Kerala High Court
Lali Varghese vs Union Of India on 28 October, 2020
Author: V.G.Arun
Bench: V.G.Arun
WP(C).30656/16 1
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR.JUSTICE V.G.ARUN
WEDNESDAY, THE 28TH DAY OF OCTOBER 2020 / 6TH KARTHIKA, 1942
WP(C).No.30656 OF 2016(F)
PETITIONER/S:
LALI VARGHESE
LINCY KOTTAGE,KATTANAM,VETTACODE.P.O,ALAPPUZHA
DISTRICT-690503.
BY ADVS.
SRI.GEORGE VARGHESE(PERUMPALLIKUTTIYIL)
SRI.A.R.DILEEP
SRI.P.J.JOE PAUL
SRI.MANU SEBASTIAN
RESPONDENT/S:
1 UNION OF INDIA.
REPRESENTED BY SECRETARY TO THE MINISTRY OF LABOUR
AND EMPLOYMENT,SHRAM SHAKTHI BHAVAN,RAFI MARG,NEW
DELHI-110001.
2 EXECUTIVE DIRECTOR
COMPREHENSIVE HEALTH INSURANCE AGENCY OF KERALA,7TH
FLOOR,TRANS TOWERS,VAZHUTHACAUD,THRIUVANANTHAPURAM-
14.
3 UNITED INDIA INSURANCE COMPANY LTD
REPRESENTED BY SENIOR DIVISIONAL MANAGER,DIVISIONAL
OFFICE,SARADA SHOPPING COMPLEX,MULLAKKAL,ALAPPUZHA-
688010.
R1 BY SRI.B.PREM KUMAR, CGC
R1 BY ADV. SRI.B.PREM KUMAR CGC
R1 BY ADV. SRI.ASHIK K.MOHAMED ALISC CHIAK
R2 BY ADV. SRI.ASHIK K.MOHAMED ALI,SC, CHIAK
R3 BY SRI.P.K.MANOJKUMAR,SC,UNITED INDIA INSU
OTHER PRESENT:
ADV.P.VIJAYAKUMAR FOR R1.
THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 19-
06-2020, THE COURT ON 28-10-2020 DELIVERED THE FOLLOWING:
WP(C).30656/16 2
V.G.ARUN, J.
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W.P(C).No. 30656 of 2016
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Dated this the 28th day of October, 2020
JUDGMENT
The writ petition is filed seeking the following reliefs;
"i) declare that the petitioner is entitled to insurance amount of Rs.2,00,000/- under the RSBY scheme for the death of her father in an accident;
ii) issue a writ in the nature of certiorari, or any other appropriate writ, direction or order, calling for the records leading to Exhibits P6 and P8 and quash the same;
iii) issue a writ in the nature of mandamus directing respondents
2 and 3 to take steps to release the insurance amount of Rs.2,00,000/- under the rsby scheme to the petitioner for the death of her father in accident."
2. The reliefs are founded on the following facts;
In the year 2008, the Central Government launched a social security scheme named, 'the Rashtriya Swasthya Bima Yojana' (RSBY), meant primarily to provide health insurance coverage to workers in the unorganised sector and WP(C).30656/16 3 their families. The premium for the insurance coverage is to be paid jointly by the Central and State Governments. The second respondent is the State Nodal Agency (SNA) bestowed with the duty of implementation of the scheme. Under the scheme, apart from other benefits, the head of the family and his spouse are covered up to Rs.2,00,000/- for accidental death. The petitioner's father Papachan, a fish vendor belonging to the unorganised sector, was eligible for benefits under the Scheme. In July, 2010, petitioner and family enrolled under the RSBY Scheme and a smart card was issued in the petitioner's name. On 20.2.2012, Pappachan died in an accident and the petitioner claimed the amount due under the RSBY. By Exhibit P6, the claim was rejected holding that insurance coverage under the scheme is restricted to the head of the family and spouse and that, in the smart card, petitioner, and not Pappachan, was shown as head of the family. According to the petitioner, her name was mistakenly entered as head of the family during pre-enrolment verification and the benefit of the scheme cannot be denied on that specious reason. Hence the writ petition.
3. In elaboration of the grounds urged in the writ petition, Sri.Joe Paul, learned counsel for the petitioner, made the following submissions; The very purpose of RSBY is to extend aid to workers in the unorganised sector. Undisputedly, Papachan belonged to the unorganised sector and was eligible for benefits under the scheme. Whereas, the petitioner, a homemaker can only figure as a family member of the beneficiary. Hence, the fact that the smart card was mistakenly issued in the petitioner's name is no reason to deny the benefit. Under the scheme, the liability of entering the correct details is that of the WP(C).30656/16 4 officials of the nodal agency and the insurance company and the family of their beneficiary cannot be penalised for the mistake.
4. Sri.Ashik K.Mohammed Ali, learned counsel for the 2nd respondent agency, explained the various facets of the RSBY and the role of the second respondent, as nodal agency for implementation of the scheme. It was submitted that the annual insurance cover will be a maximum amount of Rs.30,000 for a family of five, including the head of the family, spouse children and dependent parents. For the puirpose of providing the insurance coverage, the Union Government pays 60% of the premium and also the cost of smart cards for each family and the balance 40% is met by the State Government. The beneficiaries have to pay only an amount of Rs.30 per family. The health insurance benefits under the scheme is provided through an insurer, with whom an agreement is entered into by the second respondent. The agreement, as far as the instant case is concerned, is Ext.R2(C), which provides for coverage for meeting expenses for medical and surgical procedures, including maternity benefit up to Rs.30,000/- per family per year subject to limits in any of the network hospitals. In addition, the head of the family and spouse will be covered under the standard personal accident policy up to Rs.2,00,000/- for accidental death. It is submitted that the petitioner's family is registered with family ID 26401225 with petitioner's husband Koshy Varghese as head of the Family, the petitioner as his spouse. Deceased Pappachan is shown as the father and Tahankamma, as the mother of Koshy Varghese. Binsi, Linsi and Lijo are shown as the children of Koshy Varghese. It is contended that it is the duty of the beneficiaries to verify the WP(C).30656/16 5 details and make necessary corrections and that, in any event, the second respondent is not liable to pay any amount in view of the agreement executed with the insurer.
5. Sri.P.K.Manoj Kumar, learned counsel appearing for the 3rd respondent insurer referred to Exhibit P6 communication issued by the insurer to submit that the RSBY card was issued, showing the petitioner as head of the family. Therefore, no amount is payable on the death of Pappachan, since the Scheme covers only the head of the family and spouse.
6. In order to resolve the issue raised, it is necessary to have an overview of the RSBY Scheme and its operation. The objective of the scheme is to facilitate launching of health insurance projects for BPL workers in all the districts of the states in a phased manner. As per the eligibility criteria, unorganised sector workers belonging to BPL category and their family members (a family unit of five) will be the beneficiaries under the scheme. It will be the responsibility of the implementing agencies to verify the eligibility of the unorganised sector workers and their family members, who are proposed to be benefited under the scheme. The state government, while formulating the pilot project, will determine its implementing agency. The selection of the health insurance provider is done by the state/implementing agency through a tendering process. Accordingly the second respondent was selected as the implementing Agency and the third respondent as the health insurance provider.
7. It may also be worthwhile to have a scrutiny of the relevant clauses of WP(C).30656/16 6 the Operational Manual for the Scheme (Ext.P1). Clause 5 of the manual deals with data preparation and pre-enrolment. Clause 5.1.1 bestows the duty of collecting pre-enrolment data with the respective State departments. The procedure for enrolment is dealt with under Clause 6. The Ministry of Labour and Employment, Government of India provides the list of eligible beneficiaries to the Insurance Company, which is used for the enrolment process. Clause 6.1 to 6.3,5 detail the Steps to be followed up to the stage of enrolment. As per Clause 6.4.1, 'intimation slip' containing URN number, name of family head and names of family members should be distributed at least 48 hours prior to the commencement of the enrolment. As per clause 4.2, enrolment of family (family head, spouse and three other members identified by the family head), if available should mandatorily be completed. For undertaking this process, the family head should present the intimation slip before the official concerned, upon which the details of family is searched out from the database and the biometric data of every member captured and the family photograph taken. If the name of the member selected as head of the family is available in the database, beneficiary card can be issued without any additional verification. If the name is not available in the database, matter can be referred to the higher authority. Once the process of enrolment is successfully completed, the Field Key Officer will authenticate printing and personalisation of every beneficiary card using his biometrics. Clause 4.5 provides for handing over the RSBY card and information brochure to the beneficiary after collecting Rs.30/-.
8. From a reading of the above provisions it is clear that the procedure for WP(C).30656/16 7 enrolment of a beneficiary unit with one family member as head of the family have various inbuilt checks and balances. The intimation slip containing URN number, name of family head and names of family members is distributed 48 hours prior to the enrolment. Therefore, the beneficiaries have enough time to point out the mistakes in the details in the intimation slip. Further, for capturing their biometric details, members of the beneficiary unit should be present in person. This provides another opportunity to get the mistakes, if any, corrected. Admittedly the Beneficiary Smart Card was issued in the petitioner's name in July 2010. No effort was taken by the petitioner, at any point of time thereafter, for correcting the mistake. The petitioner came forward, attributing responsibility for the mistake on the officials of the second and third respondents only on her claim for compensation being rejected.
9. The petitioner not having taken steps to get the mistake corrected, I find no reason to invoke the jurisdiction under Article 226 of the Constitution of India to hold the officials of the respondents to be responsible for the mistake and direct the respondents to extend the benefit of the RSBY Scheme to the petitioner.
In the result the writ petition is dismissed. No order as to costs.
Sd/-
V.G.ARUN, JUDGE vgs WP(C).30656/16 8 APPENDIX PETITIONER'S/S EXHIBITS:
EXHIBIT P1 A TRUE COPY OF THE INFORMATION ABOUT THE
RSBY SCHEME DOWNLOADED FROM THE OFFICIAL
WBSITE WWW.RSBY.GOV.IN AND THE RELEVANT
PAGES OF THE OPERATIONAL MANUAL OF THE
SCHEME
EXHIBIT P2 A TRUE COPY OF THE LETTER DATED 04.02.2015
FROM THE 3RD RESPONDENT INDICATING COVERAGE
OF RS.2 LAKHS IN CASE OF ACCIDENTAL DEATH
OF THE HEAD OF FAMILY
EXHIBIT P3 A TRUE COPY OF THE SMART CARD ISSUED BY THE
NAME OF THE PETITIONER
EXHIBIT P4 A TRUE COPY OF NEWSPAPER REPORT DATED
21.02.2012 ABOUT SUCH ACCIDENT
EXHIBIT P5 A TRUE COPY OF FIR NO.98/2012
EXHIBIT P6 A TRUE COPY OF COMMUNICATION DATED
23.01.2013
EXHIBIT P7 A TRUE COPY OF REPRESENTATION DATED
09.02.2015
EXHIBIT P8 A TRUE COPY OF COMMUNICATION DATEAD
28.02.2015
EXHIBIT P9 A TRUE COPY OF REPLY LETTER DATED
18.02.2016
EXHIBIT P10 A TRUE COPY OF REPLY LETTER DATED
17.03.2016
EXHIBIT P11 A TRUE COPY OF RTI APPLICATIONS DATED
04.07.2015
EXHIBIT P12 A TRUE COPY OF RTI APPLICATIONS DATED
04.07.2016 TO ERNAKULAM BRANCH OF THE 3RD
RESPONDENT
EXBIBIT P13 A TRUE COPY OF REPLY LETTER DATED
20.7.2016.
EXHIBIT P14 A TRUE COPY OF RELEVANT PAGES OF THE RATION
CARD.