Full Judgment Text
$~42 to 47
* IN THE HIGH COURT OF DELHI AT NEW DELHI
nd
Date of Decision: 22 November, 2024
+ W.P.(C) 7516/2022
SMT. NURAISHA KHATOON .....Petitioner
versus
IFFCO TOKIO GENERAL INSURANCE CO. LTD. AND ORS.
.....Respondents
With
W.P.(C) 7552/2022, W.P.(C) 11074/2023, W.P.(C) 14529/2023,
W.P.(C) 14533/2023 & W.P.(C) 14863/2023
For Petitioner: Mr. Navneet Goyal, Advocate
For Respondents: Mr. Shivam Singh, Mr. Shaswati Parhi, Mr.
Shubham Janghu, Advocates in items no. 42, 43 &
44
Mr. Avnish Singh, SPC for UOI with Mr. Vishal
Kr. Yadav, Ms. Kanchan Kumari, Advocates in
item no. 45
Mr. Vikas Kumar Sharma, SPC with Mr. Rajat
Choudhary, Advocate for R-3 in item no. 42
Mr. Ajay Jain, SPC with Ms. Bijay Lakshmi, Mr.
M.N. Mishra, Mr. Manoj Kumar Gautam,
Advocates for R-3 in item no. 43
Ms. Uma Prasuna Bachu, SPC for R-3 in item no.
44
Mr. Haseeb, CGSC for R-3 in item no. 46
Mr. Raj Kumar Yadav, Advocate for UOI in item
no. 47
Signature Not Verified
W.P.(C) 7516/2022 & connected matters Page 1 of 26
Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
Ms. Devika Mohan, Mr. Karan Seth, Advocates
for IFFCO in item nos. 45, 46 & 47
CORAM:
HON’BLE MR. JUSTICE SANJEEV NARULA
JUDGMENT
SANJEEV NARULA, J. (Oral):
1. The present writ petitions raise common grounds of challenge and
emerge from similar set of facts. Accordingly, the same are being disposed
of by way of a common order.
2. Notwithstanding the commonalities, the specific details of each case
warrant individual attention, as the claims of each Petitioner arise from
separate insurance policies and involve distinct facts, such as the duration of
the policy, the date of the accident and the date of claim intimation. These
specific facts, are tabulated below as follows:
| Relevant Facts | W.P. (C) No.<br>7552 of 2022<br>Aisha<br>Khatoon<br>v. ITGI &<br>Ors. | W.P. (C) No.<br>7516 of 2022<br>Nuraisha<br>Khatoon v.<br>ITGI & Ors. | W.P. (C) 11074 of<br>2023<br>Smt. Lutfa Bibi v.<br>ITGI & Ors. |
|---|---|---|---|
| PBBY Policy No. | 1431648 | 30165210 | 30134291 |
| Duration of Policy | 27.11.2013 to<br>26.11.2015 | 08.01.2015<br>to<br>07.01.2017 | 30.12.2014 to<br>29.12.2016 |
| Date of Accident | 11.06.2015 | 29.01.2016 | 29.02.2016 |
| Date of Claim<br>Intimation | 07.04.2018 | 12.12.2018 | 10.09.2018 |
| Delay in Claim | 2 years 10 | 2 years 11 | 2 years 7 months |
Signature Not Verified
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
| Intimation | months | months | |
|---|---|---|---|
| Date of Claim<br>Repudiation | 15.06.2018 | 28.03.2019 | 17.09.2018 |
| Date of institution<br>of Writ Petition | 06.05.2022 | 06.05.2022 | 16.08.2023 |
| Delay in Petition<br>institution | 4 years | 3 years | 5 years |
| Date of<br>condonation of<br>delay by Embassy<br>/ Union | 22.06.2022 | 21.06.2022 | - |
| Relevant Facts | W.P. (C) No.<br>14863/2023<br>Sh.<br>Mohmmad<br>Husen<br>v. ITGI &<br>Ors. | W.P. (C) No.<br>14529/2023<br>Smt.<br>Rashida<br>Begum v.<br>ITGI & Ors. | W.P. (C) No.<br>14533/2023<br>Smt. Hashnehar<br>Bibi @ Hosnehara<br>Bibi v. ITGI &<br>Ors. |
|---|---|---|---|
| PBBY Policy No. | 30107646 | 1496190 | 1427526 |
| Duration of<br>Policy | 20.12.2014 to<br>19.12.2016 | 26.02.2014<br>to<br>25.02.2016 | 22.11.2013 to<br>21.11.2015 |
| Date of Accident | 17.11.2016 | 08.07.2015 | 23.05.2015 |
| Date of Claim<br>Intimation | 09.01.2019 | 11.07.2019 | 10.09.2018 |
| Delay in Claim<br>Intimation | 2 years and 2<br>months | 4 years | 3 years 4 months |
| Date of Claim<br>Repudiation | 22.01.2019 | 31.07.2019 | 17.09.2018 |
| Date of institution<br>of Writ Petition | 2.11.2023 | 02.11.2023 | 02.11.203 |
Signature Not Verified
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
| Delay in Petition<br>institution | Almost 5<br>years (4 years<br>and 10<br>months) | 4 years 3<br>months | 5 years 2 months |
|---|
3. To contextualize the controversy, the facts narrated in W.P.(C)
7552/2022 — Aisha Khatoon v. Iffco Tokio General Insurance Co. Ltd. &
Ors. — are being extensively noted and discussed below.
3.1 The Petitioner – Ms. Aisha Khatoon, is a citizen of India represented
through a Special Power Attorney holder, Mr. Sandeep Kumar Srivastava.
3.2 Respondent No. 1 – IFFCO-TOKIO General Insurance Co. Ltd., is a
general insurance company duly registered with Respondent No. 2 –
1
Insurance Regulatory and Development Authority of India . Respondent No.
2
3 is the Protector of Emigrants, Ministry of External Affairs , Government
of India. Respondent No. 1 provides insurance benefits to persons under the
policy issued by the MEA, Government of India, named - Pravasi Bharatiya
Bima Yojana, 2017, which is an insurance scheme for Indian emigrants
going abroad for employment.
3.3 Respondents No. 2 and 3 are ‘State’ within the meaning of Article 12
of the Constitution of India, 1950.
th
3.4 On 27 November, 2013, M/s. Al-Babtain Recruitment Office,
Riyadh (employer), purchased an insurance policy bearing No. 1431648
(P400 Policy No. 61469590) from Respondent No. 1 under the Pravasi
3
Bharatiya Bima Yojana, 2017 , for the husband of the Petitioner - Mr.
th th
Shahid Alam (emigrant) for the period covering 27 November, 2013 to 26
1
“IRDAI”
2
“MEA”
Signature Not Verified
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
November, 2015. The applicable premium for the policy was duly paid by
the employer. This policy covered personal accident covering death and
permanent total disability to the tune of INR 10 Lakhs. Subsequently, Mr.
Shahid Alam obtained his Emigration Clearance and left for work to Saudi
Arabia as an Assistant Vacuum Machine Operator for the employer - M/s.
Al-Babtain Recruitment Office, Riyadh.
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3.5 Unfortunately, on 11 June, 2015, the husband of the Petitioner, Mr.
Shahid Alam passed away in a road accident in Shaqra, Kingdom of Saudi
Arabia and intimation of his demise was received by the Petitioner.
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3.6 On 15 June 2015, a medical report concerning the deceased was
issued by the Ministry of Health, Kingdom of Saudi Arabia. This was
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followed by a communication from the Embassy of India, Riyadh, dated 14
July 2015, issuing a No Objection Certificate for the transportation of the
mortal remains of the Petitioner’s husband to India. The death certificate of
nd
Mr. Shahid Alam was subsequently issued on 22 July 2015, by the
Ministry of Health, Kingdom of Saudi Arabia.
th
3.7 On 29 July, 2015, the mortal remains were dispatched by a flight to
Delhi. The Petitioner completed the requisite formalities, and the mortal
remains of Late Mr. Shahid Alam were interred by their family members.
3.8 Once the necessary documents, including copies of the passport and
th
death report, were received from the Embassy of India, Riyadh, on 07
April, 2018, the Petitioner, through her Authorized Representative Mr.
Sandeep Kumar Srivastava, filed an insurance claim under the PBBY, 2017,
with Respondent No. 1, for the death of Mr. Shahid Alam. However, this
th
claim was rejected by Respondent No. 1 on 15 June 2018, in the following
3
“PBBY, 2017”
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
terms:
“Mrs. Aisha Khatoon, 15.06.2018
W/o. Late Shahid Alam,
Ward No 02, Gram, Sirkhindi P.O Chainpur, Bahuri,
East Champaran, PIN 845433, Bihar.
Respected Madam,
Sub: PBBY Policy# 1431648, Passport # L3009848,(P400 Policy
#61469590. Claim# 51010925) Death of Insured Mr. Shahid Alam on
11.06·2015 in KSA.
Please accept our deepest condolences on the sad demise of your
husband. This is with reference to the captioned claim lodged by you,
for the reported death of your husband Late Mr. Shahid Alam. On
verification of the documents submitted, we have the following
observations:
• The insured Mr Shahid Alam is reported to have died on 11-06-
2015, whereas the claim has been reported to us only on 17-04-2018.
• The Inordinate delay of more than 2Y, years in the claim intimation
is a violation of the General Condition No. 8A (ii) of the subject
Policy which states that: An event, which might become o claim under
the Policy, must be reported to Us as soon as possible. In case of death,
written notice also of death must, unless reasonable cause is shown, be
given before internment/cremation and In the event of Permanent
Disability, written notice thereof must also be given within one
calendar month after such disability. A written statement of the claim
will be required and o Claim Form will be provided for completion.
• By not giving timely claim Intimation, we have been deprived of the
valuable right to investigate the death claim.
• It is also noted that, the following documents have not been submitted:
➢ Claim form duly filled & signed by the Nominee
➢ Original Cancelled Passport
➢ Valid visa at the time of accident / IQAMA (Original/Attested copy)
➢ Contract copy (all pages duly attested).
➢ Death Certificate issued by the Govt. Authorities (Original)
➢ Police Report (Original)
➢ Post Mortem Report (Original)
➢ Certificate/Report from Indian Embassy {Original)
➢ Nominee's 10 proof & address proof
➢ Certified copy of Bank passbook of the Nominee, along with cancelled
cheque leaf.
In view of the above facts, we regret to inform our inability to admit the
liability under the Policy. The claim stands closed in our records & we
are treating this as an opportunity missed to serve you.”
Signature Not Verified
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
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3.9 On 28 October, 2018, the Petitioner furnished all the requisite
documents which were available with her and requested Respondent No. 1
to condone the delay in filing the claim. She explained that, being
uneducated, she was unaware of the insurance policy and its terms until
April 2018, when a person known to her advised her to initiate the insurance
rd
claim process. Thereafter, on 03 March 2019, the Petitioner approached the
grievance cell of Respondent No. 1, once again requesting them to
reconsider her claim. However, this request was also declined.
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3.10 On 30 May, 2019, Respondent No. 1 sent an email to the Petitioner
requesting her to seek the necessary approval from Respondent No. 3 –
Protector of Emigrants, for condonation of delay in intimation of the subject
claim. The email mentioned that upon receipt of confirmation from
Respondent No. 3 and submission of the necessary documents, the matter
would be forwarded to the competent authority for approval, after which the
claim would be processed in accordance with the policy terms and
conditions.
th
3.11 Accordingly, on 28 January, 2020, the Petitioner requested
Respondent No. 3 to condone of delay. However, since no response was
received, the Petitioner was compelled to institute the present writ petition,
seeking directions to the Respondents to process and settle the insurance
claim arising from the accidental death of her husband, Late Mr. Shahid
Alam.
th
3.12 When the matter was listed for the first time on 17 May 2022, the
counsel appearing for Respondent No. 3, who had received advance notice,
was directed to obtain instructions in light of the prayers sought. Thereafter,
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
Respondent No. 3 sent an email communication to the Embassy of India,
Riyadh, requesting them to issue the requisite certificate under the PBBY,
2017, establishing that the circumstances leading to the non-submission of
claim documents were beyond the control of the insured.
3.13 In response, the Embassy of India, Riyadh issued the requisite
nd
certificate on the same day - 22 June, 2022 to Respondent No. 1 –
insurance company, to the following effect:
“Madam/Sir,
This has reference to the email request dated 22.06.2022 received
from PoE, Mumbai regarding PBBY claim in respect of late Shri Shahid
Alam (passport No. L3009848) who died in a traffic accident at Shagra,
K.S.A on 11.06.2015
We would like to inform that the Saudi authorities sometimes send
death related documents including the detailed police report, forensic
report, summary of investigation, death certificate etc, to the Embassy
with lot of delay, which makes the process of forwarding these documents
to the family of the deceased further late.
Since, the circumstances were beyond the control of Embassy
/dependents of the deceased, it is requested that the insurance claim of
late Shahid Alam may please be processed again to alleviate the suffering
of his family.
With best regards”
3.14 Despite furnishing the above certificate issued by the Indian Mission
abroad, subsequent to the filing of the present writ petition, Respondent No.
1 continues to maintain their stand that the insurance claim has been rightly
and validly repudiated on the grounds of delay in intimation of claim.
4. The Court has heard the counsel for the parties extensively. The
objections raised by Respondent No. 1, both in their counter-affidavit and
during oral arguments, can be encapsulated under three principal headings:
I. The writ petition is not maintainable, as it pertains to a purely
contractual dispute and seeks monetary relief, which ought not to be
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
19:24:04
entertained under writ jurisdiction. Additionally, Respondent No. 1 is not a
‘State’ within the meaning of Article 12 of the Constitution of India, 1950.
There exists an alternative and efficacious remedy.
II. The claims are barred by delay and laches.
III. Questioning the Validity of the Petitioner’s Representation through a
Power of Attorney Holder.
I. QUESTION OF MAINTAINABILITY
HE RESENT ASE NVOLVES A URELY ONTRACTUAL ISPUTE
A. T P C I P C D
EEKING ONETARY ELIEF HICH HOULD OT E NTERTAINED
S M R , W S N B E
NDER RIT URISDICTION
U W J .
5. Mr. Shivam Singh and Ms. Devika Mohan, counsel for Respondent
No. 1, contend that the present writ petition is not maintainable. They urge
that the repudiation of the insurance claim of the Petitioners arises solely
from a contractual dispute between private parties, and the Petitioners have
failed to demonstrate any statutory violation or infringement of fundamental
rights. They emphasize that the writ petition is an attempt to revive time-
barred and contractually extinguished claims. They argue that the Petitioners
have not provided a valid explanation for the inordinate and belated
intimation of death of the insured to Respondent No. 1.
6. They further assert that it is well-established in law that writ courts
must exercise restraint in interfering with purely contractual relationships
between private entities. A writ of mandamus is a public law remedy and
cannot be invoked to enforce private or contractual rights. In support of this
proposition, they rely on precedents of the Supreme Court in Lakhiraj v. Dy
Custodian, AIR 1966 SC 334; DFO v. Biswanath Tea Co Ltd., AIR 1981
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
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SC 1368; Banchhanidhi Rath v. The State of Orissa , (1972) 4 SCC 781.
Additionally, they submit that the present case arises from an insurance
contract, which is purely a commercial transaction as held in Vikram
4
Greentech India Limited v. New India Assurance Company Limited .
Therefore, it constitutes a purely commercial relationship between two
private entities. Consequently, they argue that the dispute is not amenable to
the writ jurisdiction of this Court under Article 226 of the Constitution.
Reliance in this regard is placed on the judgement of Rajasthan State
Industrial Development & Investment Corpn. v. Diamond & Gem
5
Development Corporation Limited.
7. The counsel further contend that the Petitioners’ attempt to infuse the
present proceedings with a public law element is misguided, misconceived,
and untenable. They urge the Court to decline the exercise of its writ
jurisdiction in matters concerning the enforcement of contractual obligations
between private parties.
8. The Court has carefully considered the objections raised by
Respondent No. 1. While the broad legal propositions they rely upon are
undeniably sound, their objection to the maintainability of the writ petition
cannot be upheld in the present context. Although the dispute undoubtedly
arises from the repudiation of an insurance policy, the Petitioners have
raised significant and nuanced issues that warrant consideration under writ
jurisdiction of this Court.
9. It is imperative to acknowledge that the insurance policy in question
was issued under a scheme formulated by the Ministry of External Affairs,
4
(2009) 5 SCC 599
5
(2013) 5 SCC 470
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
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th
Government of India, through notification dated 10 July 2017. This
6
scheme, named the Pravasi Bharatiya Bima Yojana, 2017 , which came
st
into effect from 1 August 2017, is specifically framed as an insurance
scheme for Indian emigrants venturing abroad for employment. The scheme
is not a mere contractual arrangement between private parties but a
mandatory requirement for all citizens of India who apply for and obtain
Emigration Clearance under the Emigration Act, 1983. It also extends to
emigrants pursuing overseas employment in various professions falling
under work categories covered under Section 2(o) of the Emigration Act,
1983, irrespective of the passport category.
10. Clause 4 of the PBBY, 2017 explicitly mandates that all citizens
applying for Emigration Clearance must obtain an insurance policy which is
valid for a minimum period of two or three years. The insured individual
must be covered for a sum of INR 10 Lakhs in the event of accidental death
or permanent disability leading to loss of employment while abroad. The
intent behind this scheme is unequivocally welfare-oriented as it aims to
provide a safety net for Indian workers abroad; ensuring that in the
unfortunate event of death or disability, their families are not left destitute.
In the present case, there is a palpable element of dereliction of a
government-sponsored assurance. The PBBY, 2017 is not just an insurance
policy; it is a statutory mechanism framed to fulfil the government’s
obligation towards its emigrant workers. Consequently, when analysing the
repudiation of the insurance claim made by the Petitioner due to the death of
her husband overseas, it becomes essential to consider the underlying
purpose and spirit of the scheme. The issue is thus not merely a contractual
6
“PBBY, 2017”
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
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dispute between private parties; it touches upon the potential failure of a
government-mandated assurance intended to safeguard vulnerable citizens
employed abroad. In light of the above, the Court is of the view that the
matter cannot be strictly considered as a simple case of repudiation of a
contractual claim.
11. Furthermore, it must be emphasized that Article 226 confers upon the
High Courts the wide and expansive power to issue high prerogative writs
for the enforcement of fundamental rights and for any other purpose. The
Constitution places no fetters on the exercise of this power. While courts
normally exercise restraint in matters which are purely contractual in nature,
especially those involving private entities, this discretion is not absolute and
must be exercised judiciously, based on the facts of each case.
12. In this regard, it is noted that in the case of Life Insurance
7
Corporation of India and Ors. v. Asha Goel (Smt) and Anr., the Supreme
Court has delved into this question and has emphasised that when an insurer
has repudiated the claim, the High Court must consider the facts and
circumstances, the nature of dispute raised, the nature of inquiry necessary
to be made for determination of the questions raised as well as other relevant
factors before taking a decision on whether the Court should entertain the
writ petition or reject it as being non-maintainable. The Apex Court laid
emphasis on the necessity for the writ court to carefully weigh the pros and
cons of the matter within the specific context of the case. If the repudiation
of the claim raises serious disputes of fact, and the Court finds such disputes
to be bona fide , requiring oral and documentary evidence for their
resolution, then, ordinarily the writ court should refrain from exercising its
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Digitally Signed
By:DEEPANSHI NEGI
Signing Date:28.11.2024
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jurisdiction under Article 226 of the Constitution of India.
13. Turning to the facts of the present case. As noted earlier, Respondent
No. 1 repudiated the insured’s claim primarily on the grounds of delayed
intimation of the death of the insured and alleged deficiencies in the
documentation provided by the Petitioner. It is significant that there is no
dispute between the parties regarding the issuance of the insurance policy by
Respondent No. 1, the payment of the insurance premium by the employer,
the duration of the policy, or the death of the insured. Thus, in the opinion of
the Court, the most essential facts necessary for making a claim are firmly
established, and there is hardly any factual controversy. As for the objection
concerning documentation, while certain documents have not been verified
by the nominee and have been found lacking, the Petitioner can undoubtedly
remedy this by furnishing the requisite verified documents. Moreover, there
are no allegations of fraud, except for the doubt expressed concerning the
8
writ petition being filed by a Special Power of Attorney holder, which the
Court will address in the subsequent paragraphs.
14. Therefore, the Court finds that the claims of the Petitioners are not
merely a matter of enforcing private contractual rights but involves the
enforcement of a statutory scheme designed to protect the welfare of Indian
emigrant workers. The PBBY, 2017 is a social welfare initiative mandated
by the Government of India, which aims to provide financial security to
emigrants and their families in unfortunate circumstances. Denying the
Petitioners access to judicial review in such a scenario would defeat the very
purpose of the scheme and undermine the government’s efforts to safeguard
7
(2001) 2 SCC 160
8
“SPA”
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Digitally Signed
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Signing Date:28.11.2024
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citizens who are working abroad. Thus, Respondent No. 1’s objections on
the maintainability of the instant writ petition on the ground that it is a
purely contractual dispute, is not sustainable. Moreover, in the facts of the
present case, the mere existence of an alternative remedy does not oust the
writ jurisdiction of the Court, especially when the matter involves
allegations of arbitrariness or violation of fundamental rights.
B. R ESPONDENT N O . 1 IS NOT A ‘S TATE ’ WITHIN THE MEANING OF
RTICLE OF THE ONSTITUTION OF NDIA
A 12 C I .
15. Counsel for Respondent No. 1 contend that the Petitioner has failed to
demonstrate how Respondent No. 1 qualifies as an authority performing
public functions under Article 12 of the Constitution. They assert that
Respondent No. 1 is a private entity engaged in the commercial business of
selling insurance products and, as such, it does not fall within the ambit of
‘State’ or ‘other authorities’ as envisaged by the Constitution. They further
argue that the Petitioner’s request for judicial intervention does not align
with the jurisdiction of this Court under Article 226 of the Constitution. In
support of this contention, they rely on the decision in Federal Bank Ltd. v.
9
Sagar Thomas & Ors., wherein the Apex Court cautioned writ courts
against adopting a liberal interpretation in terms of private companies being
amenable to writ jurisdiction.
16. Alternatively, in terms of W.P.(C) 7552/2022 and W.P.(C)
7516/2022, counsel for Respondent No. 1 argue that the relief sought in the
present writ petitions, pertaining to the government’s role for condonation of
delay under the PBBY 2017, has already been redressed by the Embassy of
nd st
India, Riyadh, through their communication dated 22 June 2022 and 21
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Digitally Signed
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Signing Date:28.11.2024
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June, 2022 respectively. As such, the writ petitions stand infructuous against
the State entities, and any further relief sought against Respondent No. 1
falls outside the purview of this Court’s writ jurisdiction.
17. It is undeniable that Respondent No. 1 is a private insurance company
operating in the commercial sector. Ordinarily, such entities are not
considered ‘State’ or ‘other authorities’ within the meaning of Article 12 and
therefore, they are not directly amenable to writ jurisdiction. However, the
matter does not rest there. The crucial question is whether Respondent No.
1, despite being a private entity, is performing a public function or
discharging public duties under the aegis of a governmental scheme. The
PBBY, 2017 is a welfare scheme formulated by the Ministry of External
Affairs, Government of India. It mandates that all Indian citizens seeking
emigration clearance for employment abroad obtain mandatory insurance
coverage as specified under the scheme. Thus, by providing insurance
policies under this government-mandated scheme, Respondent No. 1 is
effectively participating in the implementation of a public welfare program.
The role of Respondent No. 1 thus is not that of a conventional private
insurer; it becomes an instrumentality facilitating the State’s objective of
protecting its citizens working overseas. In this capacity, Respondent No. 1
performs functions that are imbued with public interest. The Supreme Court,
10
in Zee Telefilms Ltd. v. Union of India, elucidated that even if an entity is
not ‘State’ under Article 12, it can still be subject to writ jurisdiction if it
performs public duties or functions of a public nature. In the present case,
the Petitioners’ grievance pertains to the alleged arbitrary and unjust
9
(2003) 10 SCC 733
10
(2005) 4 SCC 649
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Signing Date:28.11.2024
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repudiation of an insurance claim under a statutory scheme intended for the
welfare of Indian emigrant workers. The denial of such a claim impacts the
Petitioners’ legal rights and undermines the purpose of the government
scheme. Therefore, since the insurance company has issued the subject
insurance policies under the specific scheme of the Government of India, the
policies attain a character of discharging public function. Reliance in this
11
regard is also placed on the case of Binny Ltd. v. V. Sadasivan & Ors.
wherein it has as follows:
“11. Judicial review is designed to prevent the cases of abuse of
power and neglect of duty by public authorities. However, under
our Constitution, Article 226 is couched in such a way that a writ
of mandamus could be issued even against a private authority.
However, such private authority must be discharging a public
function and the decision sought to be corrected or enforced must
be in discharge of a public function. The role of the State expanded
enormously and attempts have been made to create various
agencies to perform the governmental functions. Several
corporations and companies have also been formed by the
Government to run industries and to carry on trading activities.
These have come to be known as public sector undertakings.
However, in the interpretation given to Article 12 of the
Constitution, this Court took the view that many of these companies
and corporations could come within the sweep of Article 12 of the
Constitution. At the same time, there are private bodies also which
may be discharging public functions. It is difficult to draw a line
between public functions and private functions when they are
being discharged by a purely private authority . A body is
performing a “public function” when it seeks to achieve some
collective benefit for the public or a section of the public and is
accepted by the public or that section of the public as having
authority to do so . Bodies therefore exercise public functions when
they intervene or participate in social or economic affairs in the
public interest…”
[Emphasis added]
18. Therefore, in this context, the actions of Respondent No. 1 are
11
(2005) 6 SCC 657
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amenable to scrutiny under the writ jurisdiction of this Court. Federal Bank
12
Ltd. v. Sagar Thomas & Ors., relied upon by Respondent No. 1 is
distinguishable on facts. In that case, the Supreme Court dealt with internal
employment matters of a private bank, where no public function was
involved. In contrast, the present case involves the implementation of a
government welfare scheme, wherein Respondent No. 1 performs a public
duty.
19. As for the alternative argument that the condonation of delay has
already been granted by the Embassy of India, Riyadh and thus the writ
petitions stand infructuous against State entities, the Court notes that this
development does not render the writ petitions infructuous. The core issue
remains Respondent No. 1’s refusal to process and settle the insurance claim
despite the condonation of delay by the competent authority.
The grounds of repudiation
20. At this juncture, the Court must take a note of the requirement of
issuance of a certificate for condonation of delay in intimation of claims
under Clause 4 (e) of the PBBY, 2017, which reads as follows:
“(e) The insurance company shall pay the sum insured in case of
accidental death or permanent disability due to any
accident/physical injury sustained while in employment abroad
occurring within twelve months from the date of such accident
provided it occurs during the currency of insurance policy and such
death or permanent disability shall be attributed to the said accident.
In such cases, intimation about the accident/physical injury will be
sent to the Insurance Company within 30 days from the date of such
accident/physical injury. Further, claim has to be filed within 90
days from the date of accidental death/permanent stability. In case
of non-submission of claim documents within 90 days, certificate
from the Indian Mission/Post stating that the circumstances were
beyond the control of the insured, will be accepted by the
12
(2003) 10 SCC 733
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Insurance Company. In case of accidental death/permanent
disability in India, certificate from Protector of Emigrants will be
accepted. ”
[Emphasis added]
21. A careful reading of the above provision reveals that if there is a delay
in submitting the claim documents beyond the stipulated 90 days, the
insurance company is obliged to accept a certificate from the Indian
Mission/Post affirming that the delay was due to circumstances beyond the
control of the insured. This clause emphasis the welfare-oriented object of
the scheme, ensuring that genuine claims are not defeated by procedural
delays, especially when such delays are attributable to factors outside the
control of the claimants. Thus, through the present writ petitions, the
Petitioners are seeking the implementation of Clause 4 (e) of PBBY, 2017
for enforcement of their claims. However, the Petitioners’ quest for relief is
not limited to obtaining condonation of delay, but extends to the
enforcement of their rightful claims under the insurance policy, which was
issued pursuant to a government scheme. Respondent No. 1’s persistent
refusal to honour the claim necessitates judicial intervention to ensure that
the objectives of the welfare scheme are not defeated by procedural
technicalities or unjustifiable repudiations.
22. In view of the foregoing analysis, the Court concludes that
Respondent No. 1, while being a private entity, is performing public
functions under the PBBY, 2017. Therefore, its actions are subject to
judicial review under Article 226 of the Constitution of India. The objection
regarding the maintainability of the writ petition on the ground that
Respondent No. 1 is not a ‘State’ under Article 12 of the Constitution is
accordingly rejected.
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C. W RIT P ETITION IS NOT MAINTAINABLE AS THERE IS ALTERNATE
REMEDY AVAILABLE
23. Counsel for Respondent No. 1 have argued that in the facts of the
case, the Petitioners have an equally efficacious and alternative remedy of
filing a civil suit or complaint under the Consumer Protection Act, 2019,
rather than filing the present writ petitions under Article 226 of the
Constitution.
24. In the considered opinion of the Court, while the Consumer Protection
Act, 2019, provides a specialized legislative framework for addressing
deficiencies in service, including disputes arising from insurance claims, the
mere existence of such remedies does not automatically preclude the
invocation of writ jurisdiction. The availability of an alternative remedy is a
factor for the Court to consider, but it is not an absolute bar on invocation of
writ jurisdiction. The present writ petitions raise broader questions of public
law, particularly concerning the implementation of the Pravasi Bharatiya
Bima Yojana, 2017. The issues at hand are not confined to a simple dispute
over service deficiency but involve the interpretation and enforcement of a
statutory scheme intended to protect the welfare of Indian emigrant workers.
Moreover, as previously noted, there is minimal factual controversy in the
present case. The essential facts, such as the issuance of the insurance
policy, payment of the premium, the policy’s validity period, and the
unfortunate death of the insured are undisputed. The primary dispute in the
present cases revolves around the delay in claim intimation and the
subsequent repudiation of the claim by the insurance company, despite the
provision for condonation of delay under Clause 4 (e) of PBBY, 2017.
25. Additionally, effective adjudication of the Petitioners’ claim
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necessitates directions to be issued not only to the insurance company but
also to government authorities involved in the administration of the scheme.
The intertwining of private and public entities in the execution of the PBBY,
2017, is an appropriate cause for judicial review under Article 226 of the
Constitution.
II. THE PETITIONER’S CASE IS HIT BY DELAY AND LACHES
26. Counsel for Respondent No. 1 have vehemently argued that the
tabulation laying out the details of the instant writ petitions, as extracted
hereinabove, clearly indicate that firstly, there was a gross delay on the part
of the Petitioners in intimation of the claim to Respondent No. 1 and
secondly, there was also inordinate delay by their side in instituting of the
present writ petitions. Thus, they argue that in light of the delay and laches
on the part of the Petitioners, the Court should not grant any indulgence by
issuing a prerogative writ in the instant matter.
27. While it is undisputed that there has been delay on the part of the
Petitioners in filing their claims and the writ petitions, the Court cannot
disregard the factual background and compelling reasons underlying this
delay. The husband of the Petitioner in W.P.(C) 7552/2022 was employed as
an Assistant Vacuum Machine Operator in Saudi Arabia, striving to support
his family. Similarly, the Petitioners in the other connected cases are
beneficiaries who have lost family members, all of whom were Indian
emigrants engaged in modest occupations abroad, under similar
circumstances. These Petitioners are individuals of limited means and
education, who have endured the profound loss of their loved ones who
ventured abroad in the hope of better prospects.
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28. The doctrine of delay and laches is an equitable principle which
requires the Court to not only consider the length of the delay but also the
reasons for the same. In cases where the delay is attributable to factors such
as poverty, illiteracy, or other compelling circumstances, courts have been
inclined to exercise discretion in favour of the Petitioners. In the present
case, the delay in gathering the requisite documents and resources to invoke
the jurisdiction of this Court is a pertinent factor that cannot be ignored. The
Petitioners faced significant obstacles due to their socio-economic status,
lack of awareness of legal processes and the complexities involved in
obtaining documentation from foreign jurisdictions. Thus, dismissing the
present writ petitions solely on the ground of delay would defeat the ends of
justice and perpetuate hardship upon individuals who are already vulnerable.
29. Furthermore, counsel for the Petitioners has explained that, due to
these valid reasons, it is the SPA holder, Mr. Sandeep Kumar Srivastava,
who has come forward to safeguard the interests of the Petitioners. His
involvement further proves the difficulties faced by the Petitioners in
navigating legal procedures and reinforces the need for the Court’s
compassionate consideration.
30. Moreover, it must also be noted that the scheme itself provides for
such a situation where delay can be caused in submission of claim
documents, not because of any fault of the insured or the beneficiaries, but
for reasons outside their control. Clause 4 (e) of the PBBY, 2017 referred
above, contemplates such a situation where there could be a delay on the
part of the nominee to make a claim. This must be because the Government
would have witnessed that claims under PBBY are being filed belatedly and
are being repudiated by insurance companies on the grounds of delay. In
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such circumstances, the Respondent No. 3 - Protector of Emigrants has been
nominated to settle the issue of certificate in case of accidental
death/permanent disability.
31. In fact, Respondent No. 3 in their counter affidavit have also
highlighted that they were in communication with the Embassy of India,
Riyadh regarding the required certificates, stating that the family of the
emigrants are very poor and uneducated and did not possess the necessary
documents required for their claim for the longest time. Therefore,
Respondent No. 3 requested the Embassy to grant the requisite certificate
expeditiously, which the Embassy complied with.
32. At this juncture, the Court must also take notice of a circular issued by
th
Respondent No. 2 – IRDAI dated 20 September, 2011, to all life insurers
and non-life insurers, which reads as follows:
“The Authority has been receiving several complaints that claims are
being rejected on the ground of delayed submission of intimation and
documents. The current contractual obligation imposing the condition
that the claims shall be intimated to the insurer with prescribed
documents within a specified number of days is necessary for insurers
for effecting various post claim activities like investigation, loss
assessment, provisioning, claim settlement etc. However, this
condition should not prevent settlement of genuine claims,
particularly when there is delay in intimation or in submission of
documents due to unavoidable circumstances.
The insurers’ decision to reject a claim shall be based on sound
logic and valid grounds. It may be noted that such limitation clause
does not work in isolation and is not absolute. One needs to see the
merits and good spirit of the clause, without compromising on bad
claims. Rejection of claims on purely technical grounds in a
mechanical fashion will result in policyholders losing confidence in
the insurance industry, giving rise to excessive litigation.
Therefore, it is advised that all insurers need to develop a sound
mechanism of their own to handle such claims with utmost care and
caution. It is also advised that the insurers must not repudiate such
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claims unless and until the reasons of delay are specifically
ascertained, recorded and the insurers should satisfy themselves that
the delayed claims would have otherwise been rejected even if
reported in time.
The insurers are advised to incorporate additional wordings in the
policy documents, suitably enunciating insurers’ stand to condone
delay on merit for delayed claims where the delay is proved to be for
reasons beyond the control of the insured.”
[Emphasis added]
33. The aforenoted circular issued by the regulatory authority for the
insurance sector emphasises that insurers must develop a sound mechanism
to handle such claims with care and caution. It has also been advised that
“ the insurers must not repudiate such claims unless and until the reasons
of delay are specifically ascertained, recorded and the insurers should
satisfy themselves that the delayed claims would have otherwise been
rejected even if reported in time” .
34. The above circular emphasises that the merits of the claims are
paramount rather than just a mere delay. After all, the life insurance policies
in the instant cases were only meant for a situation which unfortunate events
have transpired in the lives of all the Petitioners before this Court. In such
circumstances, the grounds of delay and laches is also being over-ruled.
III. APPREHENSION REGARDING THE PETITONERS NOT
BEING REPRESENTATION BY THE ATTORNEY
35. Regarding the above captioned objection, counsel for Respondent No.
1, points out that all the Petitioners in the instant writ petitions are
represented by the same SPA holder, Mr. Sandeep Kumar Srivastava.
Therefore, they raise doubts on the genuineness of the SPA and the
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authorization of Mr. Sandeep Kumar Srivastava.
36. Significantly, in W.P.(C) 7552/2022, Mr. Singh has produced a copy
of an affidavit purportedly filed by Ms. Aisha Khatoon before Respondent
No. 1. The English translation of this affidavit indicates that she has
categorically stated that she is unaware of any proceedings ongoing in this
High Court, regarding the insurance claim under the policy of her late
husband with Respondent No. 1, bearing Policy No. 1431648 and Claim No.
61010925. Relying upon this document, Mr. Singh emphasizes that the
apprehensions expressed by Respondent No. 1 in their counter-affidavit are
further substantiated by this affidavit.
37. While the objections raised by the Respondents warrant careful
consideration, they do not by themselves, justify the rejection of the writ
petitions altogether. The primary concern raised in the writ petitions is to
ensure that the rightful beneficiaries receive the insurance claim proceeds
due to them. Further, the Court is well within its powers to issue appropriate
directions to the Respondents to ensure that any claim amounts under the
insurance policies are disbursed directly to the genuine beneficiaries or
nominees, rather than to an allegedly unauthorized SPA holder. The
insurance company can undertake a thorough verification of the identity and
entitlement of the nominees or beneficiaries to alleviate any concerns
regarding the authenticity of the Petitioners’ claims.
38. It is also pertinent to acknowledge that the Petitioners, being
individuals of limited means and education, may have faced significant
challenges in dealing with the complexities of legal proceedings without
assistance. The involvement of a common SPA holder does not necessarily
imply fraud or misrepresentation; rather, it may reflect a practical approach
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adopted by the Petitioners to collectively seek justice. Prematurely
dismissing their writ petitions on the basis of such apprehensions could
unjustly deprive them of their rightful claims and access to legal remedies.
39. In light of the foregoing discussion and analysis, all the writ petitions
are disposed of with the following directions:
(a) The impugned letters issued by Respondent No. 1, repudiating the
claims of the Petitioners, are hereby set aside.
(b) The Petitioners are directed to furnish all the requisite documents, as
required under the policy and to the satisfaction of Respondent No. 1, for
processing their claims under the insurance policies.
(c) In cases where the necessary certificate under Clause 4(e) of the
Pravasi Bharatiya Bima Yojana, 2017, has already been issued by the Indian
Mission abroad, Respondent No. 1 shall proceed forthwith to process the
claims, subject to the Petitioners’ compliance with direction (b) above.
Respondent No. 1 shall verify the documents in light of the observations
made hereinabove, process the claims expeditiously, and release the
payments due to the Petitioners within a period of eight weeks from the date
of furnishing the documents.
(d) In W.P.(C) 11074/2023, W.P.(C) 14529/2023, W.P.(C) 14533/2023
and W.P.(C) 14863/2023, where the necessary certificates/communications
are yet to be issued, Respondent No. 3—the Protector of Emigrants—shall,
in consultation with the Indian Missions abroad, provide the necessary
certificates under Clause 4(e) of the Pravasi Bharatiya Bima Yojana, 2017,
within a period of four weeks from the date of this order. Thereafter,
Respondent No. 1 shall, within a period of eight weeks from the date of
receipt of the certificates/communications, verify the documents, process the
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claims expeditiously and release the payments due to the Petitioners.
(e) In W.P.(C) 7552/2022, Respondent No. 1 shall directly inform Ms.
Aisha Khatoon (the Petitioner) of the date and time when she is to visit the
regional office of Respondent No. 1 closest to her residence, for verification
of her identity.
(f) In order to address the concerns regarding representation through the
Special Power of Attorney holder, it is directed that Respondent No. 1 shall
disburse the claim amounts directly to the nominees or beneficiaries entitled
under the policy.
(g) The Respondents are directed to ensure that the benefits under the
Pravasi Bharatiya Bima Yojana, 2017, are extended to the Petitioners in a
fair and prompt manner, considering the welfare objectives of the scheme
and in accordance with law.
(h) Respondent No. 1 shall file a compliance report before this Court
within two weeks after the disbursement of the claim amounts to the
Petitioners.
40. The writ petitions are accordingly disposed of in the above terms
along with pending application(s). There shall be no order as to costs.
SANJEEV NARULA, J
NOVEMBER 22, 2024/ab
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