Insurance Claim Rejection Based Solely on Negative RTPCR Unjustified: Bombay High Court Emphasizes Consideration of Overwhelming Medical Evidence in Covid-19 Death Cases.

sketch of the Bombay High Court
Case
MACHINDRA MARUTI GAIKWAD v. THE UNION OF INDIA AND OTHERS (Bombay High Court, 09-01-2026)
Law
Constitution of India.
  • Facts: The petitioner's wife, working as a nurse and later as Arogya Sevika, died on 5.5.2021 during the Covid-19 pandemic while performing her duties. The petitioner applied for insurance under the Pradhan Mantri Garib Kalyan Yojna, a scheme for families of corona warriors. The District Collector rejected the claim because the petitioner didn't submit an RTPCR report showing the deceased was Covid-19 positive at the time of death; the available RTPCR report was negative. However, other medical records, including a CT scan indicating a high severity score for Covid-19 and a death certificate citing cardio-respiratory failure due to Covid-19, suggested otherwise.
  • Procedural Posture: The petitioner initially filed Writ Petition No. 14450/2021, leading to a direction for the Collector to decide the claim. After the Collector rejected the claim, the petitioner filed the present Writ Petition No. 286 of 2023 in the High Court of Judicature at Bombay, Bench at Aurangabad, challenging the Collector's order.
  • Issue: Can an insurance claim under the Pradhan Mantri Garib Kalyan Yojna be rejected solely based on a negative RTPCR report, despite other medical evidence indicating the deceased suffered from and died due to Covid-19?
  • Holding: No, the insurance claim cannot be rejected solely based on the negative RTPCR report when other medical evidence overwhelmingly suggests the deceased died due to Covid-19. The High Court quashed the Collector's order.
  • Reasoning: The Court reasoned that the negative RTPCR report should not be the sole criterion for determining Covid-19 positivity or cause of death, especially when overwhelming medical evidence, such as the death certificate and CT scan, indicated otherwise. The Court cited the Supreme Court's pragmatic view in Pradeep Arora and Others Vs. Director, Heath department, Government of Maharashtra and others and the Madras High Court's observation in B. Varalakshmi Vs. Secretary to Government of India, New Delhi that authorities should not stick to technicalities and consider the claim with more humanness when available documents clearly substantiate Covid-19 infection. The Court directed the Collector to forward the claim to the concerned authority for reconsideration, recognizing the deceased's Covid-19 positive status at the time of death.