LUCKNOW EYE HOSPITAL Vs. U. O. I.

JUDGEMENT

(1.) Heard Sri Vijay Dixit, learned counsel for the petitioner, learned Standing Counsel appearing for the State of U.P. i.e. respondent no. 3, Sri Madhukar Ojha, learned counsel for the respondent no. 4, Sri Sanjeev Singh, learned counsel for the respondent no. 6, Sri Satyajit Banerji, learned counsel for respondent no. 7 and there is a request for adjournment on the ground of illness on behalf of Sri Taranjeet Singh Makkar, who appears for the HDFC Ergo General Insurance Co. Ltd-respondent no. 8. Learned counsel for the petitioner has stated that all payments due from respondent no. 8 have been received by the petitioner no lis survives in so far as the respondent no. 8 is concerned, therefore, this Court has proceeded to hear the matter finally.

(2.) It is the case of the petitioner that for providing social security and welfare of the unorganized workers and for matters connected therewith and incidental thereto, the Government of India introduced the Unorganized Workers' Social Security Act, 2008, and introduced a Welfare Scheme for unorganized workers in the name of Rashtriya Swastha Bima Yojana (hereinafter referred to as 'the RSBY') to cover a number of non BPL categories of informal Sector including street vendors, domestic workers, Beedi workers, building and construction workers and workers who had worked for more than 15 days in MNREGA for covering diseases which involved hospitalization. The beneficiaries under the Scheme were entitled to hospitalization coverage of upto Rs.30,000.00 for most of the diseases and the coverage was extended upto five Members of the same family. The Scheme was sponsored by the Central Government which had to pay 75 per cent of the premium and 25 per cent of the premium was to be paid by the State Government, in most of the States of the Country.

(3.) Under the RSBY, the ICICI Lombard General Insurance Company Ltd. was empaneled for various districts including the District Lucknow and the ICICI Lombard General Insurance Company Ltd. entered into an agreement with the Government of U.P. to provide health insurance services to the persons below poverty line and also beneficiaries covered under the RSBY. The guidelines were issued by the Government of India and also by the State Government for settlement of claim, the latest being the one issued on 17/7/2012 by the Government of India and under Clause 2(iii), it has been provided that in case the Insurance Company has not received the necessary premium, then also they had to settle the claim of the hospital. However, liberty was granted to the Insurance Company to indicate that payment will be made after premium is received. The Insurance Company had to make a settlement of the claim within thirty days of receipt of the same but actual payment had to be made after premium was received. Since the ICICI Lombard General Insurance Company Ltd. was nominated for the District of Lucknow, the petitioner- Hospital entered into an agreement with ICICI Lombard General Insurance Company Ltd.