HEADNOTE
Machindra Maruti Gaikwad v. Union of India & Ors.
Court: Bombay High Court (Aurangabad Bench)
Bench: Arun R. Pedneker, J. & Vaishali Patil-Jadhav, J.
Date of Judgment: January 9, 2026
Citation: 2026:BHC-AUG:937-DB
Laws / Schemes Involved: Pradhan Mantri Garib Kalyan Package Insurance Scheme for Health Workers Fighting COVID-19
Keywords: Covid insurance claim, RTPCR report, CT scan evidence, health worker death, Garib Kalyan Yojana, humanitarian approach
Summary
The Bombay High Court (Aurangabad Bench) held that a Covid-19 insurance claim under the Pradhan Mantri Garib Kalyan Package Insurance Scheme cannot be rejected solely due to the absence of an RTPCR-positive report when overwhelming medical evidence establishes Covid-19 as the cause of death. Setting aside the District Collector’s rejection order, the Court relied on CT scan findings, oxygen saturation records, hospital discharge summaries, and the official cause-of-death certificate confirming Covid-19 complications. Emphasising that welfare schemes must be implemented with a humane and pragmatic approach, the Bench directed authorities to forward and decide the petitioner’s claim within eight weeks, reiterating that technicalities cannot defeat the object of beneficial schemes meant for frontline health workers who lost their lives during the pandemic.
Court’s decision
The Aurangabad Bench of the Bombay High Court quashed the District Collector’s order dated 15 September 2022 rejecting the petitioner’s claim for ₹50 lakh insurance under the Pradhan Mantri Garib Kalyan Package Insurance Scheme. The Court held that insistence on an RTPCR-positive report as the sole determinant of Covid-19 death was legally unsustainable. Directing a purposive interpretation of the scheme, the Bench ordered the Collector to forward the claim to the competent authority and ensure a final decision within eight weeks, underscoring that beneficial schemes must be administered with sensitivity and fairness.
Facts
The petitioner’s wife served as an Auxiliary Nurse Midwife and Arogya Sevika since 1993 and was deployed at a Covid Care Centre during the second wave of the pandemic. While performing duties involving direct contact with Covid-19 patients, she developed severe respiratory complications and died on 5 May 2021. Although a single RTPCR report showed a negative result, multiple medical documents—including CT scan reports indicating severe viral pneumonia, critically low oxygen saturation levels, and a hospital-issued cause-of-death certificate—attributed her death to Covid-19 complications. Despite these records, the insurance claim was rejected.
Issues
The central issue before the Court was whether authorities could deny insurance benefits under the Garib Kalyan Package Insurance Scheme solely on the ground that an RTPCR report did not show Covid-19 positivity, despite substantial medical evidence indicating that the health worker died due to Covid-19 infection contracted during official duty.
Petitioner’s arguments
The petitioner argued that his wife was a frontline health worker deployed for Covid duty and that her death was clearly attributable to Covid-19. It was submitted that CT scan findings, discharge summaries, oxygen saturation levels, and the official cause-of-death certificate constituted conclusive medical proof. The insistence on an RTPCR report, despite medical literature acknowledging false negatives, was contended to be arbitrary and contrary to the object of the welfare scheme.
Respondent’s arguments
The respondents justified the rejection by relying on the scheme guidelines requiring submission of a laboratory report certifying Covid-19 positivity. They argued that since the available RTPCR test showed a negative result, the petitioner failed to fulfil an essential eligibility condition, leaving the authorities with no discretion to process the claim further.
Analysis of the law
The Court examined the object and purpose of the Pradhan Mantri Garib Kalyan Package Insurance Scheme, noting that it is a beneficial and welfare-oriented scheme intended to support families of health workers who died while fighting Covid-19. The Bench observed that medical science recognises limitations of RTPCR testing and that a single negative result does not conclusively rule out Covid-19 infection, particularly when supported by other strong clinical evidence.
Precedent analysis
Reliance was placed on the Supreme Court’s decision in Pradeep Arora v. Director, Health Department, Government of Maharashtra (2025), where a pragmatic approach was adopted in recognising Covid duty beyond rigid technical classifications. The Court also referred to the Madras High Court’s ruling in B. Varalakshmi v. Secretary to Government of India (AIR Online 2021 Mad 878), which held that CT-chest findings could sufficiently establish Covid-19 infection even in the absence of an RTPCR-positive report.
Court’s reasoning
Applying the above principles, the Bench held that the cause-of-death certificate issued by the Medical Superintendent, CT scan severity score of 17/25, and critically low SPO₂ levels constituted overwhelming evidence of Covid-19 infection. The Court ruled that authorities cannot rely exclusively on a single RTPCR report while ignoring consistent medical records pointing to Covid-related death, as such an approach would defeat the very purpose of the scheme.
Conclusion
The Bombay High Court set aside the impugned rejection order and directed the District Collector to forward the petitioner’s claim by treating the deceased as Covid-19 positive at the relevant time. The competent authority was ordered to decide the claim within eight weeks, ensuring timely disbursal of benefits.
Implications
This judgment reinforces a humanitarian and evidence-based approach in processing Covid-19 insurance claims and serves as an important precedent against rigid reliance on RTPCR reports. It provides relief to families of frontline workers who lost their lives during the pandemic and strengthens judicial scrutiny over administrative denial of welfare benefits.
Case law references
- Pradeep Arora v. Director, Health Department, Government of Maharashtra (Supreme Court, 2025)
Holding: Covid duty must be interpreted pragmatically, not narrowly.
Application: Relied upon to reject technical objections defeating insurance claims. - B. Varalakshmi v. Secretary to Government of India (Madras High Court, 2021)
Holding: CT-chest findings can establish Covid-19 infection in absence of RTPCR positivity.
Application: Applied to accept alternative medical evidence over RTPCR reports.
FAQs
Q1. Can a Covid insurance claim be rejected due to a negative RTPCR report?
No. The Bombay High Court held that claims cannot be rejected solely on this ground if other medical evidence proves Covid-19 death.
Q2. What evidence can establish Covid-19 death without RTPCR positivity?
CT scan reports, oxygen saturation records, discharge summaries, and official cause-of-death certificates can be relied upon.
Q3. Which scheme was involved in this case?
The Pradhan Mantri Garib Kalyan Package Insurance Scheme for Health Workers Fighting COVID-19.
