CHAPTER X FUNERAL EXPENSES - LAW & PROCEDURE CONTENTS. Provisions in the Act to Death report Death certificate

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1 CHAPTER X FUNERAL EXPENSES - LAW & PROCEDURE CONTENTS Subject Paras No. Provisions in the Act to Death report Death certificate Other evidence in lieu of a certificate to Authority for certifying eligibility of claimant Submission of claim for funeral expenses When payable to Time barred claims to Payment procedure to

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3 CHAPTER X FUNERAL EXPENSES - LAW & PROCEDURE Provisions in the Act Section 46 (1) (f) of the Act provides for payment to the eldest surviving member of the family of an insured person who has died, towards the expenditure on the funeral of the deceased insured person, or where the insured person did not have a family or was not living with his family at the time of his death, to the person who actually incurs the expenditure on the funeral of the deceased insured person (to be known as funeral expenses ) : Provided that the amount of such payment shall not exceed such amount 1 as may be prescribed by the Central Government and the claim for such payment shall be made within three months of the death of the insured person or within such extended period as the Corporation or any officer or authority authorised by it in this behalf may allow According to definition given in clause (14) of Section 2 of the ESI Act, insured person means a person who is or was an employee in respect of whom contributions are or were payable under the Act and who is, by reason thereof, entitled to any of the benefits provided by the Act From the above it will be observed that a person who is no longer in insurable employment but is in receipt of periodical payments of permanent disablement benefit is an insured person and funeral expenses are payable in respect of death of such a person Similarly a person may be entitled to medical benefit alone on the date of his death. Funeral expenses will be payable for such a person also In terms of ESIC s circular No.6-1/91/71(M)-II, dated to all State Governments an insured person whose title to medical benefit ceases while he is undergoing inpatient treatment in a hospital, or while receiving medical care and treatment at the time his exit intimation is received (in other words, his name is deleted from the Live List of IPs entitled to medical care at the beginning of a new benefit period), continues to be entitled to medical care and treatment till the spell of sickness ends or in case of a long-term ailment as long as he requires active treatment. Funeral expenses were not payable in case such a person died while in receipt of medical benefit otherwise than under the normal rules. However, the ESIC at its meeting held on approved the grant of funeral expenses in respect of such persons also in case of deaths occurred on and after It is to be noted that funeral expenses are not payable in respect of the death of a person who left employment on attaining the age of superannuation and became entitled to medical care under Central Rule Amendment Act No. 44 of 1966 for the first time provided Rs. 100/- as funeral benefit. The Corporation raised it under its powers in Sec. 99 of the Act to Rs. 500/- with effect from The term funeral benefit was replaced by the term funeral expenses by the Amendment Act of 1989 with effect from Vide newly inserted Rule 59 in the ESI (Central) Rules, 1950, the Central Government raised funeral expenses to Rs. 1000/- with effect from With effect from , Rs. 1500/- was payable as funeral expenses under Rule 59 ibid and Rs. 2500/- effective from After amendment in ESI Central Rule 59 an amount of funeral expenses of Rs.3000/- was payable w.e.f After latest amendment in ESI Central Rule 59 an amount of Rs.5000/- is payable w.e.f towards funeral expenses. 431

4 Death report Under Regulation 95B, on the death of an insured person, a death report is required to be submitted immediately to the Branch Office of the deceased insured person by (a) the employer, if the death occurs at the place of employment, or (b) the person entitled and intending to claim funeral expenses, if death occurs at any other place, or (c) any other person present at the time of death, if he so desires. Death certificate As per Regulation 95C, the Insurance Medical Officer/Insurance Medical Practitioner attending the insured person at the time of death or the Insurance Medical Officer/Insurance Medical Practitioner who examines the body of the insured person after his death or the Medical Officer who attended the insured person in a hospital or other institution where such insured person died, shall issue, free of charge, a death certificate in form-13 (as at Annexure A ) to the person entitled and intending to claim funeral expenses. Other evidence in lieu of a certificate Under Regulation 95D, in the absence of a death certificate in form 13 referred to above, any other alternative evidence of death can also be accepted in lieu of a death certificate if, in the opinion of the Corporation, the circumstances of any particular case so justify The Regional Director, Joint Director, Deputy Director and Assistant Director at the Regional Office level, and the Branch Manager at the Branch Office level, may accept the following documents as alternative evidence under Regulation 95-D for grant of funeral expenses. (i) (ii) Death certificate issued by cremation/burial ground. Death certificate issued by a Municipal Committee/Corporation/Government hospital. (iii) Certified copy of village death records etc. (iv) Death certificate issued by an Insurance Medical Officer/Insurance Medical Practitioner in form other than the form 13, e. g., in ESIC-MED-12, etc. (v) Death certificate issued by a Government or a recognised hospital, where the insured person was receiving indoor treatment. (vi) Such other evidence as may be acceptable to the appropriate Regional Office in the circumstances of a particular case and conveyed in writing by it to the Branch Office In case claimants need the original certificate for a bona fide purpose, e. g., for claiming provident fund dues etc., the original may be returned on receipt of written request and after keeping a photocopy to be attested by the Branch Manager. The Branch Manager must certify, while attesting, that he has seen the original death certificate. Authority for certifying eligibility of claimant Under Regulation 51, the authority to certify eligibility of a claimant in respect of funeral expenses is the appropriate Branch Office. 432

5 Submission of claim for funeral expenses Regulation 95-E requires the claim for funeral expenses to be submitted by the claimant entitled to receive the same under the Act, to the appropriate Branch Office by post or otherwise in form 25-A renumbered as form 22 w.e.f (Annexure B ) supported by documents proving the death of the insured person and, in addition (i) that the person claiming the funeral expenses is the eldest surviving member of the family of deceased insured person and incurred the expenditure necessary for the funeral of the deceased, or (ii) in case the claimant is other than the eldest surviving member of the family (a) that the deceased insured person did not have a family or that he was not living with his family at the time of his death, and (b) that the claimant actually incurred the expenses claimed on the funeral of the insured person. Provided that where the appropriate office is satisfied about the bona fides of the applicant or about the truth of the facts relating to any of the matters mentioned above, one or more of the documents may be dispensed with For the purpose of items (i) and (ii) of para 10.9 above, a declaration of the claimant duly countersigned by any of the under-mentioned authorities is considered to be sufficient proof and may be accepted : - (i) (ii) An officer of the revenue, judicial or magisterial department of the government; A Municipal Commissioner. (iii) A Workmen s Compensation Commissioner. (iv) The head of gram panchayat under the official seal of the panchayat or MLA/MP. (v) Gazetted Officer of Central /State Govt.. (vi) A Member of the Local Committee /Regional Board. (vii) Any other authority considered as appropriate by BM concerned Any other evidence or declaration acceptable to the appropriate office in the circumstances of a particular case can also be accepted as proof for purpose of clauses (i) and (ii) of para 10.9 above Claim for funeral expenses is to be made within 3 months from the date of death of the insured person or within such extended period as may be allowed. The period of 3 months is to be reckoned from the day on which the insured person died. 433

6 When payable As per Regulation 52(1)(b), payment of funeral expenses shall be made by the Branch Office within 15 days after the receipt of claim, complete in all respects. Time barred claims The Employees State Insurance Corporation at its meeting held on 14 th February, 1970 resolved that the Director General or such other officer of the Corporation as may be authorised by him and subject to such conditions as may be laid down by him from time to time, may, where circumstances of any case so justify, extend the period of three months for submission of claim for funeral expenses prescribed under Section 46 (1) (f) of the Employees State Insurance Act upto two years The Director General has authorised Regional Director vide Hqrs. (Ins. II) Instruction No. 2 of 1986 dated to admit claims for the payment of funeral expenses submitted within 2 years of the date of death of the insured person, if the reasons for the delay in submission of the claim so justify Since the Corporation has not authorised the Director General to admit a claim preferred more than 2 years after death of the insured person, such cases need not be referred to Hqrs. Office For the purpose of relaxation of provisions of section 46 (1) (f) the following may be considered as sufficient cause to justify condonation of delay : - (i) (ii) Ignorance of the provisions of the Act and Regulations. Late issue of death certificate. (iii) An insured person having died at outstation, or in his native place, being a case of permanent disablement benefit, etc. (iv) Any other circumstances which in the opinion of the Regional Director, justify the delay The delayed claim for funeral expenses which is required to be forwarded to the Regional Office for the sanction of the Regional Director should be referred in the proforma at Annexure C Payment procedure Claims for funeral expenses are paid at the Branch Office. On receipt of a claim for funeral expenses, the same shall be diarised and scrutinised by the claims clerk to see if the requirements as provided in the foregoing paras have been complied with. It is, however, clarified that a claim supported by declaration and attestation would be sufficient and no vouchers/cash memos in support of expenditure claimed are necessary. It is also not necessary to enquire into the details of ceremonies on which expenditure has been incurred Where there is abnormal delay in submission of the claim, all possible care should be taken to scrutinise the claim papers thoroughly so as to ensure that the payment is promptly made to the right person If the claimant is a minor, the claim can be submitted by his/her guardian indicating the relationship to the claimant. In that case, the declaration in claim in form 22 can be suitably modified If the claim is otherwise in order, the claims clerk will prepare benefit payment docket and make an entry in the ledger sheet in red ink. This will generally be the last or closing entry in the document and may be entered on the sickness benefit column and further blank space on the page may be cancelled by a cross. 434

7 He will at the same time also cancel the certificate of death and the claim form (form 22) as at Annexure B and make an entry about the death of the insured person in his declaration form (form 1) The claim will then be passed on to the checker for checking and then to the Manager for pay order and finally to the Cashier for making payment. The cashier after payment will make necessary entry in the appropriate column of the schedule of benefits paid Funeral expenses is one of the statutory benefits. Therefore, its cost is booked under the head B-Cash Benefits-Funeral Expenses Under Regulation 52 of the ESI (General) Regulations, 1950, payment of funeral expenses must be made by the Branch Office within a maximum period of 15 days after the claim thereof with relevant documentary evidence has been furnished to the Branch Office. It is absolutely essential to make payment of funeral expenses promptly and in actual practice the payment should be made immediately on the presentation of a proper claim Where the Branch Manager finds that the claim has not been submitted in time, he will obtain clarification in writing from the claimant about the reasons for delay in submitting the claim and may make a reference to the Regional Office immediately indicating the particulars required, in proforma at Annexure C. In order to avoid inconvenience to the claimant he may, at the same time, be advised to submit a request for payment of funeral expenses through money order at an address to be indicated by him. It may, however, be clarified to him that the payment would be made only if the delay is condoned by competent authority According to the provisions of the Act, funeral expenses cannot be paid to more than one person. The Branch Manager may, therefore, obtain a declaration on Form 22, from the claimant to the effect that to the best of his knowledge and belief no other person except the claimant has incurred any expenditure on the funeral, before the payment is effected to the claimant. 435

8 Annexure A (See paragraph 10.6) FORM 13 EMPLOYEES STATE INSURANCE CORPORATION DEPENDANTS BENEFIT OR FUNERAL EXPENSES (Regulations 79 and 95-C) DEATH CERTIFICATE Book No Serial No... Stamp of the Dispensary Name of the deceased insured person s/w/d of..insurance No. I certify that in my opinion the above-named deceased insured person died on the..day of (month)..(year) as a result of an injury/ due to *..I ** had been attending him/her for providing medical benefit before his/her death and I attended him/her for the last time on the.day of... Date Signature. Insurance Medical Officer/I.M.P Rubber stamp or name in block letters Any other remarks by the Medical Officer. * Please indicate the name of the disease. ** The language may be suitably amended if the Insurance Medical Officer had not attended the deceased person before his/her death. 436

9 FORM 22 Annexure B (See paragraphs 10.9 and 10.23) EMPLOYEES STATE INSURANCE CORPORATION (Regulation 95-E) FUNERAL EXPENSES CLAIM FORM Claim arising out of death on.. of.. s/w/d of..aged....years, having Insurance No. and last employed as. by M/s.Code No.. I. s/w/d of. aged....years declare :- * i) that I am the eldest surviving member of the family of the deceased insured person, whose particulars are furnished here-in-above, and that I actually incurred an expenditure of Rs. (Rupees only) necessary for the funeral of the said deceased person. or * ii) that the deceased insured person, whose particulars are furnished here-in-above did not have a family/was not living with his family at the time of his/her death and that I actually incurred an expenditure of Rs. (Rupees only) on the funeral of the deceased insured person. iii) To the best of my knowledge and belief no other person except me has incurred any expenditure on the funeral. Accordingly, I do hereby claim funeral expenses for the amount of Rs. (Rupees only) Date Name in Block Signature or thumb impression Letters of the claimant ATTESTATION ** Certified that the declarations, as made here-in-above, are true to the best of my knowledge and belief. Signature Name in block letters and rubber stamp or seal of the attesting authority Designation Date.... * Delete either (i) or(ii), which may not be applicable in the case. ** This certificate is to be given by (i) an officer of the Revenue, Judicial or Magisterial Department, or (ii) a Municipal Commissioner; or (iii) a Workmen s Compensation Commissioner; or(iv) the Head of the gram Panchayat under the official seal of the Panchayat, or M.L.A./M.P.; or (v) A Gazetted Officer of the Central/State Govt., (vi) a member of the Local Committee/Regional Board or (vii) any other authority considered as appropriate by the Branch Manager concerned. Important : Any person who makes a false statement or representation for the purpose of obtaining benefit, whether for himself or for some other person, commits an offence punishable with imprisonment for a term which may extend up to six months or with a fine up to Rs.2,000/-, or with both. Note : In case of a minor, the guardian should sign the claim form on behalf of the minor, and then add the following below his /her signature:- (Name of the minor) Through (Name of the guardian) his/her (Relationship with the Minor) 437

10 BRANCH OFFICE FORM FOR SANCTION BY REGIONAL DIRECTOR FOR PAYMENT OF CLAIM FOR FUNERAL EXPENSES SUBMITTED OVER 3 MONTHS AFTER DEATH Annexure C (See paragraph and 10.22) 1. Name and insurance number of the deceased 2. Date of death 3. Date of claim 4. Period of delay months days 5. Reasons for delay in submission of the claim 6. Amount involved 7. Recommendation of the Branch Manager 8. Date of receipt of claim at Branch Office 9. Date of reference to Regional Office 10. Reasons for delay, if any, in referring the case MANAGER 438

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