Km.Vidyawati vs State Of U.P. And 4 Others

HIGH COURT OF JUDICATURE AT ALLAHABAD
WRIT - C No. - 28051 of 2023
Km.Vidyawati
…..Petitioner(s)
Versus
State of U.P. and 4 others
…..Respondent(s)
Counsel for Petitioner(s) : Ramesh Chandra Pathak
Counsel for Respondent(s) : Arun Kumar Shukla, C.S.C.
A.F.R.
Reserved on 25.09.2026
Delivered on 26.10.2026
Court No. - 5
HON'BLE PRAKASH PADIA, J.
HON'BLE GARIMA PRASHAD, J.
(As per Hon’ble Garima Prashad, J.)
1. Heard Sri Jagdish Prasad Chaurasia, learned Advocate holding brief of
Sri Ramesh Chandra Pathak, learned counsel for the petitioner, Sri Arun
Kumar Shukla, learned counsel for the respondent no. 5 and learned
Standing Counsel for the State. 
2. The present Writ Petition has been filed challenging the rejection of
the petitioner's claim under the Mukhyamantri Kisan Evam Sarvahit
Bima Yojana, communicated by the Oriental Insurance Company
Limited on 16.04.2021. The petitioner seeks payment of Rs.5,00,000/-
on account of the accidental death of her brother, Abhay Charan Darshan
Dubey.

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3. Briefly stated, the facts are that the petitioner's brother died in a road
accident on 18.05.2019. A First Information Report was lodged at Police
Station Chhawani, District Basti, and his death was registered by the
competent authority. The petitioner claims that, after the death of their
parents, her brother cultivated the family agricultural land and was the
head and breadwinner of the household. She was unmarried and
dependent upon him. The revenue records concerning the family holding
have been filed with the Writ Petition.
4. The petitioner submitted a claim for the insured amount under the
Scheme. By a communication dated 03.10.2019, the Insurance Company
informed her that the claim had been rejected because a sister was not
included in the definition of family in the Memorandum of
Understanding. The claim was thereafter placed before the District
Committee, Basti. In its meeting held on 18.11.2019, the Committee
considered the report of the Sub-Divisional Magistrate, Harraiya,
recorded that the deceased was the head of the family and directed the
Insurance Company to accept the claim and ensure payment. The
petitioner was informed of that decision by the office of the District
Magistrate on 09.03.2021.
5. The Insurance Company nevertheless maintained its rejection. In the
communication dated 16.04.2021, it stated that the claim had been made
by the deceased's sister and that, under the definition of family on page 5
of the Memorandum of Understanding, a sister was not entitled to the
benefit upon her brother's death.
6. Learned counsel for the petitioner submits that the deceased was an
agriculturist and the head and breadwinner of the family. After the death
of their parents, the petitioner depended upon him and is now the only

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WRIC No. - 28051 of 2023
surviving member of the household. She claims as his nominee and legal
heir. The Scheme provides for payment to the nominee or legal heir upon
the accidental death of the insured head or breadwinner. The Committee
examined the claim and directed payment after considering the report of
the revenue authority. The petitioner submits that her relationship as
sister cannot defeat the death claim when the insured event and the
deceased's coverage are otherwise established.
7. Per contra, learned counsel for the Oriental Insurance Company
submits that the Scheme is implemented under an agreement between
the State Government and the Company, and the rights of the parties are
governed by the Memorandum of Understanding and the insurance
policy. The family composition specified in those documents includes
the head or breadwinner, the spouse, an unmarried daughter, a dependent
son and parents in the stated circumstances. A sister is not included. The
Company therefore maintains that the Committee acted contrary to the
contractual terms in directing payment and that the Court cannot require
payment of an uncovered claim merely because the Scheme has a
beneficial object.
8. The Company also refers to its challenge to the payment directions
issued by the District Magistrate, Basti, in Writ-C No. 28577 of 2021
before the Lucknow Bench. It relies upon The Oriental Insurance
Company Limited and others v. State of U.P. and others, Writ-C No.
59959 of 2017, decided on 21.12.2017, and Smt. Rajwati Devi v. State
of U.P. and others, Writ-C No. 5612 of 2023, decided on 19.04.2023, to
submit that the Committee must act within the Scheme and give reasons,
and that an unlawful direction cannot be enforced through a writ of
mandamus.

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9. We have considered the rival submissions and the material on record.
The question is whether the omission of a sister from the list of persons
covered as family members also excludes her from receiving the
personal accident death benefit as the legal heir of an insured head or
breadwinner.
10. The present claim is governed by the Mukhyamantri Kisan Evam
Sarvahit Bima Yojana implemented through the State's agreement with
the Insurance Company. The agreement dated 13.09.2018 continued the
Scheme for the insurance period from 14.09.2018 to 13.09.2019. The
group personal accident policy filed by the Company covers that period.
The accident on 18.05.2019 occurred during its currency. The State
undertook payment of the premium, and the Company undertook
assessment and payment of claims according to the agreement, the
incorporated Scheme and its amendments. 
11. The Scheme makes a distinction between personal accident insurance
and post-accident medical benefits. Under the first part, the head or
breadwinner is insured against accidental death or disability. Under the
second part, medical treatment and artificial limb benefits are extended
to the head or breadwinner and covered family members. The provision
headed “ ” states that the head or breadwinner is covered
परिवारआच्छादन
for personal accident insurance up to Rs.5,00,000/-, while the head or
breadwinner and family members are covered for the stated post-
accident medical benefits. The policy schedule preserves the same
distinction.
12. The provision concerning family composition reads:
– /
“
परिवारनिर्धारण परिवारकेअन्तर्गतपरिवारकामुखिया रोटीअर्जक
( / ) / , , ,
पुरुष स्त्री उसकीपत्नी पति अविवाहितपुत्री आश्रितपुत्र मुखिया

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-
पति एवंअविवाहितपुरुषकेआश्रितमाता पिताबीमाकालाभप्राप्त
”
करनेहेतुआवृत्तहोंगे।
Translated into English, it provides that the head or
breadwinner, male or female, the spouse, an unmarried
daughter, a dependent son and dependent parents of an
unmarried male or of a husband who is the head of the
family are covered for insurance benefits. The policy
likewise lists those categories and states that the wife's
parents are not covered. A sister is not separately included
in that list.
13. The provision governing payment upon death appears under Part I,
personal accident insurance, and reads:
– /
“
दुर्घटनामेंमृत्यु यदि दुर्घटनाकेकारणपरिवारकेमुखिया रोटी

अर्जककीमृत्युबीमाअवधि केदौरानहोजातीहैतोबीमाकम्पनी
5.00 /
सम्पूर्णबीमितराशि रू० लाखकाभुगताननामिनी कानूनीवारिस
”
कोकरेगी।
The English translation reads:
“ Death in an accident—If the head of the family or
breadwinner dies as a result of an accident during the
insurance period, the Insurance Company shall pay the
entire insured amount of Rs.5.00 lakh to the nominee or
legal heir.”
14. The agreement repeats this recipient category in the personal
accident claim procedure. Clause (a) provides:
“ In case of accidental death or physical disability (as the
case may be), Head of the Family/ Bread Earner/

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WRIC No. - 28051 of 2023
nominee/ legal heir (as applicable) shall submit claim
documents through Common Service Centers/ outlets to
Insurance Company.”
The procedure further requires a legal heir certificate only in
controversial cases and provides for payment to the head or breadwinner,
nominee or legal heir, as applicable. Thus, the person whose accident is
insured and the person who receives payment after that person's death
are separately identified by the contract.
15. The family-composition provision identifies persons covered for the
benefits available under the Scheme. The death-payment provision
identifies the recipient when the insured head or breadwinner dies. A
person claiming that her own accident is covered as a family member
must satisfy the applicable coverage provision. A person seeking
payment after the death of the insured head or breadwinner must
establish her entitlement as nominee or legal heir. The latter provision
does not restrict a legal heir to the relationships listed in the family-
composition clause.
16. The Company's interpretation would add such a restriction to the
words “nominee/legal heir”. It would require those words to be read as
“nominee/legal heir who is also a covered family member”, although the
agreement contains no such qualification. The repeated use of the
recipient category in the claim and payment provisions must be given
effect. The petitioner does not seek a benefit for an accident suffered by
her as an insured sister. She seeks the amount payable upon the
accidental death of her brother, who was found by the Committee to be
the head of the family. Her claim must be examined in that capacity.

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WRIC No. - 28051 of 2023
17. The law governing this insurance arrangement was considered by a
Division Bench of this Court in Oriental Insurance Company Ltd. v.
Smt. Uma Devi and others, Writ-C No. 21066 of 2020, decided on
25.01.2021, reported in (2021) 1 ILR (All) 314. In paragraph 29, the
Court explained that insurance liability is governed by the contract,
whose words must be given effect without addition or substitution and
whose provisions must be read together. In paragraphs 12 and 15, it also
recognised the contractual effect of a decision of the District Review
Committee. These principles require consideration of the death-payment
clause together with the coverage clause. The beneficial object supports
that reading, but the entitlement follows from the contractual text itself.
18. The Committee's authority is expressly provided in clause (m) of the
personal accident claim procedure. Its material part reads:
“ The Committee shall take decision on all the
discrepant/ Controversial claims. The Insurance
Company shall be bound to adhere to the decision taken
by the Committee and make the payment within one
month.”
The clause then provides for delivery of the cheque to the concerned
head or breadwinner, nominee or legal heir, as applicable. The
Committee's decision must be consistent with the Scheme and supported
by reasons; its contractual authority does not permit enlargement of the
insured risk.
19. The decision in The Oriental Insurance Company Limited and others
v. State of U.P. and others (supra) concerned claims rejected in District
Shamli and coercive recovery directions issued against the insurer. The
Division Bench held that both the Company and the Committee must act

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WRIC No. - 28051 of 2023
within the Scheme, and that the Committee must give reasons for
altering a rejection. That principle applies to the present claim. It does
not, however, decide that a sister is incapable of receiving a death benefit
as legal heir. The Committee here considered the objection concerning
her relationship, referred to the Sub-Divisional Magistrate's inquiry and
recorded that the deceased was the head of the family. The present
decision further examines the specific payment provision on which the
petitioner's entitlement rests.
20. In Smt. Rajwati Devi v. State of U.P. and others (supra), the Division
Bench declined to enforce a direction for payment where death by
murder was held not to be covered by the Scheme considered there. The
case establishes that an unlawful award cannot be enforced merely
because it was made by the District Magistrate. The present case
concerns a road accident during the insurance period. The Company's
objection is to the recipient's relationship, rather than to an excluded
cause of death. The petitioner seeks payment under the provision for a
nominee or legal heir. Applying that provision enforces the agreed
liability and does not create insurance cover for an excluded event.
21. The order dated 09.12.2021 filed by the Company in connection with
Writ-C No. 28577 of 2021 calls for instructions concerning the
procedure followed for resolution of disputed claims. It contains no stay
of the payment directions and no determination of the petitioner's
entitlement. The Company's reference to those proceedings does not
answer the interpretation of the contract which arises in this Writ
Petition. The petitioner's claim has been examined here on its own facts
and under the provisions governing receipt of the death benefit.

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WRIC No. - 28051 of 2023
22. The petitioner's case, is that both parents had died, that she and her
brother formed the surviving household and that he was its only
breadwinner. She states that she is now its only surviving member. The
Company's affidavit does not put forward any competing claimant or any
different basis of succession. Its case is that a sister, by reason of that
relationship alone, is outside the Scheme. The Committee's decision
identifies Abhay Charan as the deceased, Vidyawati as the claimant and
18.05.2019 as the date of death, and records the finding concerning the
deceased's position as head of the family. The insurer has maintained the
same categorical objection after that inquiry.
23. The petitioner's entitlement can therefore be determined as legal heir
without treating the pleaded description of her as nominee as proof of a
separate nomination. The Company's objection does not disclose a
dispute between rival heirs, and the Scheme requires a succession
certificate from the competent Court only where succession is disputed.
The omission of a sister from the list of covered family members cannot
itself create such a dispute or defeat the express provision for payment to
a legal heir.
24. The deceased's status as head of the family was examined by the
revenue authority and accepted by the Committee. His death in a road
accident during the policy period and the claim for the prescribed death
benefit are before the Court. The rejection is maintained solely because
the claimant is his sister. The Company has thereby applied the family-
composition provision to a question governed by the death-payment
provision and has failed to give effect to the contract as a whole. That
error vitiates the rejection.

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25. We accordingly hold that an unmarried sister is not disqualified from
receiving the personal accident death benefit merely because she is not
separately listed as a covered family member. Where the deceased was
an insured head or breadwinner and the claimant is entitled as nominee
or legal heir, payment is governed by the provision expressly applicable
to that recipient. On the facts of this case, the petitioner is entitled to
receive the prescribed amount as the legal heir of the deceased. This
finding concerns receipt of the death benefit and does not enlarge the
categories of persons whose own accidental injury or medical treatment
is insured under the Scheme.
26. Accordingly, the Writ Petition is allowed. The rejection
communicated by the Oriental Insurance Company Limited on
16.04.2021 is quashed. The Company is directed to pay Rs.5,00,000/- to
the petitioner under the Mukhyamantri Kisan Evam Sarvahit Bima
Yojana within four weeks from the date of production of a certified copy
of this judgment. The District Magistrate, Basti, shall facilitate payment
in accordance with the claim-payment procedure. No order as to costs.
(Garima Prashad,J.) (Prakash Padia,J.)
October 26, 2026
Sachin Mishra
Digitally signed by :-
SACHIN MISHRA
High Court of Judicature at Allahabad