Ambika PK, a 46-year-old nurse working in a private hospital in Delhi, died on May 25, days after she tested positive for Covid-19. She was the first nurse in India’s capital to have perished in the pandemic.

“The last thing my mum told me before dying was that she had accompanied a patient with Covid symptoms in the ambulance to the hospital,” said her son, Akhil Kumar S.

But two months since, her children are struggling to claim the Rs 50 lakh insurance that the Central government announced in March for healthcare workers who die in the line of Covid-19 related duty.

The reason: they cannot prove that Ambika was involved in the treatment of Covid-19 patients and may have come in contact with one who could have infected her. The hospital where she worked has refused to give a certificate attesting to this possibility.

In Kolkata, when 69-year-old orthopaedic surgeon Sisir Mandal died of the virus on April 27, getting the required documentation was a breeze for his family. “He was seeing patients so he may have got the virus from one of his patients,” said his son, Soham Mandal, also an orthopaedic surgeon. The private hospital where he worked was quick to issue a certificate.

But his insurance claim appears to have been rejected. “The reason we were given was that he was not a central government employee,” said Soham Mandal.

The health ministry’s information brochure of the insurance schemes categorically states that it also covers “private hospital staff”.

Reading the fine print

There is no official data on the number of frontline workers who have died of Covid-19 in India. But stories of doctors, nurses, sanitation workers, community health workers and others succumbing to the virus fill the news every week, as the number of cases in the country crosses 15 lakh with over 33,000 deaths.

Anticipating the deaths of healthcare workers, the Central government announced an insurance scheme for them on March 26 as part of its Rs 1.7 lakh crore Covid-19 relief package. “Approximately 22 lakh health workers would be provided insurance cover to fight this pandemic,” said the official press note. “Safai karamcharis, ward-boys, nurses, ASHA workers, paramedics, technicians, doctors and specialists and other health workers would be covered.”

Initially, it appeared the scheme would also cover the treatment costs of healthcare workers, but it soon became clear that it was limited to their death. “Loss of life due to Covid-19 and accidental death on account of Covid-19 related duty,” said the health ministry’s information brochure.

Five months into the pandemic, even this is proving hard to access, as bereaved families of healthcare workers are finding out across India. If some are struggling to get hospitals to issue the required documents, the claims of others are held up because of confusion over their eligibility, courtesy a set of riders buried in the fine print of the scheme. In some cases, even after all the documents have been submitted and vetted by health departments, the claim has been rejected by the insurance company.

A file photo of Ambika PK provided by her family.

A missing certificate

Originally from Kerala’s Pathanamthitta, Ambika PK worked in Kalra Hospital, a multi-speciality tertiary hospital in Delhi’s Kirti Nagar area. Her 23-year-old son, Akhil Kumar S, said he had visited the hospital several times since his mother had died, but “the medical superintendent is saying they will not give any such certificate”.

Under the insurance scheme, hospital authorities have to certify that the worker who had died of Covid-19 “was deployed/drafted for care and may have come in direct contact of the COVID-19 patient”.

But Kalra Hospital told Ambika’s family that it had not been admitting any lab-confirmed Covid-19 patients at the time when she contracted the virus. Thus, according to the hospital, she was not involved in the treatment of Covid-19 patients and could not have contracted the virus while discharging her duties.

But what of the possibility, Ambika’s family asks, that she caught the virus from a patient she was treating and who was never tested?

Her colleagues said that the hospital had indeed been admitting several patients at the time with ostensible Covid-19-like symptoms – and personal protective equipment had been scarce. Shortly after Ambika’s death, several other nurses in the hospital also tested positive for the virus.

“There are two patients that the doctors were saying were 100% Covid cases, but they management did not recommend tests,” alleged a nurse at the hospital, who did not want to be identified since she was speaking against her employers. “They flatly refused [to test them] because if the patients test positive, they [the hospital] can’t make money as they have to release them since they had no permission to treat Covid-19 patients.”

The hospital management refused to field specific queries, saying they had “already submitted information to the government in writing”. “It is now up to the government if they want to give the benefits or not,” said a spokesperson for the West Delhi hospital.

A private (hospital) problem

The reluctance of private hospitals to provide that crucial piece of certification, indispensable for families making insurance claims and seeking compensation, seems to be of a pattern – at least in Delhi.

This has rendered many healthcare workers in the state ineligible for not only the Centre’s insurance scheme, but the Delhi government’s Rs 1 crore compensation that chief minister Arvind Kejriwal had promised in April for families of frontline workers who die of the virus while “deployed for COVID-19 duties”.

Facing a similar ordeal as Ambika’s son is the family of Rajamma Madhusudan who died on June 3 after being diagnosed with the virus. Madhusudan, 67, had been employed as a nurse at Shivaji Medical & Maternity Center, a small family-run maternity clinic in the capital, since the last 20 years.

Her daughter, Divya Madhusudan, 29, also a nurse, is convinced that her mother contracted the virus while attending to a patient at the clinic. “My mother told me she had handled a pregnant woman who had fever just before she started showing symptoms,” she claimed.

But as in the case of Ambika, the maternity hospital has refused to certify that Rajamma Madhusudan may have got infected at work “We were not having any reported Covid-19 cases till the time she passed away,” said Reena Jain, the doctor who runs the clinic. “So, this is not a case of taking care of Covid-19 patients. How can I give a false certificate?”

Divya Madhusudan said this was an absurd contention. “My mother was handling OPD patients, one of them even had fever, and she was never given adequate PPE,” she said. “Can you screen Covid-19 with your eyes?”

A file photo of Rajamma Madhusudan provided by her family.

Who has the last word?

In the case of such competing claims, is the word of the hospital final? Since claims get forwarded to the insurance company – the state-owned New India Assurance is the implementing agency of the scheme – by the state or the central government depending on the jurisdiction, do they conduct their own investigations?

Queries sent to the Delhi and the Central government seeking clarity on the process remained unanswered.

It is also not clear how many insurance claims under the scheme have been settled so far – New India Assurance did not reply to a questionnaire seeking details.

However, accounts from across the country suggest that settling claims under the government’s new scheme is an arduous task – even if one has all the required documentation.

In the case of the Kolkata orthopaedic surgeon, Sisir Mandal, who died in April 27, the private hospital issued a certificate as early as the mid-May. Armed with all the necessary documents, his son Soham Mandal applied directly to New India Assurance, but was then told to route the application through the state health department.

“We – me and my mother – then personally went to the department on two days to submit the form and documents and a personal verification was also done after that,” said Soham Mandal. “But after that we received a call from the insurance company in Delhi saying that we were not eligible. The reason we were given was that he was not a central government employee.”

The family is yet to receive a rejection in writing, said Mandal.

New India Assurance did not respond to a query seeking comment on what could be the reasons for rejection if a case had been greenlighted by the state government.

A file photo of Sisir Mandal provided by his family.

‘Accidental death’

Indeed, meeting the eligibility criteria and submitting the required documents, it appears, is often not enough. In Karnataka’s Ballari, Sakamma, an accredited social health activist, or Asha worker as they are called, collapsed while on Covid-19 duty in the first week of May. She had been going door to door collecting information about possible infection carriers at the time, said D Nagalakshmi, the general secretary of the state’s Asha workers’ union. “The pressure was very high because we had to meet our daily targets and also feed information to the system,” said Nagalakshmi. “She was diabetic and weak, yet she made sure she did her job.”

A couple of days later when she was being taken to the Ballari hospital as her condition deteriorated, Sakamma purportedly died on the way in the ambulance. Nagalakshmi said Sakamma was running a fever when she collapsed. However, her dead body tested negative for the virus. Even the gold standard test for Covid-19 is known to give false negatives.

According to the health ministry’s information sheet on the insurance scheme, it covers “accidental death on account of COVID-19 related duty”. The document defines accident as a “sudden, unforeseen and involuntary event caused by external, visible and violent means”.

Following pressure by the union, the state government forwarded her details to the insurance company, but the family is yet to hear back. “Till now, there is nothing, no response from Delhi,” said Nagalakshmi.

A file photo of Sakamma provided by the Karnataka Asha Workers' Union.

Defining Covid-19 duties

In Delhi, 34-year-old Ajay (who goes by only one name) is also nervously waiting to hear back from the authorities. His 53-year-old mother Kamla Suresh, a sanitation worker with the North Delhi Municipal Corporation, died on May 31 after contracting Covid-19.

For more than 25 years, Suresh had swept Delhi’s streets. Her husband had died 30 years ago. She had raised four children on her meagre salary. During the lockdown, she continued to render her “essential services”, cleaning the streets of Paharganj.

Staff of local urban bodies are covered under the Centre’s insurance scheme, but they have to be “requisitioned” by a hospital and “drafted for Covid-19 related responsibilities”, according to the health ministry.

Yet, Ajay is hopeful that the family will be eligible for compensation. He has little choice, for the tragedy in the family did not end with Suresh’s death. Both he and his brother have lost their cleaning jobs at a private office in the city’s Connaught Place area after they were forced to self-isolate for two weeks when their mother was detected of Covid-19 – the two live with their wives and children in Suresh’s two-room house. “When we went back we were told we were not required anymore,” said Ajay. “We have zero income right now. We hope they give us compensation, or a job, something. “

Ajay said he had submitted the documents relating to his mother’s death to the Delhi Commission for Safai Karamcharis.

Said Sanjay Gehlot, who heads the commission: “Around 17 safai karmacharis have died of Covid-19 in Delhi, we have forwarded their files, but no one has got the Prime Minister’s insurance till now.”

The municipal corporation, for its part, struck a similar note. “From our end, we are applying for everything, including the Rs 1 crore compensation announced by the Delhi government, that our staff can be remotely eligible for,” said Ira Singhal, additional commissioner at the North Delhi Municipal Corporation. But whether they were eligible, said Singhal, was for the insurance company and the Delhi government to adjudicate.

A file photo of Kamla Suresh provided by her family.

Navigating the bureaucracy

But even in what are seemingly open and shut cases, the process of settlements is long-drawn and tiresome – the families of the frontline workers have to produce eight documents.

Fifty-five-year-old Hira Lal, a senior sanitation supervisor at the All India Institute of Medical Sciences in Delhi, died on May 25 of the virus. His family initiated the process of seeking insurance claim almost immediately, but it is yet to be settled. “There was some problem with his documents,” said his son, Prahlad. “But we have been told it is sorted now and the money will come soon.”

For some, arranging the documents and navigating the bureaucracy is a daunting task in the face of tragedy. In Mumbai, days after 35-year-old Surender Satveer Singh Sarkania, a contractual sanitary worker at King Edwards Memorial hospital, died of Covid-19 on May 24, his family saw another death – that of his uncle.

His brother Rishi Sarkania, who said he was unemployed, is now reeling under severe Covid-19-like symptoms “We got the death certificate late and after that I fell sick,” said Satveer over the phone, his voice faint with exhaustion and palpable discomfort. “Then I got a call from an officer at KEM [hospital] to submit Satveer bhai’s documents, but I am so sick now that I can’t get up from the bed only.”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.