COMMON CAUSE Vs. UNION OF INDIA

JUDGEMENT

(1.) The present petition is limited to the issue as to whether the persons who were covered under the Employees State Insurance Act, 1948 (for short 'the Act') and who superannuated from insurable employment in which they were engaged till superannuation, would be entitled to medical benefits under the Act and the Employees State Insurance (Central) Rules, 1950 (for short 'the Rules').

(2.) The petition has been filed by Common Cause, a registered Society, through its Director, Mr. H.D. Shourie, espousing the case of six retired employees of Eicher Tractors and their spouses for grant of medical benefits. M/s Eicher Tractors Limited in 1995 made a representation to respondent No.2, the Employees State Insurance Corporation, through its Director General, requesting them to grant medical benefits to six of its retired employees and their spouses. The matter was considered by respondent No.2, who rejected the claim of the six retired employees to medical benefits under the Act on the ground that they were not insured persons at the time of their retirement within the meaning of the Act. The respondent No.2 contended that the persons had retired with wages exceeding Rs.3,000.00 per month and that they were not insured within the meaning of the Act and were not entitled to any medical benefits after superannuation. The main contention of the petitioner is that from a reading of the relevant provisions of the Act, in particular Section 56 and of the Act Rule 61 of the Rules framed under the Act, it is evident that all retired employees are entitled to medical benefits even after superannuation. The said contention was refuted by respondent No.2 and it was contended that medical benefits are admissible to a superannuated insured person and his spouse if he was otherwise eligible and entitled to medical benefits before their retirement and was not beyond the wage limit for coverage under the Act. The definition of 'insured person and his family' in Section 2(14) of the Act excludes the extension of benefits to a person who is not an 'insured person'. Those insured persons who have crossed the prescribed wage limit before superannuation even though they fulfil all other criteria, are not entitled to the grant of medical benefits under the Act and the Rules. To fully appreciate the present questions and the issue involved in the present petition, certain provisions of the Act and the rules may be reproduced as under :- Section 2 sub-section (9) of the Act reads as under:

(3.) Provided that an employee whose wages excluding remuneration for overtime work exceed such wages as may be prescribed by the Central Government a month at any time after and not before the beginning of the contribution period shall continue to be an employee until the end of that period. Section 2(14) of the Act reads as under: "2(14) - "insured person" means a person who is or was an employee in respect of whom contributions are or were payable under this Act and who is, by reason thereof, entitled to any of the benefits provided by this Act; Section 56 of the Act lays down conditions for eligibility to make medical benefits available to the 'insured persons and his family members'. The said section reads as under :