D.O.F:11/08/2020
D.O.O:05/05/2023
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KASARAGOD
CC.No.90/2020
Dated this, the 5th day of May 2023
PRESENT:
SRI.KRISHNAN.K :PRESIDENT
SRI.RADHAKRISHNAN NAIR.M : MEMBER
SMT.BEENA.K.G : MEMBER
Prasanna Kumari T.V,
Retired Headmistress,
Thekkemanakkad,
Near C.K.V. House, : Complainant
Karivellur P.O,
Kannur- 670521
(Adv. Shrikanta Shetty.K)
And
- The Director of Insurance,
- Thiruvanathapuram
- Kerala
: Opposite Parties
- The District Insurance Officer,
Old Bus stand,
(Adv: Dist. Govt. Pleader)
ORDER
SRI.RADHAKRISHNAN NAIR.M : MEMBER
The complaint is filed for compensation on the basis of service deficiency and on the part of the opposite parties.
The fact of the case in brief is that the complainant, being a Primary School teacher, became a member of a Group insurance scheme introduced by the opposite parties, with No.120148900222, when she was working in ZIALP school, during 29.07.1989 to 23.10.1990. Thereafter she got relieved from that school and joined in Bekal Islamia ALP School and served there as Primary School teacher and retired from service as Headmistress on 31.03.2020. The subscription amount was being deducted from her monthly salary and remitted regularly to the scheme. Even though the remittance of subscription amount for certain months were defaulted due to the delay in disbursement of salary in Bekal Islamia ALP School, the entire arrears in subscription amount were paid subsequently. Initially the subscription amount was Rs.20/- month and the same was periodically increased to Rs.600/-, by the time of retirement on 31.03 2020. There after the complainant applied for closure and an amount of Rs.57,849/-was sanctioned towards insurance benefit, which is an amount less than the total amount remitted by the complainant towards subscription. Hence this complaint is filed to direct the opposite party to pay the entire amount of insurance benefit as per law together with interest and compensation for mental agony and costs.
The notice sent to the opposite parties duly served and they entered in appearance through their counsel, who filed written version. As per the version of the opposite parties, the complaint is false, frivolous, vexatious and not maintainable in law. The opposite parties admit the fact that the complainant became a member of a Group insurance scheme, when she was working in ZIALP school under Badiadka AEO and she was issued with Passbook No.KGD7558(120148900222), and the subscription was at a rate of Rs.20/-. Thereafter she was transferred to Islamia ALP School under Bekal AEO, but she discontinued and defaulted the remittance of subscription from November 1990 to September 1991.Therefore the membership of the complainant in the Scheme was cancelled, as per the Rule 21 of GO(P)/371/85/Fin. dated 04.07.1985, as she defaulted the payment of subscription continuously for more than 6 months. As per the amended Rule GO(P) 460/2002/Fin the membership could have been revived with permission of the government by paying defaulted subscription with interest. As per the amended Rule No. GO(P) 460/2015/Fin. dated 13.10.2015, The District Insurance Officer is empowered to revive the cancelled membership even after 2 years by receiving defaulted subscription on application. Here the complainant never applied for revival of cancelled membership in the scheme. Therefore the membership of the complainant in the Scheme was considered and limited only from 09/89 to 10/90 and she was released with the benefit only for that period. She was also refunded with the amount, which she had remitted after 10/1991. The opposite parties are bound to follow the rules and therefore acted accordingly. The averment that the complainant revived the membership by paying the defaulted premium and that she is entitled for more benefit under the scheme and the opposite parties did not pay the entire amount of benefits and that she is entitled for more amount are false and hence denied. The complaint is devoid of any merit and the complainant is not entitled toany relief.
The complainant filed proof affidavit in lieu of chief examination and was cross examined.
The opposite parties did not adduce any oral evidence. Certain documents produced by the Opposite parties are marked as Ext.B1 to B7. The documents Ext.B1 is the original Passbook of the complainant produced at the time of closure of the scheme.Ext.B2 is a copy of the GO(P) No.392/1984/Fin dated 09.08.1984, Ext B3 is a copy of the GO(P) No.448/2002/Fin Dated 06.07.2002, Ext. B4 is a copy of the GO(P) No.460/2015/Fin, Dated 13.10.2015, Ext.B5 is a calculation statement of account of the complainant, Ext B6 is the petition dated 08.06.2020 submitted by the complainant before opposite party, Ext.B7 is the petition dated 25.06.2020 submitted by the Headmaster, IALPS Bekal before the opposite parties.
Based on the pleadings and documents of the rival parties the following issued are framed in this case.
1. Whether there is any service deficiency on the part of the opposite parties?
2. If so what is the relief?
For convenience, both these issues are discussed together. The specific caseof thecomplainants is that the amount of Rs.57,849/- sanctioned towards insurance benefit is less than the total amount remitted by the complainant towards subscription and she is entitled to get more amount as per the group insurance scheme.
The opposite parties submit that the membership of the complainant in the Scheme was cancelled, as per the prevailing Rules and the complainant never applied for revival of cancelled membership in the scheme, invoking the relevant provisions of the rules. Therefore the membership of the complainant in the Scheme is considered and limited only from 09/89 to 10/90 and she was released with the benefit only for that period. She was also refunded with the amount which she had remitted after 10/1991. Admittedly, as per the amended Rule GO(P) No.448/2002/Fin Dated 06.07.2002 the membership could have been revived with permission of the government by paying defaulted subscription with interest. As per the amended Rule No.GO(P) 460/2015/Fin. dated 13.10.2015, The Dist. Insurance Officer is empowered to revive the cancelled membership even after 2 years by receiving defaulted subscription.
The opposite party furnished a copy of GO(P)/371/85/Fin. dated 04.07.1985 for reference. The Rule 21 of the above order would show that,“in cases, where subscription for continuous period of 6 months are in default, the membership will automatically cease and such cases the members will not be re-admitted to the scheme thereafter. In such cases, the members will also lose their entitlements under the insurance Fund in the event of death. The accumulations in their savings fund with interest up to the dates of termination of their membership will be repaid to them ONLY at the time of retirement /death whichever is earlier”. It is clear that the opposite parties relied up on this provision in this case.
But the document Ext.B3 the GO (P) No.448/2002/Fin Dated 06.07.2002 would showthat as per the GO(P) 968/96/Fin Dated 21.11.96, the government have modifiedRule 21 and certain category of govt. servants (including those who are insuspension) are exempted from the purview of the rule on the condition that the defaulted subscription should be recovered in not more than 3 installments from the salary of the subscriber for the month, in which he/she resumed duty.
The document Ext B4, the GO(P) No.460/2015/Fin, dated 13.10.2015 would show that that the District Insurance Officers are empowered to permit re-admission of the members having the age below 50 years, who defaulted the payment of subscription for up to 2 years, by remitting the amount with stipulated interest in 3 installments.
But interestingly, nowhere it is stated that for reviving the membership, it is mandatory to file an application by the concerned person. Instead, the document Ext.B3 the GO(P) No.448/2002/Fin. dated 06.07.2002 would also show that it is the duty of the Drawing and Disbursing officer to maintain a register in form GSIE to watch the recovery of the subscription in the above cases. However, government have received a number of petition to sanction insurance coverage in the cases of defaulted premium for certain spell due to the fault of DDOs, even though the incumbent was subscribing to the scheme at the time of his/her death. This is not admissible as per the existing rules/clarifications. Also it is stated that the government have examined the matter in all respects and are pleased to issue the further orders in the matter. (I) Insurance coverage will be sanctioned to all incumbents after deducting the defaulted premium with interest, if the incumbent was subscribing to the scheme at the time of his/her death and if the default in subscription is due to the fault of the Drawing officer and Disbursing officers. All the unsettled cases on the date of issue of the order will be settled in the above lines on satisfaction of these conditions.
The complainant would submit that from 29.07.1989, the insurance premium were being deducted from her salary and remitted to the scheme. The monthly premium was being deducted compulsorily by the HM of the school, who is the drawing and disbursing officer. The complainant was not having the control over the deduction and remittance of the premium. After the transfer to the Bekal school, there was some legal procedure which delayed the disbursement of salary of the complainant and the premium could not be deducted and remitted by the HM. Thus the default in payment of premium occurred during a short period of 11 months from November 1990 to September 1991. But the entire arrears of the premium was being deducted and remitted to the scheme account, when the salary was got regularised. That remittance of defaulted premium were being accepted by the opposite parties without any objection. Thereafter the amount of premium have been regularly deducted from the salary and remitted towards the scheme without any failure, till the end of the service of the complainant. That aspect is evidenced by the documents Ext B1, the original Passbook of the complainant and Ext.B5, the calculation statement of account of the complainant. The delayed payment or defaulted payment of premium for a short period was occurred not due to any latches of the complainant, but due to the delay occurred in the disbursement of her salary.
Here the opposite parties have no case that they have intimated the complainant about default in the payment of subscription through any notice. Also no notice is issued to the complainant informing her about the cancellation of her membership, due to default in payment of subscription or directing her to file application for permission to revive the membership. The premium amount was being deducted from her salary in each and every month and remitted to the account of the scheme by the concerned H M of the school, the Drawing and Disbursing officer and such remittance was accepted by the opposite party. This fact would prove that the government have impliedly granted permission for revival of the membership of the complainant in the scheme. Thus the membership of the complainant was deemed to be revived.
The opposite parties submit that even though the complainant had remitted the defaulted premiums subsequently, she did not remit interest on the amount for defaulted period. Therefore she is not entitled for any amount towards insurance benefit. In that respect the complainant furnished a copy of the terms and conditions of the Kerala State Life Insurance Scheme- The Kerala State Life Insurance Scheme-Recovery of subscription-it is clearly provided that “(6). No interest shall be levied on arrears of subscription, if the non-recovery is delayed due to delayed payment of salary/wages.” Here the payment of subscription amount was being defaulted due to the delay in disbursement of salary of the complainant and therefore she is not liable to pay interest.
The complainant would argue that therefore the opposite parties cannot deny the full benefit of the insurance scheme to her by arguing technical reason that she has not submitted any application for permission to revive the membership. The denial of the entire amount of insurance benefit to the complainant amounts to service deficiency on the part of the opposite parties.
Considering the facts and circumstances of the case this commission is of the view that the denial of insurance benefit in whole is not justified under law. Therefore the act of the opposite parties amounts to deficiency of service, which caused loss and mental agony to the complainant and the opposite parties are liable to compensate for that.
For fixing the quantum of the insurance benefit, the only available document before this commission is the Answer dated 15.11.2021 submitted by the opposite parties to the interrogatory filed by the complainant as per IA 187/2021. In the answer of the opposite parties to the Question No.15, it is stated that the maximum claim amount that can be allowed to the complainant, if the payment of subscription for the period from 11/1990 to 09/1991 were not defaulted would be Rs.87,716/-
Here an amount of Rs.57,849/- only is paid to the complainant towards the insurance benefit. So, there is an amount of Rs.29,867/- as balance. The complainant is entitled for that amount with interest. She is also entitled for compensation for mental agony due to the denial of the amount in time. The complainant prays for Rs.50,000/- in that account. This commission is of the view that Rs.20,000/- would be a reasonable amount of compensation in this case.
In the result, the complaint is allowed, directing the opposite parties jointly and severally, to pay Rs.29,867/- (Rupees Twenty Nine Thousand, Eight Hundred and Sixty Seven only) to complainant towards the balance in insurance benefit, with interest at the rate of 8% per annum from 11.08.2020, the date of complaint to the date of payment. The opposite party is also directed to pay Rs.20,000/-, (Rupees Twenty Thousand only) towards compensation and Rs.5,000/- (Rupees Five Thousand only) towards litigation cost.
Time for compliance is 30 days from receipt of copy of this judgment.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exhibit
B1: Original Passbook
B2: Copy of the GO(P) No. 392/84/Fin dated 09/08/1984
B3: Copy of the GO(P) No. 448/02/Fin dated 06/07/2002
B4: Copy of the GO(P) No. 460/2015/Fin dated 13/10/2015
B5: Calculation statement
B6: Petition dated 08/06/2020
B7: Petition dated 25/06/2020
Witness Cross examined
PW1: Prasanna Kumari. T.V
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Forwarded by Order
Assistant Registrar
Ps/
