IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT : THE HONOURABLE MR. JUSTICE P.N.RAVINDRAN FRIDAY, THE 8TH APRIL 2011 / 18TH CHAITHRA 1933 WP(C).No. 1963 of 2011(U) -------------------------------------- PETITIONER(S): ------------------------- K.S.MADHU, AGED 49 YEARS, S/O.P.SREEDHARAN, KONNAKERIYIL HOUSE, ALUPURAM, KUTTIKATTUKARA-683 504. BY ADVS. SRI.P.KESAVAN NAIR SRI.K.G.CLEETUS RESPONDENT(S): ------------------------- 1. MANAGER, REGIONAL OFFICE, E.S.I. CORPORATION, PANCHADEEP HOUSING COMPLEX, SWARAJ ROUND NORTH, TRISSUR. 680 001 2. REGIONAL MANAGER, SUB REGIONAL OFFICE (ERNAKULAM), E.S.I.CORPORATION MALU'S COMPLEX, ST.FRANCIS CHURCH ROAD, KALOOR, KOCHI-682 017. 3. THE MANAGER, BRANCH OFFICE, E.S.I. CORPORATION, UDYOGAMANDAL, PIN-683 501. R1 TO R3 BY ADV. SRI.P.SANKARANKUTTY NAIR, SC, ESI CORPN THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 08/04/2011, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: tss W.P.(C) NO.1963/2011 APPENDIX PETITIONER'S EXHIBITS P1:- COPY OF THE IDENTITY CARD ISSUED BY E.S.I. CORPORATION. P2:- COPY OF THE PROFORMA FOR GIVING DETAILS OF THE CASE FOR REFERENCE TO OTHER HOSPITAL DTD. 26.10.2010 ISSUED BY MEDICAL OFFICER OF THE ESI DISPENSARY. P3:- COPY OF THE REPRESENTATION DTD. 1.11.2010 SENT TO THE 2ND RESPONDENT FROM THE PETITIONER. P4:- COPY OF THE DISCHARGE SUMMARY ISSUED FROM THE LOURDES HOSPITAL ERNAKULAM. P5:- COPY OF THE INTIMATION DTD. 14.1.2011 ISSUED BY LOURDES HOSPITAL ERNAKULAM TO MEDICAL OFFICER. P6:- COPY OF THE PROFORMA ISSUED BY MEDICAL OFFICER, E.S.I. DISPENSARY UDYOGAMANDAL. P7:- COPY OF THE DECISION DTD. 27.1.2011 ISSUED BY 3RD RESPONDENT. P8:- COPY OF THE INSTRUCTIONS DTD. 4.3.2005 ISSUED BY DEPUTY DIRECTOR, ESI CORPORATION, TRICHUR. P9:- COPY OF THE DISCHARGE SUMMARY DTD. 24.1.2011 ISSUED FROM LOURD'S HOSPITAL , ERNAKULAM. RESPONDENT'S EXHIBITS NIL:- TRUE COPY P.A. TO JUDGE tss P.N.RAVINDRAN, J. --------------------------- W.P.(C) No. 1963 OF 2011 -------------------------- Dated this the 8th day of April, 2011 J U D G M E N T The petitioner is an employee of M/s. Hindalco Industries Limited, Alupuram and an insured worker under the Employees State Insurance Act, 1948 (hereinafter referred to as 'the Act' for short). The petitioner states that his father who is aged 76 years is dependent on him for his livelihood and that Ext.P1 identity card issued by the third respondent in terms of regulation 17 of the Employees State Insurance (General) Regulations, 1950, hereinafter referred to as 'the regulations' for short, includes the name of his father as a member of the family entitled to medical benefits under regulation 95A thereof. The petitioner states that on 26.10.2010, the Medical Officer of E.S.I. Dispensary, Udyogamandal referred his father to Lourdes Hospital for specialised treatment, but, notwithstanding the request made and the submission of a proforma from the dispensary, the third respondent declined to issue the entitlement certificate to the petitioner. It is stated that therefore the petitioner had to meet the expenses of treatment out of pocket and that long thereafter, the entitlement certificate was rejected by Ext.P7 letter dated 27.1.2011 on the short ground that the petitioner WPC No.1963/2011 2 has not produced any document to prove that his father is dependent on him and that his father's income is below Rs.1,500/- per mensem. Ext.P7 is under challenge in this writ petition. 2. The main ground raised by the petitioner is that in view of regulations 17 and 104 of the regulations, the petitioner is entitled to claim medical benefits on production of the identity card which contains the name of his father and therefore the rejection of the request for entitlement certificate is illegal. The respondents have filed a counter affidavit dated 10.2.2011. It is stated that in order to confirm the declaration made by the petitioner that his father Sri.K.P.Sreedharan is dependent on him and also to ascertain the income of his father, the petitioner was asked to produce the ration card, which on production revealed that the name of his father is not included therein. It is stated that as the petitioner was not in a position to prove that his father's income from all sources does not exceed Rs.1,500/- per month, his application for entitlement certificate was rejected. The respondents have however admitted that the petitioner is entitled to medical benefits under the Act. 3. I heard Sri.K.G.Cleetus, learned counsel appearing for the petitioner and Sri.P.Sankarankutty Nair, learned standing counsel WPC No.1963/2011 3 appearing for the respondents. It is evident from the pleadings and the materials on record especially the contents of Ext.P7 that the petitioner's request for entitlement certificate was rejected on the short ground that he has not produced any evidence to prove the dependency of his father on him and also the fact that his father's monthly income from all sources is below Rs.1,500/- per mensem. The respondents do not however dispute the fact that in the identity card issued to the petitioner in terms of regulation 17 of the regulations the name of the petitioner's father is entered. Regulation 17 contemplates issue of identity cards prepared in Form No.4 for each person in respect of whom an insurance number is allotted. The regulations also provides that in such cards the particulars of the family entitled to medical benefit under regulation 95A shall be included. Regulation 95A stipulates that medical benefits may be extended to the families of insured persons with effect from such date as the Corporation may, in consultation with State Government may notify. It is also stated that the family of an insured person shall become entitled to medical benefit from the day the insured person himself becomes entitled to medical benefit and shall continue to be so entitled so long as the insured person is entitled to receive WPC No.1963/2011 4 medical benefit for himself. Regulation 104 stipulates that a person intending to claim medical benefit and who is otherwise entitled to such benefit shall produce his identity card or such other document as may have been issued in lieu thereof at the time of claiming such benefit if demanded by the Insurance Medical Officer. It is also stipulated that if he fails to do so, medical benefits may be refused to him. 4. As noticed earlier, it is not in dispute that the name of the petitioner's father has been entered in the identity card issued to the petitioner. The respondents have no case that the name of the petitioner's father was wrongly entered in the identity card. In terms of regulation 95A(2), the family of an insured person shall (in the instant case the family of the petitioner) become entitled to medical benefit from the day the insured person himself becomes entitled to medical benefit and shall continue to be so entitled so long as the insured person is entitled to receive medical benefit for himself. The respondents admit the fact that the petitioner is entitled to receive medical benefit for himself. They have no case that the petitioner has become ineligible to receive medical benefit. The regulations do not stipulate that the insured person will have to prove the continued WPC No.1963/2011 5 entitlement of the member of the family for medical benefits by periodically producing proof of dependency of the member of the family on him. There is no material on record before me to even prima facie show that the petitioner's father is gainfully employed or is having a monthly income from all sources in excess of Rs.1,500/-. In other words, there is nothing on record to show that the petitioner's father is not dependent on him. In such circumstances, as the enrolment of the petitioner's father as a member of the family dependent on the petitioner for the purpose of medical benefits is not in dispute, the respondents were not justified in taking the stand that as the name of the petitioner's father is not mentioned in the ration card held by the petitioner, the petitioner's father cannot be said to be dependent on him. For a variety of reasons a citizen may not apply for a ration card. Therefore the mere fact that a citizen's name is not included in the ration card held by his son, daughter or spouse cannot be a reason to hold that, that person is not a person dependent on the holder of the ration card. The respondents have in my opinion stipulated terms and conditions which do not find place in the regulations or in the Act. Such a stand cannot in my opinion be entertained. I am therefore of the opinion that the petitioner is WPC No.1963/2011 6 entitled to succeed. I accordingly allow the writ petition, quash Ext.P7 and direct the competent authority among the respondents to reimburse the medical expenses incurred by the petitioner for the treatment of his father in Lourdes Hospital, Ernakulam. It will be open to the respondents to verify with the hospital authorities the correctness of the amount claimed by the petitioner. The medical expenses shall be reimbursed to the petitioner expeditiously and in any event within one month from the date on which the petitioner produces a certified copy of this judgment before the third respondent. P.N.RAVINDRAN, (JUDGE) vps