‘Society Won’t Forgive Us’: Supreme Court to Set Principles for Private Doctors' COVID-19 Insurance Claims

New Delhi – In a hearing laden with significant observations on the State's duty towards its frontline workers, the Supreme Court of India on Tuesday reserved its judgment in a pivotal case concerning insurance coverage for private medical professionals who lost their lives during the COVID-19 pandemic. A Bench of Justice PS Narasimha and Justice R Mahadevan indicated it would lay down broad, guiding principles to determine eligibility under the Centre's insurance scheme, moving beyond a narrow interpretation that has left many families of deceased private doctors without compensation.

The Bench's poignant remarks, particularly from Justice Narasimha, underscored a deep-seated judicial concern for the welfare of those who served on the front lines of a national health crisis. “Society will not forgive us if we don't take care of our doctors,” Justice Narasimha observed, capturing the moral and constitutional imperative at the heart of the matter. This statement signals a potential shift towards a more inclusive and purposive interpretation of welfare schemes designed for "COVID warriors."

The Court was hearing an appeal against a March 9, 2021, order by the Bombay High Court. The High Court had held that private hospital staff were not entitled to benefits under the Pradhan Mantri Garib Kalyan Package (PMGKP) unless their services were explicitly requisitioned by the state or central government. The PMGKP, announced in March 2020, provides a ₹50 lakh insurance cover to healthcare workers as a safety net for their families. The case before the Supreme Court originated from a plea by Kiran Bhaskar Surgade, whose husband, a private doctor running a clinic in Thane, succumbed to COVID-19 in 2020. Her claim was rejected because her husband's clinic was not an officially designated COVID-19 hospital.

---

Challenging the 'Public vs. Private' Distinction

Throughout the hearing, the Supreme Court Bench critically examined the rationale for excluding doctors simply because they were not on a government payroll. Justice Narasimha directly addressed the assumption that private practitioners were motivated by profit and were not genuinely part of the national pandemic response.

“Merely because they were not in government duty, the assumption that they were making profits and sitting idle is not correct,” the judge remarked to Additional Solicitor General Aishwarya Bhati, who was representing the Centre. This observation cuts through the formalistic distinction between public and private service, focusing instead on the substantive contribution made by all medical professionals during the pandemic.

The Court asserted that the government has a responsibility to ensure its insurance partners honour legitimate claims. “You should compel the insurance company to pay if according to you the condition is met that they were on COVID response and they died because of COVID,” Justice Narasimha stated, placing the onus on the government to enforce the scheme's intended purpose.

A Principled Approach Over Individual Adjudication

Clarifying its judicial role, the Bench stated it would not function as a claims tribunal but would instead establish a clear legal framework. “We will not go into individual claims. We will just lay down the principles,” Justice Narasimha explained. This approach aims to create a durable and consistent standard that can be applied by insurance companies and lower courts, potentially resolving a large number of pending and future claims without the need for case-by-case Supreme Court intervention.

The proposed principles are expected to be straightforward and evidence-based, focusing on two central questions:

1. Proof of Service: Was the deceased doctor actively engaged in providing medical services during the pandemic? The Bench elaborated, “That the said doctor volunteered to offer his medical services by keeping his clinic or hospital open for patients to consult him must be proved by way of some credible evidence.”

2. Proof of Causation: Was the doctor's death a direct result of a COVID-19 infection? “There must also be proof about the fact that the doctor has passed away because of being infected by COVID,” the Court specified.

Crucially, the Bench suggested that once these two conditions are met, the inquiry should end. “It is not for us to question as to whether the doctor has opened his clinic or offered his services for COVID alone,” Justice Narasimha added. This pragmatic criterion acknowledges the reality that private clinics served as the first point of contact for countless patients with various ailments, inevitably exposing doctors to the virus regardless of whether their facility was officially designated for COVID treatment.

Legal and Constitutional Implications

The Supreme Court's impending judgment holds significant legal ramifications. By focusing on the act of service rather than the nature of employment, the Court is leaning towards a constitutional interpretation rooted in the principles of equality (Article 14) and the right to life (Article 21), which includes the right to health and the State's corresponding duty to protect it. The judgment could establish a precedent that the State’s duty of care extends to all individuals who contribute to a national effort during a crisis, irrespective of their formal association with the government.

For legal practitioners in insurance and administrative law, this case highlights the judiciary's increasing willingness to look beyond the black letter of a policy or scheme to its underlying spirit and purpose. An outcome favouring a broader eligibility criterion would compel a re-evaluation of how such welfare schemes are drafted and implemented, discouraging exclusionary clauses that defeat the program's objective.

Furthermore, the Court has directed the Centre to provide comprehensive data on all "similar or parallel schemes" available apart from the PMGKP. This directive suggests an attempt by the Bench to understand the entire landscape of governmental support for frontline workers, ensuring its principles are holistic and do not operate in a vacuum. “We will lay down the principle and on that basis claims can be made to the insurance company. It is for the insurance company to consider and pass orders on the basis of our judgment,” the Bench concluded.

As the legal community awaits the final verdict, the oral observations from the Bench have already sent a strong message: in times of national crisis, the contribution of every citizen, especially those who risk their lives for others, must be recognized and protected by the State. The forthcoming judgment is poised to be a landmark ruling on the State’s obligation to its pandemic heroes.