition. Non-submission of the application cannot be a ground for the purpose of rejecting the claims as the welfare scheme hypo-technically cannot come in the way of the affected parties and even the letter dated 15.05.2017 cannot modify the order as issued under Article 309 of the Constitution of India. As an upshot of the findings, we do not find any illegality and perversity in the judgment of the Single Bench. No merit in the intra court appeals, accordingly, are dismissed.