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IN THE HIGH COURT OF KERALA AT ERNAKULAM
A.M. Badar, J.
Smitha Rajendran – Petitioner
Versus
Employees State Insurance Corporation and Ors. – Respondents
WP(C).No.28767 of 2020(U)
Decided On : 08-02-2021
ESI Act - Medical Benefits - Sections 26, 28, 39, 40, 45B, 45G, 68, 19, 46, 56, 57 - The court held that the petitioner and her husband are entitled to super specialty medical benefits under the ESI Act for renal transplantation despite the employer's failure to remit contributions. The court emphasized the duty of the ESI Corporation to provide benefits to insured persons and their dependents, even if the employer fails to remit contributions, and highlighted the provisions of Section 68, which allows recovery from the employer. The court also noted that the ESI Act should receive a liberal and beneficent construction and that the petitioner's family should not be disentitled to benefits due to the employer's failure to remit contributions.
Fact of the Case:
The petitioner, an insured person under the ESI Act, sought medical benefits for her husband's renal transplantation. The employer failed to remit contributions, leading the ESI Corporation to deny the benefits. The petitioner challenged this denial through a writ petition.
Finding of the Court:
The court found that the petitioner and her husband are entitled to super specialty medical benefits under the ESI Act, despite the employer's failure to remit contributions. The court emphasized the duty of the ESI Corporation to provide benefits to insured persons and their dependents, even if the employer fails to remit contributions, and highlighted the provisions of Section 68, which allows recovery from the employer. The court also noted that the ESI Act should receive a liberal and beneficent construction and that the petitioner's family should not be disentitled to benefits due to the employer's failure to remit contributions.
Issues: The main issue was whether the petitioner and her husband were entitled to super specialty medical benefits under the ESI Act, despite the employer's failure to remit contributions.
Ratio Decidendi: The court held that the ESI Corporation is duty bound to provide benefits to insured persons and their dependents, even if the employer fails to remit contributions, and highlighted the provisions of Section 68, which allows recovery from the employer. The court also emphasized that the ESI Act should receive a liberal and beneficent construction and that the petitioner's family should not be disentitled to benefits due to the employer's failure to remit contributions.
Final Decision: The court allowed the writ petition, declared the denial of super specialty medical benefits to the petitioner's family as illegal, and directed the ESI Corporation to provide immediate super specialty medical benefits for renal transplantation to the petitioner and her husband.
JUDGMENT :
By this writ petition, the petitioner has prayed for the following reliefs:
ii. Issue a writ of certiorari or other appropriate writ, order or direction to call for the records leading to the entitlement status of super specialty for IP as well as for Family as 'NO' in Exhibit P5 and quash the same to that extent;
iii. To declare that the petitioner as well as her husband R. Rajendran entitled to get the super specialty medical benefits under the Employees State Insurance Act with Insurance Number 4810399074;
iv. Issue a writ of mandamus or other appropriate writ, order or direction by directing the respondents 1 to 3 to immediately disburse the medical benefits against the Super specialty for IP as well as Super specialty for Family in connection with the donation of the kidney by the petitioner and for the renal transplantation for R. Ranjendran, the husband of the petitioner.
2. Heard the learned counsel appearing for the petitioner. Learned counsel argued that the petitioner is working as a Teacher with the 4th respondent-school from June 2010 and is an insured person as defined by Section 2(14) of the Employee's State Insurance Act, 1948 (hereinafter referred to as 'the ESI Act'). According to the learned counsel for the petitioner, the contribution as per the provisions of the ESI Act is being regularly deducted from the salary of the petitioner right from her joining the 4th respondent-school as a Teacher in June 2010 and this fact is reflected from the certificate dated 01.12.2020, Ext.P2. Even e-Pehchan card, Ext.P3, is issued in favour of the petitioner by respondents 1 to 3 which shows that the petitioner is an insured person and her husband Sri.Rajendran R apart from her two sons are her dependents. In submission of the learned counsel for the petitioner, the petitioner as well as her dependents including her husband, Sri.Rajendran R, are entitled for medical benefits as provided under Section 56 of the ESI Act. The husband of the petitioner is suffering from end stage renal disease and he is advised to undergo renal transplantation. The petitioner is willing to donate her kidney to her husband Sri.Rajendran R and is found to be a suitable donor. The petitioner intends to undergo kidney transplantation for her husband Sri.Rajendran R in ASTER Medcity Hospital. My attention is drawn to the certificate at Ext.P4 issued by the Department of Nephrology of the ASTER Medcity Hospital for pointing out that the husband of the petitioner is advised to undergo renal transplantation. Learned counsel for the petitioner contended that when the petitioner approached the 1st respondent-ESI Corporation for seeking medical benefits for her husband Sri.Rajendran R, she came to know that her employer has not remitted employer's contribution to the ESI Corporation and therefore, she is not entitled for medical benefits for renal transplantation of her husband. She came across report, Ext.P5, issued by the respondent-ESI Corporation showing that she is not entitled for super specialty treatment of her husband Sri.Rajendran R for the reason that she has not completed six months of service from the date of registration and contribution is less than 78 days in a contribution period. The Branch Manager of the respondent-Corporation vide communication at Ext.P6 has informed that as online contribution particulars for the contribution periods April 2019 to September 2019 and October 2019 to March 2020 are showing “no records”, the family of the petitioner is not eligible for super specialty treatment for the benefit period 01.07.2020 to 31.12.2020. With this, learned counsel for the petitioner urged that failure to remit contribution by the employer of the insured person is not a criteria to deny medical benefits to the dependents of the insured person. The ESI Act, 1948 provides for machinery to
The ESI Corporation is duty bound to provide benefits to insured persons and their dependents, even if the employer fails to remit contributions, and recovery from the employer is allowed under Secti....
Damages under the E.S.I. Act are discretionary, not mandatory, and must consider genuine hardships, reaffirming that penalties should not automatically apply.
The ESI Corporation must ensure adequate medical facilities for insured persons and their families, including the establishment of dispensaries as mandated by the ESI Act.
Authority must not invoke Section 45A for best judgment assessment unless there is no submission of required documents; disputes should be resolved in ESI Court.
Eligibility for admission as 'Ward of Insured Person' does not require receipt of benefits under the ESI Act, but rather being eligible as defined.
The main legal point established in the judgment is that a subsequent transferee may not be liable for belated payment of contribution under the ESI Act if there is no mens rea on their part, and the....
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