The Allahabad High Court has held that an unmarried sister is not disqualified from receiving the personal accident death benefit under the Mukhyamantri Kisan Evam Sarvahit Bima Yojana merely because she is not separately listed as a covered family member.

The High Court was considering a Writ Petition filed against the rejection of the petitioner's claim under the Mukhyamantri Kisan Evam Sarvahit Bima Yojana, communicated by the Oriental Insurance Company Limited. The petitioner sought payment of Rs 5 lakh on account of the accidental death of her brother.

The Bench comprising Justice Prakash Padia and Justice Garima Prashad held, “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.”

Advocate Ramesh Chandra Pathak represented the Petitioner while Advocate Arun Kumar Shukla represented the Respondent.

Factual Background

The petitioner's brother died in a road accident in 2019. A First Information Report was lodged, and his death was registered by the competent authority. The petitioner claimed 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. The petitioner submitted a claim for the insured amount under the Scheme. 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.

The Sub-Divisional Magistrate 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. The Insurance Company maintained its rejection. In the communication, it was stated that the claim had been made by the deceased's sister and, under the definition of family in the Memorandum of Understanding, a sister was not entitled to the benefit upon her brother's death.

Reasoning

The Bench noted that the claim was governed by the Mukhyamantri Kisan Evam Sarvahit Bima Yojana implemented through the State's agreement with the Insurance Company. The agreement continued the Scheme for the insurance period from September 14, 2018 to September 13, 2019. The group personal accident policy filed by the Company covered that period. The accident on May 18, 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 amendment.

The Bench noted that 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 Bench noticed that the provision states that the head or breadwinner is covered 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”, it added.

On a perusal of the facts of the case the Bench noted the petitioner's case that both parents had died and she and her brother formed the surviving household and he was its only breadwinner. She stated that she was now its only surviving member. “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”, it held.

Thus, holding that the petitioner was entitled to receive the amount as the legal heir of the deceased, the Bench ordered, “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.”

Cause Title:Km.Vidyawati v. State of U.P. and 4 others (Neutral Citation: 2026:AHC:221877-DB)

Appearance

Petitioner: Advocate Ramesh Chandra Pathak

Respondent: Advocate Arun Kumar Shukla, Chief Standing Counsel

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Allahabad High CourtJustice Prakash PadiaJustice Garima Prashad

Tulip Kanth

Assistant Editor

Tulip Kanth is an Assistant Editor at Verdictum having over 5 years of experience in the field of legal journalism and editing. She extensively covers judgments of the Supreme Court, High Courts as well as Tribunals. She has previously worked with a legal publishing website where she oversaw the work of other editors and has also created updates on notifications of different Government Ministries. She holds an English Honours Degree from SGTB Khalsa College, Delhi University and has completed her LLB course with specialisation in Corporate Law from Amity University.