Are Private Doctors Who Worked During Pandemic & Died Of COVID Eligible Under PM Insurance Scheme? Supreme Court Reserves Judgment

The Supreme Court on Tuesday reserved its judgment in a plea concerning the Central Government's insurance coverage scheme "Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19", for doctors who lost their lives due to COVID-19 during the pandemic.

The matter was heard by a Bench comprising Justice PS Narasimha and Justice R Mahadevan, which made significant observations emphasising the duty of the State to protect those who served during the pandemic crisis.

The petition challenges a Bombay High Court judgment which denied insurance coverage under the scheme to doctors who were not formally requisitioned by the government for COVID-19 duties.

During the hearing, Justice Narasimha underscored the immense contribution of medical professionals in combating the pandemic, remarking, “Society will not forgive us if we don't take care of our doctors.” The Bench was dealing with the question of eligibility under the government's insurance scheme, particularly in cases where doctors were not officially on government duty but continued to serve patients during the pandemic.

Additional Solicitor General Aishwarya Bhati appeared for the Centre and opposed the plea. She highlighted that the insurance cover was for a specific period and the Supreme Court has held that the insurance policies have to be interpreted as per the terms of the insurance contract. She added that the scheme was not a welfare measure by the state but an insurance policy covering specific people. Further, the doctors involved in the present case did not respond to the call for volunteers for COVID duty specifically, but merely responded to a general call to keep their facilities open, she said. For COVID deaths there is a separate scheme for ex-gratia payment by the National Disaster Management Authority, she said.

Justice Narasimha further observed that the government must ensure that insurance companies honour valid 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. Merely because they were not in government duty, the assumption that they were making profits and sitting idle is not correct,” the judge remarked.

The Court clarified that it would not adjudicate individual claims but would instead lay down broad principles to guide the implementation of the insurance scheme. “We will not go into individual claims. We will just lay down the principles,” Justice Narasimha said, adding that the criteria would focus on whether the deceased doctor was actively engaged in medical service and whether death was a result of COVID-19 infection.

“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,” the Bench said.

"There must also be proof about the fact that the doctor has passed away because of being infected by COVID.Once these two questions as satisfied, 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 explained.

Justice Narasimha also asked Bhati to provide relevant data and information regarding other similar or parallel schemes available apart from the Pradhan Mantri Insurance Scheme. “Give the data to us and some information about other parallel schemes that are available apart from the present Pradhan Mantri scheme. 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 said.

Concluding the hearing, Justice Narasimha said, “It will be disposed of as per our judgment.”

Background

The case arises from the March 9, 2021 judgment of the Bombay High Court dismissing a plea by the widow of Dr. BS Surgade, an Ayurvedic practitioner who died of COVID-19 in June 2020. Dr. Surgade's widow sought ₹50 lakh compensation under the Pradhan Mantri Garib Kalyan Package. The New India Assurance Company rejected her claim on the ground that Dr. Surgade was carrying out private practice and was not requisitioned for COVID-19 duty by the Navi Mumbai Municipal Corporation.

The High Court held that the insurance scheme applied only to health workers whose services were “requisitioned or drafted” by government authorities for COVID-19-related duties. It found no evidence that Dr. Surgade's services were requisitioned under the scheme and concluded that private practitioners not specifically drafted could not claim its benefits. The Court noted that the petitioner had not challenged the constitutionality of the scheme but only sought her husband's inclusion under it.

On October 29, 2021,the Supreme Court issued notice in the special leave petition filed by Dr. Surgade's widow and other similarly placed petitioners. Apart from the petitioner, several other doctors and families of deceased medical professionals joined the proceedings. The Supreme Court observed that the matter raised issues of “significant public importance” as it concerned the assurance of insurance cover for health professionals who served during the pandemic.

The Supreme Court has now reserved its verdict after hearing arguments on whether doctors who voluntarily continued to serve patients during the pandemic but were not formally requisitioned by the government can be covered under the scheme.

Case no. – SLP(C) No. 16860/2021

Case Title – Pradeep Arora v. Director, Health Department