Point of Law: Private practice of hospital not entitled for compensation under the Mantri Garib Kalyan Package

JUDGMENT :

1. By the above Writ Petition, the Petitioner prays for the following reliefs :

"a) That this Court be pleased be exercise its jurisdiction under Constitution of India and issue writ or direction calling for the record and proceedings from the office of the respondents Nos.1 and 2 and after examining the validity, legality and propriety and correctness be given order and or direction to the respondent Nos.1 and 4 to quash and set aside the Impugned Order annexed as Exhibit- "O" and allow the claim of the Petitioner that annexed as Exhibit-"J".

(b) The Court be pleased to give an order and or direction to the respondent No.6 - The New India Assurance Co. Ltd. to immediately disburse the claim of the Petitioner annexed as Exhibit- "J" in time bound schedule.

(c) Pending the hearing and final disposal of the writ petition be pleased to direct the respondents except respondent No.6 to file their respective affidavit in respect of claim of the Petitioner.”

2. The Petitioner is the widow of Dr. B.S. Surgade who passed away on 10th June 2020 being infected by COVID-19.

3. Post Dr. Surgade’s unfortunate demise, the Petitioner submitted a Personal Accident Insurance Claim Form dated 2nd August, 2020 with Respondent No.6 – The New India Assurance Company Limited. By this claim, the Petitioner sought for compensation of Rs.50,00,000/- (“Claim”) under the Pradhan Mantri Garib Kalyan Package (“Scheme”).

4. By an Order dated 7th September, 2020, Respondent No.6 - The New India Assurance Company Limited rejected the Claim inter alia on the grounds that Dr. Surgade was carrying out private practice, he was not recognized by the Navi Mumbai Municipal Corporation and that his private dispensary was not recognized as a COVID-19 dispensary.

5. A few facts and correspondence may be necessary as under:

5.1. The Ministry of Health & Family Welfare (“MoHFW”) issued an order dated 28th March, 2020 setting out the criteria as to who can be included and would be eligible under the Scheme. The said order reads as under:

“ORDER

As per the announcement made under the Pradhan Mantri 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 lakh 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 COVID-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 f Central hospitals/ autonomous hospitals of Central/States/UTs, AIIMS & INIs/ hospitals of Central Ministries can also be drafted for COVID19 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.”

5.2. On 31st March, 2020, the Navi Mumbai Municipal Corporation’s (“NMMC”) Commissioner issued a ‘Notice to keep the Hospital/Dispensary open in lock down period’ (“NMMC Notice”). The NMMC Notice reads as under:

“SUB:- Explanation as to why your hospital/dispensary is kept closed in the lock down period

WHEREAS the Government Of Maharashtra, in the exercise of the power conferred under section 2,3 and 4 of the Epidemic Diseases Act, 1897 has framed Regulation vide Notification dated 14th March 2020, for prevention and