An insurance appeal by the Regional Director against an Insurance Court order granting sickness benefit to a retired employee. The High Court held that sickness benefit requires abstention from work, which is not possible post-retirement, and thus dismissed the claim.
The decision of the Employees' Insurance Court, Kozhikode in E.I.C.No.91 of 2005 is set aside.
This page shows the compact analysis of this judgement. The full analysis — procedural history, issue-by-issue holdings with ratio and obiter, advocates, and paragraph-level evidence for every claim — is being added to the record in batches and will appear here when this judgement has been through it.
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT:
THE HONOURABLE MR. JUSTICE P.B.SURESH KUMAR
TUESDAY, THE 10TH DAY OF MARCH 2015/19TH PHALGUNA, 1936
Ins.APP.No. 77 of 2009 ( )
IC 91/2005 of EMPLOYEES' INSURANCE COURT, KOZHIKODE APPELLANT(S)/RESPONDENT :
THE REGIONAL DIRECTOR,
E.S.I. CORPORATION, THRISSUR-20.
BY ADV. SRI.T.V.AJAYAKUMAR
RESPONDENT(S)/APPLICANT :
M.K. KUTTAN, S/O. ARAMUGAN, ELAYEDATH THAZHATH HOUSE, P.O. FAROKE COLLEGE KOZHIKODE.
BY ADV. SRI.A.RANJITH NARAYANAN BY ADV. SRI.S.K.SAJU
THIS INSURANCE APPEAL HAVING BEEN FINALLY HEARD ON 10-03-2015, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:
P.B.SURESH KUMAR, J.
Ins. Appeal No.77 of 2009
Dated 10th March, 2015.
J U D G M E N T
The decision of the Employees' Insurance Court, Kozhikode in E.I.C.No.91 of 2005 is under challenge in this appeal. The Regional Director of the Employees' State Insurance Corporation ('the Corporation' for short) is the appellant.
Ins.Appeal No.77 of 2009
2
sickness benefit. The decision of the Corporation was challenged by the respondent before the Insurance Court in the proceedings referred to above and as per the order impugned in this appeal, the Insurance Court directed the Corporation to extend sickness benefit to the respondent for the period from 7.3.2005 to 12.11.2005 also. The Corporation is aggrieved by the said decision of the Insurance Court and hence this appeal.
2(20) "sickness" means a condition which requires medical treatment and attendance and necessitates abstention from work on medical grounds;
Section 46(1)(a) of the Act provides that insured persons are entitled to periodical payments in case of sickness certified by a duly appointed medical practitioner. Regulations 52A(1) of the Employees' State Insurance (General) Regulations, 1950 ('the Regulations' for short) reads thus :
52A. Abstention verification
[(l)] Every employer shall furnish to the appropriate Office such information and particulars in respect of the abstention of an insured person for work for which sickness benefit or
Ins.Appeal No.77 of 2009
3
disablement benefit for temporary disablement, as provided under the Act have been claimed or paid, in Form No.10 and within such time as the said office may in writing require in the said Form.”
It is evident from the said provisions that sickness for which sickness benefit under the Act is claimed is a condition which requires medical treatment and necessitates abstention from work on medical grounds. Regulation 52A(1) of the Regulations reiterates the said position by requiring the employer of the insured person to furnish to the appropriate office such information and particulars in respect of the abstention of the insured person from work for which sickness benefit has been claimed. In other words, sickness benefit is contemplated under the Act only when the insured employee is unable to attend his regular work. When a person retires from service on superannuation, the question of abstention from work does not arise. In this context, it is worth referring to Rule 61 of the Employees' State Insurance (Central) Rules, 1950. The said rule provides for medical benefits to retired persons. As per Rule 61, a retired employee is entitled to medical benefits on an
Ins.Appeal No.77 of 2009
4
additional payment. Thus, on a consideration of the scheme of the Act and the Rules and Regulations made thereunder, it is clear that a retired employee is not entitled to sickness befit for the period after the date of superannuation.
Ins.Appeal No.77 of 2009
5
extended only from a later point of time. The learned counsel for the Corporation pointed out that Regulation 4 of the Regulations is intended only to ensure that benefits under the Act are claimed by genuine employees and to rule out payment of contribution in the pretext of employment solely for the purpose of claiming benefits under the Act. Be that as it may, the fact that the benefits provided for under the Act can be claimed only in accordance with the provisions of the Act, the Rules and the Regulations, cannot be disputed. When the Act, and the Rules and Regulations made thereunder, do not confer on an insured employee the sickness benefit after retirement, the same cannot be claimed on the strength of Regulation 4, for, the said Regulation only provides for the time from which the benefits under the Act can be claimed. The payment of contribution upto the date of superannuation is a statutory requirement and merely for the reason that contribution has been paid upto the date of superannuation, it cannot be contended that the benefits can be claimed otherwise than in accordance with the provisions of the Act, Rules and the
Ins.Appeal No.77 of 2009
6
Regulations. The decision of the Insurance Court that the respondent is entitled to sickness benefit for the period from 7.3.2005 to 12.11.2005 is, therefore, unsustainable.
In the result, the appeal is allowed and the impugned order is set aside. I.C.No.91 of 2005 before the Employees' Insurance Court, Kozhikode stands dismissed.
Sd/-
P.B.SURESH KUMAR, JUDGE.
tgs
(true copy)
1 issue framed by the court
Whether a retired employee is entitled to sickness benefit under Section 46(1)(a) of the Employees' State Insurance Act, 1948 for the period after his retirement date.
5 provisions across 3 enactments
THE REGIONAL DIRECTOR, E.S.I. CORPORATION, THRISSUR
M.K. KUTTAN
P.B.SURESH KUMAR
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
