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Thread Started by #CRK.MBAHR@yahoo.com

Hi, Let us post our discussions, queries & clarifications and share our knowledge on ESI ...... YOUR CONTRIBUTIONS ON THE TOPIC ARE INVITED & HIGHLY APPRECIATED... Regards CRK crk.mbahr@yahoo.com
23rd January 2010 From India, Vijayawada
The Employees' State Insurance Act, 1948 is a piece of social welfare legislation enacted primarily with the object of providing certain benefits to employees in case of sickness, maternity and employment injury and also to make provisions for certain other matters incidental thereto.

The Act in fact tries to attain the goal of socio-economic justice enshrined in the Directive Principles of State Policy under Part IV of the Constitution, in particular articles. 41, 42 and 43 which enjoin the State to make effective provision for securing the right to work, to education and public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of any undeserved want to make provision for securing just and human conditions of work, and maternity relief and to secure by suitable legislation or economic organisation or in any other way, to all workers, work, a living wage, decent standard of life and full enjoyment of leizure and social and cultural activities. The Act strives to materialise these avowed objects though only to a limited extent. Broadly, the benefits provided by the Act to insured persons or their dependants are :

(i) periodical payment in case of sickness of the insured person, (sickness benefit);

(ii) periodical payment to an insured woman in case of confinement or miscarriage or sickness arising out of pregnancy, confinement, premature birth of child or miscarriage (maternity benefit);

(iii) periodical payment to an insured person suffering from disablement as a result of an employment injury (disablement benefit);

(iv) periodical payment to dependants of an insured person who dies as a result an employment injury (dependant's benefit);

(v) medical treatment for and attendance on insured person (medical benefit), and

(vi) payment for expenditure on the funeral of the insured person (funeral expenses).

Here employment injury includes occupational diseases, and disablement may either be temporary or permanent, whether total or partial.

This Act covers a wider spectrum than the Factories Act in the sense that while the Factories Act concerns with the health, safety, welfare, leave, etc. of the workers employed in the factory premises only, the benefits of this Act extend to employees whether working inside the factory or establishment or elsewhere or they are directly employed or employed by the principal employer or through an intermediate agency, if the employment is incidental or in connection with the work in the factory or establishment, meaning thereby, under the Act it is not the place of work but the nexus between the work and the factory or establishment to which the Act is extended is material.

Extensive regulations have been framed under the Act to identify the employees who would be entitled to the benefits. The employees are to be registered and their contribution cards and identity card are to be prepared.

An employee therefore has to be identified in the records of the Employees' State Insurance Corporation so that he is entitled to claim various benefits.
An elaborate machinery is provided for the effective administration of the Act, the apex body being the ESI Corporation, subordinate to which are the Standing Committee and Medical Benefit Council. The Corporation is a public corporation controlled and subsidised by the government for the benefit of the employees, its object being rendering service to a penurious section of the public. The funds required for functioning of the scheme are raised from contributions, both of employer's and employees', grants, donations and gifts from governments, local bodies, individuals or bodies whether corporate or not. (ESI Fund). For adjudication of disputes and claims Employees Insurance Courts are being created. Provision for recovery of contribution, penalty and damages for default, prosecution and punishment, etc. have also been provided.

The ever-expanding industrial horizon and reciprocal uprising of labour conciousness necessitate the employer and employee to be conversant with the current labour legislations that govern their relationship, rights and obligations.

YOUR CONTRIBUTIONS ON THE TOPIC ARE HIGHLY APPRECIATED...

Regards
CRK
23rd January 2010 From India, Vijayawada
Some information on ESI -

--> In addition to necessities of food, clothing, housing etc., man needs security in times of physical and economic distress consequent upon sickness, disablement etc. The Employees’ State Insurance Scheme is an integrated measure of Social Insurance embodied in the Employees’ State Insurance Act and is designed to accomplish the task of protecting ‘employees’ as defined in the Employees’ State Insurance Act against the hazards of sickness, maternity, disablement and death due to employment injury and to provide medical care to insured persons and their families. The Scheme covers employees of non-seasonal power-using factories employing 10 or more persons. There is, however, a built-in provision for its extension to other establishments or classes of establishments, industrial, commercial, agricultural or otherwise. The Scheme has been progressively extended to cover employees in non-power using factories employing 20 or more persons and to commercial establishments.

--> The Employees’ State Insurance Scheme is administered by a corporate body called the Employees’ State Insurance Corporation (ESIC), which has members representing Employees, Employers, the Central Government, State Governments, Medical Profession and the Parliament. The Director General is the Chief Executive Officer of the Corporation and is also an ex-officio member of the Corporation. The other bodies at the national level are the Standing Committee (a representative body of the Corporation) and the Medical Benefit Council, a specialized body which advises the Corporation on administration of Medical Benefit. At the Regional and Local levels, the Regional Boards and Local Committees have been constituted. There is, thus, an association of interests and interest groups at all levels.

ESIC is the trustee of the interests of the insured persons. It discharges its obligations and duties through a network of Regional Offices and Local Offices, Hospitals and Dispensaries spread over the entire country.

--> The Employees’ State Insurance Funds are primarily built out of employers contribution and employees contribution payable monthly as a fixed percentage of wages.

--> The Contribution is deposited by the Employer in cash or by cheque at the designated branches of some nationalized banks. The responsibility for payment of all contributions is that of the employer with a right to deduct the Employees’ share of contributions from employees’ wages relating to the period in respect of which the Contribution is payable.

--> Workers, covered under the ESI Act, are required to pay contribution towards the scheme on a monthly basis. A contribution period means a six-month time span from 1st April to 30th September and 1st October to 31st March. Thus, in a financial year there are two contribution periods of six months duration.

Cash benefits under the scheme are generally linked with contributions paid. The benefit period starts three months after the closure of a contribution period. The two types of periods are illucidated below: –

1st October to 31st March 1st July to 31st December

--> A network of Local Offices has been established by the Corporation in all implemented areas to disburse all claims for sickness, maternity, disablement and dependents’ benefit. The Local Office also answers all doubts and enquiries and assists otherwise in filling in claim forms and completing other action necessary in connection with the settlement of claims. These offices also interact with the employers of the area. The Local Offices are managed by a Manager and work under the direction and control of the Regional Offices.

--> The contribution condition required to be fulfilled for admissibility of sickness benefit during any benefit period is that contributions should have been paid in respect of an insured person in the corresponding contribution period for not less than 78 days.

--> Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as mentioned below.

Diseases

1. Tuberculosis

2. Leprosy

3. Chronic Emphysema

4. Bronchiectasis

5. Interstitial Lung disease

6. AIDS

7. Malignant Diseases

8. Diabetes Mellitus-with proliferate retinopathy/diabetic foot/ nephropathy.

9. Monoplegia

10. Hemiplegia

11. Paraplegia

12. Hemiparesis

13. Intracranial space occupying lesion

14. Spinal Cord Compression

15. Parkinson’s disease

16. Myasthenia Gravis/Neuromuscular Dystrophies

17. Immature Cataract with vision 6/60 or less

18. Detachment of Retina

19. Glaucoma

20. Coronary Artery Diseases

21. Congestive Heart Failure-Left, Right

22. Cardiac valvular Diseases with failure/complications

23. Cardiomyopathies

24. Heat disease with surgical intervention along with complications

25. Chronic Obstructive Long diseases (COPD) with congestive heart failure (Cor Pulmonale)

26. Cirrhosis of liver with ascitis/chronic active hepatitis (“CAH”)

27. Dislocation of vertebra/prolapse of intervertebral disc

28. Non union or delayed union of fracture

29. Post Traumatic surgical amputation of lower extremity

30. Compound fracture with chronic osteomyelitis

31. (a) Schizophrenia

(b)Endogenous depression

(c)Maniac Depressive Psychosis (MDP)

(d)Dementia

32.More than 20% Burns with infection/complication

33.Chronic Renal Failure

34.Reynaud’s disease/Burger’s disease.

In addition, extended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority.

--> Except in case of disability from administration of drugs/injections, the insured person should have been in continuous employment for a period of 2 years and should have contributed for at least 156 days in 4 preceding contribution periods.

--> The daily rate of Extended Sickness Benefit is 40% more than the Standard Sickness Benefit rate admissible

Regards

CRK
26th January 2010 From India, Vijayawada
Ur postings are highly appreciable... i am quite happy to see u of having such good informatin about ESI....keep on sharing the knowledge........
Dont disappoint for no response, now a days many of the persons are misutilising this forum without their contribution........
In addition to the information u shared the main change in ESI in next few months........ Its going to be fully computerized for a better service to its stake holders....... for Insured Persons ESIC is providing smart card to the employee and their family to access any of the dispensary or hospital through out india.......Employers will be allowed to submit their returns and forms thru online........In addition to that the dream of poor workers in come to reality, ie. seeing their kids as doctors........with an admission to ESI established Medical Institutions........
with best wishes.........
2nd June 2010 From India, Hyderabad
Hi!
Every body!
Very Good and useful information furnished by Mr. CRk. But its quite surprising that nobody had respond to it. I request all of you to kindly participate actively in the discussion, and share your knowledge with others. You may kindly posts your doubts, clarifications required, or procedural aspects and latest developments/amendments about ESI. Let us help each other in knowing more about ESI, so that the employers know their obligations and employees covered under the Scheme understand the benefits admissible to them, to make it more meaningful to achieve its object.
K.V.Ramana Murty, Deputy Director(Rtd.), ESIC, Hyderabad
2nd June 2010 From India, Hyderabad
Dear Seniors,
i had earlier posted a question on esi contribution in which i had some doubts.
My query is whether an advance bonus and ex-gratia which an x company pay to his employee as a part of salary ,can attract for esi contribution or like washing allowance exemption is given to this component.
regards
Mohan
3rd June 2010 From India, Mumbai
For the benefit of all the members connected with ESI,I am giving below a detailed explanation about the wages and its interpretation.Suggestions and further discussion are welcome.
The term 'wages' under Section 2(22) of the ESI Act has been divided in to four parts as follows:
1. All remuneration paid or payable in cash to an employee, if the terms of contract of employment, express or implied, were fulfilled;
2. and includes any payment to an employee in respect of any period of authorized leave, lockout, strike which is not illegal or lay off;
3. and other additional remuneration, if any paid at intervals not exceeding two months;
4. but does not include:-
a) any contribution paid by the employer to any pension fund or provident fund, or under this Act;
b) any traveling allowance or the value of any travel concession;
c) any sum paid to the person employed to defray the special expenses entitled to him by the nature of his employment; or
d) any gratuity payable on discharge.
Each part is explained below.
Part I
1. The remuneration must be in ‘cash’ and not in ‘kind’.
2. It need not necessarily be paid. It is sufficient that it is accrued and payable. An employee may leave the employment in the middle of a month without receiving his wages for the period he worked. Though, the salary was not paid to him, contribution is due on it as the salary has accrued to him and is payable.
3. There is no periodicity or duration. Salary paid once in a quarter or annually is also thus wages.
4. The remuneration must be in terms of contract of employment. It may be oral or written. Thus, an offer of appointment specifying the nature of job and quantum of wages admissible to an employee or an agreement between the employer and the employees’ union/Association, whether orally agreed to or reduced to writing can be termed as contract of employment. The standard rules of the company regulating the pay structure and other fringe benefits binding on the employee are also a contract of employment. Normally, the following items come under this category.
a) Basic Pay, Wages, Salary;
b) D.A./HRA/CCA/Overtime/officiating allowance /Night shift allowance/efficiency allowance/Heat, Gas, Dust allowance/Education allowance/Food & Tea allowance/conveyance allowance etc;
c) Wages/salary/pay for weekly off and public holidays;
d) Commission paid to sales staff;
e) Subsistence allowance paid to an employee during the period of suspension;
f) Attendance Bonus or incentive or exgratia in lieu of Attendance Bonus or production incentive;
g) Regular Honorarium or salary or remuneration paid to a Director;
h) Collection Batta paid to running staff.
This list is only illustrative and not exhaustive.
Part II: The second category includes any payment actually made for:-
a) Authorized Leave, b) Lock-out, c) Lay-off and d) Legal strike.
Thus, in the case of a ‘salary’, contribution is due even though the salary is not actually disbursed to the employee. But, in the case of ‘leave salary’ or any other items of wages shown above, contribution becomes due only when it is actually paid to the employee and not otherwise.
In a case where an employee worked for the first 15 days of a month and proceeded on authorized leave for the remaining 15 days. But he did not return back and left the service, without receiving the wages for that month. In this case, the first 15 days, falls under the first category. Therefore contribution is payable even though ‘salary’ was not disbursed to the employee. No contribution need be paid on the leave wages for the second 15 days, as the leave salary was actually not disbursed to the employee.Contribution is due on the leave wages as and when it is actually disbursed to the employee.
Lay-off compensation might have been paid to an employee after the lay-off is lifted or after a considerable time. The contribution is then payable within 21 days of the expiry of the calendar month in which the lay-off compensation has actually been disbursed to the employee. Similar is the case with wages for the strike period.
Part III: This part deals with ‘any additional remuneration’ that is not covered under part I and II, and also not covered by any service condition or terms of contract of employment. This additional remuneration must also be actually paid, and the duration between each such payment should not exceed ‘two months’. Normally, no payment is termed as additional remuneration which is not forming part of the service condition or without inclusion in the terms of contract of employment. Where the employer pays this kind of remuneration on his own will and pleasure without any ‘right’ on the part of the employee to claim its continuance or regular payment, and the employer has the ‘right’ to withdraw, modify, alter or revise the scheme of payment, comes under this category. Production incentive paid by the employer quarterly at his option, without any agreement with the employees comes under this category, and was held as ‘not wages’ by the Supreme Court in the case of M/s Whirepool India Ltd.vs. ESIC in civil Appeal No. 1903 of 2000.
Part IV: Deals with exclusions of employers’ share of PF/ESI Contribution, traveling allowance, washing allowance, gratuity etc.
The following items are treated as “not wages’
1. Salary drawn by the proprietor, Partners and the contractor himself;
2. Daily allowance paid to running staff;
3. Reimbursement of actual cost of conveyance for coming to work and going back on production of tickets or season ticket or buss pass subject to proof of actual expenditure;
4. Washing allowance if dress is provided by the Employer;
5. Cycle allowance, if the cycle is used for official purpose;
6. Shoe allowance for polishing the shoes, if shoe is supplied;
7. Service charges collected by the Hotel management on behalf of their employees in lieu of direct tips and the same is paid to the employees at a later date. (M/s Rambagh palace Hotel, Jaipur, vs. ESIC)
8. Annual Bonus;( But if this bonus is paid every month, it is considered as wages. In the case of Beedi establishments, 8.33 percent of wages is paid every month as bonus, which is considered as wages)
9. Annual sales commission;
10. Payments made for Annual/periodical service contracts ;
11. Commission paid to dealers/agents;
12. Payments made to Labour consultants, Lawyers, Engineers, Counsels, chartered Accountants;
13. Encashment of un-availed leave;
14. Inam or incentive paid at an interval exceeding two months in the absence of any agreement or contract and the employer has got right to revise or withdraw it at his will;
This list is not exhaustive bur only suggestive.
Why all allowances are to be included?
The cash benefits payable to an employee are always a percentage of wages he could have earned. An employee who loses his wages during his abstention from work due to sickness, disablement etc. is expected to get cash compensation proportionate to to the total wages and allowances he would have received had he been working during this period. It is therefore, necessary to include all allowances for the purpose of wages and payment of contribution. If the contribution is confined to only basic wages, the cash benefits would be too low, to subsist the employee himself. It also tempts the employers to keep the basic wages to the barest minimum and show the balance as package of various allowances, to avoid their share of contribution, but the employee is put to loss when he receives the cash benefit at a lower rate.
Why overtime should be included in wages for payment of contribution but
not for deciding coverage of an employee?
Overtime is not a regular and continuous payment, but it is of an occasional nature. If overtime is also taken for wage limit for coverage of an employee, he may be going out of coverage for some time and again coming within the orbit of the scheme, when overtime is not there. This frequent interruption from the scheme deprives him of the benefits admissible under the scheme even after making payment of contribution for part of a contribution period. To ensure continued security and protection, overtime is excluded for determining the wage ceiling for coverage of an employee. However, it is included for payment of contribution to cover the accident risk during the period he was on overtime work, and to enable him to draw the cash benefits at an enhanced rate, as by adding overtime wages to his average daily wages, he is fitted in to the next higher slab in the Standard Benefit rate table in Rule 54 for claiming cash benefits.
Why contribution should be paid on the total wages beyond the wage ceiling limit when an employee crosses the wage limit prescribed by the Central Government? (The present limit is Rs. 15,000/- from 01-5-2010)
An employee whose wages (excluding O.T.)crosses the prescribed ceiling limit in any month at any time after commencement of the contribution period, continue to be an employee till he end of that contribution period.
Though there is a wage ceiling limit for coverage of an employee, there is no ceiling limit in the definition of wages for payment of contribution. Hence contribution is payable on the total wages without any ceiling limit. As the cash benefit is regulated on the average daily wages in a contribution period, such employee gets fitted in to higher wage slab in the standard benefit table in view of payment of contribution on the total wages.Now, there are 99 wage groups in the standard rate table, and the maximum daily standard benefit rate is Rs. 480/
Wage period related to an employee is the period in respect of which wages are ordinarily payable to him in terms of the contract of employment, express or implied or otherwise. It may be daily, weekly, fortnightly or monthly. (Sec. 2(23))
Average daily wages during a wage period: (Rule 1-B)
i ) Time-rate basis: in respect of an employee who is employed on time rate basis, the amount of wages which would have been payable to him for the complete wage period had he worked on all the working days (including paid holidays) in that wage period, divided by 26 if he is monthly rated, 13 if fortnightly rated, 6 if weekly rated and 1 if he is daily rated.
As the wage ceiling of Rs. 15,000/- is prescribed for a month, to arrive at the average daily wages, it is to be divided by 26.Thus, employees drawing 576.92and below for a day stand covered.

ii) Other basis (piece rated): in respect of an employee on any other basis, the amount of wages earned during the complete wage period (including paid holidays) divided by the number of days in full or part for which he had worked for such wages in that wage period.
Average daily wages during a contribution period for the purpose of payment of cash benefits.: (Rule 1-A)
In respect of an employee for the purpose of the daily rate of sickness benefit, maternity benefit, disablement benefit and dependant benefit, the sum equal to one hundred and fifteen percent of the aggregate amount of wages paid or payable to him during that contribution period, divided by the number of days (including paid holidays and leave days) for which such wages are payable.
Thus, the average daily wages worked out on Return of contribution are enhanced by another 15 percent before fitting it in to the Standard benefit rate table to determine the daily rate of sickness benefit/disablement benefit /Maternity benefit/Dependants' benefit. This enhancement is however not admissible to an employee who sustains employment injury before completion of his first wage period, for payment of his disablement benefit.
K.V.Ramana Murty, Deputy Director (Rtd.),ESIC, Hyderabad
3rd June 2010 From India, Hyderabad
Dear Seniors,

Pls share your view on the following points

1.once the establishment is covered ,its branch office automatically come under esic compliance bracket.

But in certain region where esic facilites or dispensary is not existing where the said company employee are working,to those employee how can we provide benefit through this scheme or is there any exemption for compliance .

02. x company is registered under esic . nature of work of x company is to supply menpower to various company across india.

X company do its compliance from head office. it has taken sub-code where manpower is supplied. but to some district it has not taken sub-code there , it is sending copy of RC half-yearly regulary to those district without obtaining the sub-code number. ,of those employees who are working in that district. they insurance no is obtained from the adjacent district.

Now My question is can x company's employee who are deployed on those district avail the esic benefit .if the IP Insurance No is obtained from adjacent district's esi office.

your suggestion would be highly appreciate.

Regards

Mohan
4th June 2010 From India, Mumbai
dear kvrm2002

We know that ESI contribution is payable for OT (overtime). This item is variable and depends on various factors. So, as you rightly said, it cannot be added to total wages for exempting an employee from coverage.

Similarly, some companies. preferably sales related businesses and retail showrooms give "Incentive" monthly based on the reaching the targets.

My doubts are :

1. My doubt is whether "Incentive" can be treated in the same analogy as that of "OT" ?

2. In case if it is a part of remuneration, whether an employee becomes exempted by adding the incentive to his gross payroll salary ?

3. Also, suppose an employee is exempted at the start of the contribution period April, becomes coverable due to fall in incentive earnings on May, becomes coverable until the end of the contribution period i.e. up to Sept. Suppose his june sal is 25000 inclusive of the incentive. then whether contribution is payable on th entire 25000 or upto max ceiling i.e. 15000 /

4. If the Corporation is insisting on the payment of contribution on th entire salary (inclusive of incentive). In what way the corporation justifies its stand, since the highest benefit is capped on basis of average salary earned by a 15000 earning guy. So the employee stands to lose on paying contribution for rs 25000 whereas he gets the same benefit as that of the employee earning 15000 pm ?

Sir Please clear my long pending doubts?

Ramesh, Chennai
8th June 2010 From India, Madras
Dear Ramesh,
1. Incentive can not be treated in the same analogy as that of O.T.
2. O.T. is exempted for wage ceiling in the Act itself under the proviso to the definition of 'employee'.
Therefore, we are going by the provisions of the said definition for O.T.
3. If by adding 'incentive', if the employee crosses the ceiling limit, definitely, he stands exempted after the end of the relevant contribution period.
4. As and when there is no incentive, again he is to be re-covered and to be continued till the end of the relevant contribution period.
5. There is a ceiling for coverage of an employee. But there is no such ceiling in the definition wages. If you read the definition it starts with "All remuneration paid or payable to an employee...'
A person drawing 25,000/-in the middle of a contribution period is also an employee till the end of that contribution period. Therefore, all remuneration paid or payable is wages and therefore, contribution is payable on the entire amount and not to be restricted to 15,000/-
6.As regards payment of cash benefit, the 'Standard benefit rate table' in Rule 54 contains 99 wage slabs to cover the wages of an employee up to Rs. 25,000/- (Which is the coverage limit for an employee with disability). The maximum daily standard benefit rate is 480/- If an employee gets sickness benefit for 30 days @480/- it works out to 14,400/- So, benefit is not restricted to the wages of Rs. 15,000/- as presumed by you.
Hope, it is clear to you now.
You are welcome to contact me on my mail ID: for any doubts or clarifications.
8th June 2010 From India, Hyderabad
Dear ESIC Knowledgeable ones.

I hope that after such a great policy on ESIC by the govt., it would have also put some insight into the kind of Hospitals and facilities available in practice. Without having proper hygenic hospitals, skilled doctors who should be available, proper treatment facilities on demand etc.....WHAT WOULD BE THE USE OF HAVING A GREAT POLICY ON PAPER???????????????????????????????.............. .....People want good facilities and not good worded policies......The ESIC hospital facts are not hidden to anyone....infact employees have protested for raising the limit to Rs 15,000/- because they dont want to contribute from their salaries for pathetic factilities....because even after the deductions, people would prefer paying to private practioners or hospitals rather than visiting hospitals under ESIC..........The Ground Work on ESIC should have been completed..i.e. Ensuring Stringent Rules for Hospitals to qualify for ESIC.......over here we have every tom, dick n harry hospital applying for ESIC and making it to the grade too!!!!!!!!! Four Bedded nursing homes with no regular doctors have made to the grade of ESIC...what more should one say.............Patriotism is very appreciated but not at the cost of ill-planned, irresponsible policies....just because it involves common man, its such....tell me how many of the political leaders, breaureaucrats would opt for getting treated in such ESIC Hospitals?????????...........Unless they dont apply the rules for themselves, why do they want filthy services for common man?? that too at a contribution from the common man himself??.......Thinking positive is one thing and Thinking practical is another.........all that can be said is "NOT ENOUGH DONE"...........................rgrds

1st October 2010 From India, Mumbai
Re: ESI Act - Inviting discussions
Dear Seniors,
Thank you for your valuable information provided on ESIC.
I have a query. I work in an company having 400 employees all over India. In Mumbai ,there are 60 employees. Out of which only 7 are under ESIC.
Recently, a female who is under ESIC has conceived a child. Her maternity leave of 84 days started from the day after she conceived as she conceived on the day after attending office.
Understand that the wages are paid through ESIC and not by the employer when on maternity leave.What are the obligations of the employer here then???
This is my first time experience and would apreciate your valuable suggestions on the same.
Please guide.
Regards,
Swati
1st October 2010 From India, Pune
Dear ESIC Knowledgeable ones.

I hope that after such a great policy on ESIC by the govt., it would have also put some insight into the kind of Hospitals and facilities available in practice. Without having proper hygenic hospitals, skilled doctors who should be available, proper treatment facilities on demand etc.....WHAT WOULD BE THE USE OF HAVING A GREAT POLICY ON PAPER???????????????????????????????.............. .....People want good facilities and not good worded policies......The ESIC hospital facts are not hidden to anyone....infact employees have protested for raising the limit to Rs 15,000/- because they dont want to contribute from their salaries for pathetic factilities....because even after the deductions, people would prefer paying to private practioners or hospitals rather than visiting hospitals under ESIC..........The Ground Work on ESIC should have been completed..i.e. Ensuring Stringent Rules for Hospitals to qualify for ESIC.......over here we have every tom, dick n harry hospital applying for ESIC and making it to the grade too!!!!!!!!! Four Bedded nursing homes with no regular doctors have made to the grade of ESIC...what more should one say.............Patriotism is very appreciated but not at the cost of ill-planned, irresponsible policies....just because it involves common man, its such....tell me how many of the political leaders, breaureaucrats would opt for getting treated in such ESIC Hospitals?????????...........Unless they dont apply the rules for themselves, why do they want filthy services for common man?? that too at a contribution from the common man himself??.......Thinking positive is one thing and Thinking practical is another.........all that can be said is "NOT ENOUGH DONE"...........................rgrds

1st October 2010 From India, Mumbai
Great 28677c5420521383353edc6e6 (One of the ESIC Knowledgeable ones).........
Think u have good social consciousness. It's highly appreciated....... But instead of pointing out and blaming the system or processes, it would be more better if taken initiative to work on the issue, gathering such valid proofs........ and produce them through proper channel, which should move the concerned officers, department, politicians, parties................ But we don't do..... because....... its not our duty.... right???
Its not "NOT ENOUGH DONE".........
Its the people i.e. we who should have to make it done............

CRK

1st October 2010 From India, Vijayawada
GREATEST CRK.MBA.(...FILL THE BLANKS..........)

Mr V SYAM PRASAD (THE ESIC INSPECTOR) WHO HAS COMMENTED IN THIS POST HAS ALREADY ACKNOWLEDGED THIS DRAWBACK OF NOT ENOUGH DONEON ESIC IN A SIMILAR POST WHERE I HAD POSTED MY SIMILAR VIEWS. N IF YOU ASK WHY WE COMMON MEN DONT ROUTE THROUGH PROPER CHANNELS TO POLICTICAL LEADERS, CONCERNED OFFICERS AND THE ROT....BCOZ ITS OF NO USE......ALL THIS HOG WASH THAT PEOPLE SHOULD BRING TO NOTICE, PROTEST ETC ETC IS OF NO USE IN OUR COUNTRY. YOU CAN BE THE BILLIONTH ONE TO TRY IT IF YOU DONT BELIEVE ME. ROUTE YOUR CONCERN THROUGH PROPER CHANNEL AND LET ME KNOW WHAT RESULTS YOU GOT. ...AND MOREOVER MY POST IS NOT AGAINST YOU OR YOUR KNOWLEDGE BASE ON ESIC...MY POST IS ABOUT WHAT EMPLOYEES THINK ABOUT IT. I AM DOING MY BIT BY POSTING IT AS A MATTER OF CONCERN TO THE CONCERNED ESIC AUTHORITY WITH HIS ACKNOWLEDGEMENT ON MY VIEWS IN MY EARLIER POST AND PROMISE FROM HIM THAT HE WOULD LOOK INTO THE MATTER.......AND LOOKING INTO MATTER ALSO TAKES AGES IN OUR COUNTRY......AND THIS ISNT AN OVERNIGHT OPINION...POST INDEPENDENCE POLICIES ARE A PROOF OF IT WHICH YOU CAN VERY WELL REASEARCH AS THIS WONT BE AN IDEAL PLACE TO POST THEM.............ONCE AGAIN ...DONT TAKE IT PERSONAL...THIS IS NOT FOR YOU....THIS IS ABOUT AGGREAVED EMPLOYEES WHO ARE CONCERNED ABOUT SALARY CUTS AND DONT WANT THIS OPTION OR WANT A BETTER OPTION...HOPE YOU UNDERSTAND............RGRDS
1st October 2010 From India, Mumbai
Dear 28677c5420521383353edc6e6,
I don't know whether you understood or not....
I appreciated you for your social consciousness and humanity. I don't know why you are reacting in such a way....
I have responded to your post.... pl don't react..... just respond, if you can or just leave it...
According to you, it is of no use even we put efforts........ So, you opine to leave it...... And someones thought would be like if our freedom fighters left the fight in the middle, thinking like that, where would be the independence....
No issues thats your opinion..... You can put the same in proper way, not reacting so emotionally and taking personally.
And i dont know in which phrase you feel that i took personally
Anyhow, let us please end this unnecessary discussion and please don't expect my response in this regard henceforth.
Thanks & Regards
CRK

1st October 2010 From India, Vijayawada
Don't mis interprete my acknowledgement........... In every govt. departments.......... which consists of the people like YOU and ME only run the show and give the image of the organisation...................
One simple question i ask u instead of narrate so much ESSAY WRITING against ESIC, why don't you directly meet the concerned Regional Director and the Director (medical scheme) and bring the facts before them with proof.................India needs such kind of people.........not the people who fills pages n pages against the demerits of the system.......
Hope u will become a good INSTRUMENT in IMPROVISING the facilities in ESIC.............finally USEFUL to our brethrens of the people whom U feels suffered with ESIC........
All the best........
1st October 2010 From India, Hyderabad
Please find attached the applicability, eligibility, benefits, provisions............ of ESIC. to be updated........ Might be useful....... CRK
4th October 2010 From India, Vijayawada

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@CRK.MBA

I was busy with breaureaucracy work and knew you wud be responding. I arrived early morning to just reply to you n by the way i dont like putting a PHD tag on my name.

1) If you did read your reaction throughly you would know why i responded and not reacted.

2) I have read many of your post and have liked it. But In this case, i would want people to know the ground realties. And if you want me to do ESIC Responsibilities then what are ESIC Officials FOR????? Anyways the entire country knows what are they for...so forget it.

3) Comparing Freedom Fighters analogy is completely UNWARRANTED AND MEANINGLESS. Comparisons are made to get similar results and not otherwise.

4) Rightly as you said and even as i have already hinted, I leave it here.............rgrds

@VSP

if you want me to do ESIC Responsibilities then what are ESIC Officials FOR?????....and i might even go the distance to follow your advice but in that case you need to do the JOB that I am doing right now..........sorry I dont agree with you and once again, lets leave it here.......rgrds
4th October 2010 From India, Mumbai
Hi Friends, Attached is a file with details of Benefits under ESIC. Hope this will be helpful to all. I had to prepare this to inform my employees.
4th October 2010 From India, Mumbai

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Hi,
As i wanted to know the procedure of Maternity benefit who falls under ESI and what are the documents to be submitted? Eligibility?........ Looking for the early reply....
Thanks & Regards,
Jayachandra.M
Mail Id:
5th October 2010 From India, Bangalore
Please visit this post which has a recent speech from Narayan Murthy. CRK & VSP & Co. should enjoy this.
https://www.citehr.com/285972-excell...anamurthy.html
Regrds
5th October 2010 From India, Mumbai
Dear Jayachandra,

An Insured woman, has to give notice of pregnancy before confinement in the Form - 17.

For claiming maternity benefit a certificate of expected confinement in the Form 18 has to be submitted to the appropriate office not earlier than 15 days before the date of confinement.

A claim for maternity benefit in form - 19 stating therein the date on which she ceased or will cease to work for remuneration and

within thirty days of the date on which her confinement takes place a certificate of confinement in form 18 given in accordance with these regulations. (within 30 days in case of miscarriage in form 18 and form 19)

In case of claim for maternity benefit after death of insured woman leaving behind the child: Form 20;within 30 days of the death of the insured woman with a death certificate in form 21.

Claim for maternity benefit in case of sickness arising out of pregnancy, Form No.9 along with medical certificate in Form 7 or 8,

Maternity benefit is paid from the date which it is claimed provided that such date does not precede the expected date of confinement by more than 42 days and no work is done by the insured woman for remuneration.
5th October 2010 From India, Mumbai
Source: ESI Corporation
DO's
Take permission in Form No. 105 before leaving your station of work
Apply for examination by Medical Board immediately after you TDB terminates
Appear before Medical Referee/Board when advised
Avail of the benefits only when needed
Fill in full particulars with date on your claim form
Local Office Manager is your guide. Take his advice in case of any problem for drawal of cash benefits
DON'TS
Do not lend your Identity Card to any one else
Do not put unnecessary demands upon your doctor. Let him help others waiting for their turn.
Do not tamper with your medical certificate. This is punishable act.
Do not delay in depositing your medical certificate with the local office.
Do not make false statements or false representation to obtain benefits which are not legally due to you
CRK
6th October 2010 From India, Vijayawada
Hey all give me full list of esic forms with description. And procedure for using them.. And awailing benefit from esic.
6th October 2010 From India, Panipat
Please find some of the attached forms used for ESIC.. CRK
7th October 2010 From India, Vijayawada

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Dear All,
In this context of ESIC wages I have a confusion...can someone clarify me the difference between TRAVELLING ALLOWANCE and CONVEYENCE/CONVEYENCE ALLOWANCE? Are these two terms can be used interchangibly? What will be the deduction status in case of these components?
8th October 2010
Dear Mitrasugata,
Please visit the below link for some clarifications -
Directorate of Income Tax, RSP & PR, New Delhi
CRK
8th October 2010 From India, Vijayawada
Respected Sir
Thank u for the elaborated discussion. In this regard I got one doubt. The Contractor who is working himself along with other employees deployed by him and who is getting remuneration for the work done by him is also coverable under the Act as per the amended provisions in the year 1989. However if the contractor is covered independently under the Act under sec 1(5), then he is not covered even though he draws the remuneration below the ceiling limit.
with regards
Sanagapalli VR
Gr I Manager (Retd) ESI Corporation
16th October 2010 From India, Hyderabad
Dear CRK,
I have a query regarding ESIC benefits.
If an employee contribute towards ESIC till 31st Oct 10 and after that he/she leaves the services.
How long can he/she avail ESIC benefits under the scheme ???
Regards
21st October 2010 From United States, Cincinnati


How does the Employees' State Insurance Scheme assist you?
The dependence of an individual on cash income is a characteristic feature of modern economy. An interruption of money income even for a small period is, therefore, a hardship; a prolonged loss of income is indeed a catastrophe. By coming forward to provide health protection and income maintenance in a series of oft-experienced contingencies like sickness, maternity, disablement and death due to employment injury, the Employees' State Insurance Scheme tends to ameliorate your economic anxiety and to be a friend in need and distress.

Why is it called a Health Insurance Scheme?
The Employees' State Insurance Scheme performs a dual role; by providing assistance in kind (medical care) it tries to restore your health and working capacity and by assistance in cash (cash benefit) it tries to sustain you when your income is interrupted. With a better and facile health protection, greater vitality, and assurance of income-maintenance in times of need, it makes you every inch a better, a healthier, secure worker and therefore, a happier man. The assistance comes to you not as an act of benevolence but in virtue of an acquired right.

Who administers the Employees' State Insurance Scheme?
The Employees' State Insurance Scheme is administered by a corporate body called the Employees' State Insurance Corporation (ESIC), which has members representing Employees, Employers, the Central Government, State Governments, Medical Profession and the Parliament. The Director General is the Chief Executive Officer of the Corporation and is also an ex-officio member of the Corporation. The other bodies at the national level are the Standing Committee (a representative body of the Corporation) and the Medical Benefit Council, a specialized body which advises the Corporation on administration of Medical Benefit. At the Regional and Local levels, the Regional Boards and Local Committees have been constituted. There is, thus, an association of interests and interest groups at all levels. ESIC is the trustee of the interests of the insured persons. It discharges its obligations and duties through a net-workof Regional Offices and Branch Offices, Hospitals and Dispensaries spread over the entire country.

Whom does the Scheme protect?
The Scheme protects all "employees" engaged on a monthly remuneration not exceeding Rs. 6500/- in a factory/ establishment to which the Act applies. Persons employed for wages on any work connected with the administration of the factory or establishment or any part, department or branch There of or purchase of raw materials, or distribution or sale of the product of a factory or establishment are also covered. Mines, Railway Running Sheds, Naval, Military and Air Force Workshops and specified seasonal factories are excluded. The scheme also provides full medical cover to the dependants of insured persons. In the event of death of an insured person due to employment injury dependants become eligible to cash benefit.

Where do Employees' State Insurance Funds come from?
The Employees' State Insurance Funds are primarily built out of employers contribution and employees contribution payable monthly as a fixed percentage of wages.

How are the employees registered under the Scheme?
Simultaneously with his/her entry into employment in a covered factory or establishment, an employee is required to fill in a Declaration Form. The employee is then allotted a Registration Number, which distinguishes and identifies the person for the purposes of the Scheme. A person is registered once and once only upon his entry in insurable employment.

What is an Identity Card?
Simultaneously with his/her entry into employment in a covered factory or establishment, an employee is required to fill in a Declaration Form. The employee is then allotted a Registration Number, which distinguishes and identifies the person for the purposes of the Scheme. A person is registered once and once only upon his entry in insurable employment.

What are the rates of contribution?
Contributions payable in respect of an employee comprise of employer's contribution and employee's contribution prescribed in Schedule I of the Act. An employee covered under the scheme has to contribute 1.75% of the wages whereas, an employer contributes 4.75% of the wages payable to an employee. The total contribution in respect of an employee thus works out to 6.50% of the wages payable.

Who is exempted from payment of contribution?
Employees earning less than Rs 40/- a day are exempted from payment of contribution. The employers share of contribution is, however, payable.

How are the Contributions collected?
The Contribution is deposited by the Employer in cash or by cheque at the designated branches of some nationalized banks. The responsibility for payment of all contributions is that of the employer with a right to deduct the Employees' share of contributions from employees' wages relating to the period in respect of which the Contribution is payable.

What are 'Contribution Periods' and 'Benefit Periods?
Workers, covered under the ESI Act, are required to pay contribution towards' the scheme on a monthly basis. A contribution period means a six-month time span from 1st April to 30th September and 1st October to 31st March. Thus, in a financial year there are two contribution periods of six months duration.

Cash benefits under the scheme are generally linked with contributions paid. The benefit period starts three months after the closure of a contribution period. The two types of periods are iIIucidated below:-
Contribution Period
Benefit period

1st April to 30th September Corresponding

1st October to 31st March
1st January to 30th June of the following year

1st October to 31st March 18th July to 31 st December

SOCIAL SECURITY BENEFITS
SICKNESS BENEFIT


What does 'Sickness Benefit' mean?
Sickness signifies a state of health necessitating medical treatment and attendance and abstention from work on medical grounds. Financial support extended-by the Corporation is such a contingency is called Sickness Benefit.

What are the Contributory Conditions?
The contribution condition required to be fulfilled for admissibility of sickness benefit during any benefit period is that contributions should have been paid in respect of an insured person in the corresponding contribution period for not less than 78 days.

How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate" this rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure 'A'.

How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate" this rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure 'A'.

What is the duration of Sickness Benefit?

Sickness benefit is payable' for a maximum period of 91 days in any two consecutive benefit periods. Benefit is not paid for an initial waiting period of 2 days unless the insured person is certified sick within 15days of the last spell in which Sickness Benefit was paid.

What is Extended Sickness Benefit?

Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as mentioned below.

Tuberculosis
Leprosy
Chronic Empyema
Bronchiectasis
Interstitial Lung disease
AIDS
Malignant Diseases
Diabetes Mellitus-with proliferative retinopathy/diabetic footl nephropathy.
Monoplegia
Hemiplegia
Paraplegia
Hemiparesis
Intracranial space occupying lesion
Spinal Cord Compression
Parkinson's disease
Myasthenia Gravis/Neuromuscular Dystrophies
Immature Cataract with vision 6/60 or less
Detachment of Retina
Glaucoma
Coronary Artery Diseases
Congestive Heart Failure-Left, Right
Cardiac valvular Diseases with failure/complications
Cardiomyopathies
Heat disease with surgical intervention along with complications
Chronic Obstructive Long diseases .(COPD) with congestive' heart failure (CorPulmonale),
Cirrhosis of liver with ascitis/chronic active hepatitis, ("CAH")
Dislocation of vertebra/prolapse of intervertebral disc
Non union or delayed union of fracture
PostTraumatic surgical amputation of lower extremity
Compound fracture with chronic osteomyelitis
Schizophrenia
Endogenous depression
Maniac Depressive Psychosis (MDP)
Dementia
More than 20% Burns with infection/complication
Chronic Renal Failure
Reynaud's disease/Burger's disease

In addition, extended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority.

What are the contributory conditions?
Except in case of disability from administration of drugs/ injections, the insured person should have been in continuous employment for a period of 2 years and should have contributed for atleast 156 days in 4 preceding contribution periods.

How much is the benefit rate?
The daily rate of Extended Sickness Benefit is40% more than the Standard Sickness Benefit rate admissible.

How Long is the benefit available?
After exhausting Sickness Benefit payable for 91 days the ESB is payable upto a further period of 124/309 days that can be extended upto 2 years in special circumstances. Thus, together with the Sickness Benefit for 91 days, it puts a claimant on benefit for an aggregate period 400 days for all specified diseases and 2 years in chronic suitable cases on recommendation of competent authority.

What is Enhanced Sickness Benefit ?
Enhanced Sickness Benefit is cash benefit for the insured persons undergoing sterlisation operation of vasectomy/ tubectomy for family planning.
What are the contributory conditions?
Enhanced Sickness Benefit is cash benefit for the insured persons undergoing sterlisation operation of vasectomy/ tubectomy for family planning.

How much is the benefit available?
The contributory conditions are the same as for claiming sickness benefit.

How Long is the benefit available?
The benefit is available upto 7 days for vasectomy and upto 14days for tubectomy operations. This period can however be extended in cases of post operative complications or sickness arising out of these sterlisation operations. Its duration is not counted towards the total number of 91 days for which
the sickness benefit is available during any two consecutive benefit periods.

What is 'Disablement'?
Disablement is a condition resulting from employment Injury which may be :-
(a) temporary i.e. rendering an insured person incapable of work temporarily and necessitating medical
treatment; .
(b) permanent partial i.e. reducing the earning capacity of the insured person generally for every employment;
(c) permanent total Le. totally depriving the insured person of the power to do all work.

What constitutes an "Employment Injury"?

Employment injury means a personal injury caused to an employee by an accident or occupational disease arising out of and in course of his employment in a factory or establishment covered under the Employees' State Insurance Act. The law relating to Employment injury has been liberalised. Now, an accident arising in the course of employment is presumed also to have arisen out of his employment if there is no evidence to the contrary. Further, an accident brought about by willful disobedience, negligence or breach of regulations etc. or an accident happening while traveling in a transport provided by the employer or while meeting an emergency is accepted subject to certain conditions, to have arisen in the course of and out of employment. Injuries suffered while under the influence of drink sand drugs take away the right to the employee to this benefit.

Roadside accident caused while commuting between place of residence and workplace is also treated as notional extension of employment for purpose of death or disablement benefit.

What are 'Occupational Diseases'?
Occupational Diseases are such diseases as are susceptible of being traced back to their occupational origin. There are specified under Schedule III of the Employees' State Insurance Act, which enumerates the compensable Occupational Diseases and the corresponding industrial processes involving exposure to the diseases are thus recognised without any further evidence.

What are the Benefits granted?
Temporary Disablement Benefit is paid periodically in arrears as the evidence of incapacity (medical certificate) is produced. Permanent total disablement and permanent partial disablement benefits are paid in the form of pensions. Current employment for wages or engagement in any gainful activities is no bar to payment of permanent disablement benefits. An insured person suffering from an occupation disease is also entitled to full medical care.

How much is the Benefit Rate?
The daily benefit rate for permanent total disablement and temporarydisablementis40% more than the Standard Sickness Benefit rate and is roughly equivalent to about '10%of the wage rate. For permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also.

What is the duration of Benefit?
Temporary Disablement Benefit is paid as long as disablement lasts. There is a waiting period of 3 days (excluding the day of accident), but if in capacity exceeds this period, benefit is paid from the very first day. The permanent disablement benefit is paid for the life-time of the beneficiary.

What are the contributory conditions?
There are no qualifying conditions as to the length of employment or the number of contributions paid. Protection accrues from the very moment of entry into insurable employment.

How is Permanent Disablement assessed?

There is indeed no way of adequately compensating a permanently disabled employee and yet some method of determining whether an employment injury has resulted in permanent disablement and of assessing the extent of permanent damage caused by that employment injury has to be adopted for the purpose of determining the scale of compensation for the loss of earnings. This is done by evaluating loss of earning capacity with reference to general disability for all work. The evaluation is done by a Medical Board whose decision can be appealed against to a Medical Appeal Tribunal presided over by a judicial officer, with a further right of appeal to Employees' Insurance Court or directly to Employees' Insurance Court. Pending an appeal, payment for permanent loss of earning capacity as recommended by the Medical Board is made, subject to adjustment later. Loss of wages and expenditure on conveyance occasioned by attendance before the Medical Board are compensated by the Corporation in accordance with rates framed for the purpose.

Where the assessment of loss of earning capacity by the Medical Board is not of a final character, the beneficiary is required to appear again before the Medical Board for a review of the assessment.

Can the decisions of Medical Board or of Medical Appeal Tribunal be reviewed?
Yes. If the Medial Board or the Medical Appeal Tribunal is satisfied by fresh evidence that a. decision was given because of non-disclosure or mis-representation of a material fact, it can review its earlier decision at any time. A Medical Board can also review its earlier assessment of extent of disablement, if it is satisfied that there has been substantial and unforeseen aggravation of the results of the relevant injury and substantial injustice would be done by not reviewing it. Such review, however, cannot be made earlier than 5 years or in the case of the provisional assessment, earlier than 6 months of the date of assessment to be reviewed.

Is lumpsum Benefit allowed in place of Pension?

Yes. At the option of the beneficiary, permanent disablement pension, where the daily rate payable is not significant, can be commuted for a lumpsum payment subject to the fulfilment of the following two conditions :-

(i) that the permanent disablement has been assessed
as final, and
(ii) the daily rate of permanent disablement does not
exceed Rs 5/- and the total commuted value does not
exceed Rs 30,000/- (effective from April-D3).

Is there any provision for physical rehabilitation?
The Corporation at its cost arranges for the vocational rehabilitation of disabled insured persons provided the disability has been assessed at above 40 percent and the beneficiary is not over 45 years of age. The training is provided at vocational rehabilitation centres run by the Govt. of India etc. The fee, travelling expenses etc are borne by the Corporation.

What about vocational rehabilitation?
The Corporation at its cost arranges for the vocational rehabilitation of disabled insured persons provided the disability has been assessed at above 40 percent and the beneficiary is not over 45 years of age. The training is provided at vocational rehabilitation centres run by the Govt. of India etc. The fee, travelling expenses etc are borne by the Corporation.

What is 'Dependents' Benefit'?
Dependents Benefit is a monthly pension payable to the eligible dependents of an insured person who dies as a result of an Employment Injury or occupational disease.

Who are the Beneficiaries and how long is the Benefit available?

Dependants entitled to the benefit could be :-
(a) Widow/Widows during life or until remarriage:
(b) Legitimate or adopted son until age 18 or if legitimate son is infirm, till infirmity lasts;
(c) Legitimate or adopted unmarried daughter until age 18 or until marriage, whichever is earlier, or if infirm, till infirmity lasts and she continues to be unmarried.

In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age 18 or to an unmarried or widowed female dependant until age 18.

How much is the Benefit for each Beneficiary?
The total divisible benefit is equivalent to the temporary disablement benefit rate (roughly 70% of the wage rate). The widow/widows share 3/5th of the benefit and the legitimate or adopted son and daughter 2/5th each of the benefit. If the total benefit so divided exceeds the full rate, there is a proportionate reduction in the respective shares of the beneficiaries.

How to claim 'Dependants' Benefit'?
To establish title to Dependant' Benefit, the following documents should be submitted at the Branch Office:-
(a) Claim in the appropriate form;
(b) Evidence of death being due to employment injury;
(c) Proof of relationship to the deceased supporting eligibility of the claimant as a "dependant";
(d) Evidence of age of the claimant(s) (certified copy of official record of birth, Baptismal register, school records, original horoscope etc;
(e) Certificate of infirmity from Medical Referee or any other prescribed authority in case of legitimate infirm son or legitimate or adopted unmarried infirm daughter.
After the claim to Dependant's Benefit has been admitted, the beneficiary should submit at six-monthly intervals (with the claim for June and December),a declaration that he/she is alive and has not married/remarried, attained the prescribed agel continues to be infirm, as the case may be duly attested by the prescribed authority.

Can Dependant's Benefit be reviewed?
Yes. Dependant's Benefit once awarded can be reviewed by the Corporation at any time if it is satisfied on fresh evidence that the earlier decision was due to non-disclosure or misrepresentation of material facts. It can also be reviewed on birth, death, marriage, re-marriage and attainment of age 18, by a claimant. The benefit can be continued, increased, reduced or discontinued.

What is Maternity Benefit?
Yes. Dependant's Benefit once awarded can be reviewed by the Corporation at any time if it is satisfied on fresh evidence that the earlier decision was due to non-disclosure or misrepresentation of material facts. It can also be reviewed on birth, death, marriage, re-marriage and attainment of age 18, by a claimant. The benefit can be continued, increased, reduced or discontinued.

What are the contributory conditions?

The contribution condition is the same as for Sickness Benefit.

How much is the Benefit?
The daily benefit rate is double the Sickness Benefit rate and is thus roughly equivalent to the full wages. Benefit is paid for Sundays also.

What is the duration of the Benefit?
The Benefit is paid as follows:-

(a) For confinement:-

For a total period or 12 weeks beginning not more than 6 weeks before the expected date of child birth.

If the insuredwoman dies during confinement or within 6 weeks thereafter, leaving behind the living child, the benefit continues to be payable for the whole of the period. But if the child also die during that period, the benefit will be paid upto and including the day of death of the child.

(b) For Miscarriage:-

For a period of 6 weeks following the date of miscarriage.

(c) For Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage:- For an additional period of upto four week.

In all the cases, the benefit is paid only if the insured woman does not work for remuneration during the period for which benefit is claimed. There is no waiting period.

How to claim Maternity Benefit?
Where an insured woman wishes to claim Maternity Benefit after confinement or for miscarriage, she should obtain from the Insurance Medical Officer/insurance Medical Practitioner, a certificate of confinement or miscarriage and submit it to her Branch Office personally or by post along with a claim for Maternity Benefit. The claim form also contains a declaration of abstention from work.

If Benefit is desired before confinement, a Notice and Certificate of Pregnancy and a Certificate of Expected Confinement obtained from the Insurance medical Officer/ Insurance Medical Practitioner are also required to be submitted.

For claiming Benefit in the event of death of an insured woman leaving behind a child, her nominee and if there is no such nominee, her legal representative should submit personally or by post to the Branch Office of the deceased insured woman, claim for the Benefit together with a certificate of death of the insured woman.

An insured woman claiming Maternity Benefit for Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage should submit her claim in the manner as for sickness benefit.

Where a claim to Maternity Benefit is not submitted Along with prescribed certificates referred to above, the Corporation has the discretion to accept other evidence in lieu thereof.

What is Medical Bonus?
Medical Bonus is lump sum payment made to an insured woman or the wife of an insured person in case she does not avail medical facility from an ESI hospital at the time of delivery of a child. This bonus of Rs. 250/- has been increased to Rs. 1000/- from 1st April 2003.

What does Medical Benefit consist of?
Medical Benefit means medical care of insured persons and their families, wherever covered for medical benefit.

Where are 'out-patient' services provided?
Out-door medical care is provided at State Insurance Dispensaries or Mobile Dispensaries manned by full-time doctors ('Service' system) or at the private clinics of Insurance Medical Practitioners ('Panel" system). The scope of medical services also includes simple ante-natal and post-natal care for women, family welfare planning services and immunization against the common infectious diseases. The Scheme provides at the sole cost of the Corporation, artificial limbs to insured persons who lose their limbs due to employment injury or in certain circumstances otherwise also, dentures, spectacles arid hearing-aids where the loss of teeth, impairment of eye-sight or hearing respectively is due to employment injury.

How and where are 'In - patient' Services Provided?
ESIC has a network of 141 hospitals country wide. Majority of these hospitals are administered by the State Govts. In - patient and diagnostic services in basic specialties are available
at these hospitals. State schemes have also tie-up arrangements with a number of Medical colleges. major state hospitals, as well as, private hospitals for advanced treatment for malignant diseases and complicated surgical interventions.

What about Preventive health care services?
ESI Scheme provides preventive health care services through the network of its dispensaries and hospitals. These include immunization against some killer diseases, pulse polio vaccination and family welfare services etc. The scheme also participates in all major national preventive health service campaigns.

How long Is Medical Benefit available?
Insured worker and the members of his family are eligible for medical care from the very first day of the worker coming under ESI Scheme. The medical care includes primary medical care, diagnostic services, specialist consultations and indoor medical care. Whenever the patient is not able to travel by himself/herself, ambulance services are also provided. The I.P. or his family members are not required to pay for any of the services.

A worker who is covered under the Scheme for the first time is eligible for medical care for a period of three months. If he/she continues in insurable employment for three months or more the medical care is available to him/her till the start of the first benefit period. If he/she contributes atleast for 78 days in a contribution period the eligibility is there upto the end of the corresponding benefit period.

A worker is also eligible for extended sickness benefit when he/she is suffering from anyone of the long term 34 diseases listed in the Act. This is admissible after the worker has been under ESI coverage for atleast 2 years during which he/she should have contributed atleast for 156 days. When these conditions are satisfied medical benefit is admissible for a maximum period of 730 days for the I.p. and his/her family.

What are Funeral expenses?
This component consists of a lump sum payment toward the expenditure on the funeral of the deceased insured person.

What is the amount payable?
The lump sum amount of this benefit is equal to the actual expenditure, not exceeding Rs. 2500/- towards the funeral of the deceased insured person.

Are there any Contribution Conditions?
No contribution condition is required for this Benefit. The only condition for admissibility of this Benefit is that the deceased person should have been an insured person at the time of his death. The Funeral expenses are thus payable in respect of an insured person in receipt of Permanent Disablement Benefit even if he may not be employed at the time of his death in a factory or establishment covered under the ESI Act.

To whom are the Funeral expenses payable?

The expenses are payable to the eldest surviving member of the family of the deceased insured person. If the insured person did not have a family or if he was not living with his family at the time of his death, the benefit is payable to the person who actually incurs the expenditure on the funeral of the deceased insured person.

How to claim the Funeral expenses?
To claim the expenses, the claimant should submit his/ her claim personally or by post to the Branch Office of the deceased insured person within three months, together with the following documents:-

(a) Death certificate as proof of death of the insured person issued by the Insurance Medical Officer/ Insurance Medical Practitioner or such other Medical Officer of a hospital or other institution who attended the insured person at the time of death or examined the body aft~r the death; (Death certificate issued by cremation/burial ground or by Municipal authorities or certified copy of village etc. death records may also be accepted as evidence of death);

(b) a declaration of the claimant, either

(i) that he is the eldest surviving member of the family of the deceased insured person and incurred expenditure on the funeral of the deceased. or

(ii) in case the claimant is other than the eldest. surviving member of the family, that the deceased insured person did not have a family or was not living with his family at the time of his death and that the claimant actually incurred expenditure on the funeral of the deceased insured person. The declaration should be countersigned by a competent authority

CRK
21st October 2010 From India, Vijayawada
The Contractor who is lending the services of his employees to the principal employer is not to be counted either for coverage of the factory/establishment or for his own coverage. Proprietor, partners and the contractors are not to be covered. Thus, at both the places, the contractor is not covered.
22nd October 2010 From India, Hyderabad
The employee and his family are entitled to Medical Benefit till the end of June, 2011. Subject to fulfilment of contributions, he is also entitled to cash benefits (except employment injury benefit) during this period.
22nd October 2010 From India, Hyderabad
Thank you Mr. CRKM for the detailed information on benefits admissible under the ESI Scheme as available in the ESI "Employee Guide" (2003 edition). I am giving below the details of the medical benefit admissible to the retired employees and permanently disabled persons, and also the "Un-employment allowance" admissible to the insured person in case of retrenchment/closure of the factory.I am also giving an up date wherever required ,to the information furnished by you.



What is the medical benefit admissible to an insured person after leaving his insurable employment?

An insured person who leaves the insurable employment on attaining the age of superannuation or retires under a voluntary Retirement Scheme or takes premature retirement, after being an insured person for not less than 5 years, shall be eligible to receive medical benefit for himself and his spouse subject to production of proof thereof, and payment of a nominal contribution of rupees one hundred and twenty for one year. In case the insured person expires, his spouse is entitled to the medical benefit for the remaining period for which the contribution was made, and she can continue to received the medical benefit on payment of the contribution @ 120/p.a. for further period.

This medical benefit is also admissible to an insured person who ceases to be in employment on account of permanent disablement caused due to employment injury for himself and his spouse on payment of similar contribution till the date on which he would have vacated the employment on attaining the age of superannuation, had he not sustained such permanent disablement.

2. What is unemployment allowance?

The ESI Scheme has introduced a scheme of unemployment allowance to the IPs who have been rendered unemployed involuntarily due to closure of the factory / establishment , retrenchment or permanent invalidity arising out of non-employment injury w.e.f. 1-4-2005. Affected IPs and their families will also be entitled to medical care from ESI Dispensaries / hospitals during periods of unemployment allowance.

Unemployment which arises due to following reasons shall be covered under the Scheme:-

Retrenchment as defined in the Industrial Disputes Act, 1947

Closure of the factory / establishment as defined in the Industrial Disputes Act, 1947.

Permanent invalidity not less than 50% arising out of non-employment injury. (The invalidity should be duly certified by a Medical Board constituted by the Central or State Government)

The applicant should have been an Insured Person under the ESI Act on the date of loss of insurable employment on account of retrenchment, closure of the factory / establishment or permanent invalidity arising out of non-employment injury.

Contribution in respect of him/ her should have been paid/ payable for a minimum period of three years (with effect from 11.09.2009 - previously five years) prior to the loss of employment. The duration of a year in this context, would mean a period of 156 days or more. An IP who has lost employment and in respect of whom the contribution was paid/ payable for 156 days or more in any two consecutive contribution periods in this reckoning will be deemed as having worked for one full year. Similarly, those who have paid contribution for 78 days more in a contribution period will be deemed as having served for a half year.



The period of service of an I.P .need not be continuous with one employer. The I.P. shall be entitled to this allowance irrespective of the fact whether part of his/her service as employer in the same or in any other region.



The I.P. need not satisfy any qualifying conditions afresh for claiming unemployment allowance for any subsequent spells provided to him/her but he/she should be an IP on the subsequent dates of unemployment. The unemployment allowance in the subsequent spells shall be at the same rate as has already been decided /paid.

As specified in section 65 of the Act, an IP shall not be entitled to any other cash benefit and the unemployment Allowance simultaneously for the same period. However, he/she may opt for either of the two, i.e., cash benefit or unemployment allowance . The term ‘cash benefit’ excludes periodical payments of PDB under ESI Act and Regulations.

As specified under Section 61 of the ESI Act , an IP who is in receipt of unemployment allowance shall not be entitled to receive any similar benefit admissible under the provisions of any other enactment.

There will be one month waiting period after the retrenchment.

Unemployment allowance shall not be admissible in the following circumstances:

During lock out; Lay off/temporary closure of factory /estt.;Strike resorted to by the employees ;and Voluntary abandonment of employment/premature retirement.

The rate of unemployment allowance in respect of a person who becomes unemployed shall be calculated on the basis of average daily wage during the last four completed contribution periods, immediately preceding the date of unemployment.

The daily rate of unemployment allowance shall be the Standard Benefit Rate as specified in the Table of Standard Benefit under Rule 54 of ESI (Central)Rules 1950 corresponding to the average daily wage so arrived.

Duration of allowance:

The maximum duration , for which an IP shall be eligible to draw the unemployment allowance during his/her entire life time, would be six months. However, the unemployment allowance shall not be admissible for a period less than one month at a time.

In case the beneficiary gets gainful employment subsequently , he/she can avail the balance allowance in case the contingency so arises but he/she should again be IP to be eligible for unemployment allowance for subsequent spells.

The IP eligible for unemployment allowance under the Scheme shall also be entitled to medical care for himself/herself and his/her family from the ESI Dispensaries/ESI hospitals/ IMPs Clinics for a period corresponding to contribution Period before unemployment, whichever is later.

In the event of death of the IP on any date prior to the expiry of 6 months period of unemployment allowance , the family of the deceased IP shall continue to be entitled to medical care for the remaining period as the case would have been, had the IP remained alive.

Medical care under this scheme shall, however, be restricted to only for the first spell of unemployment.

The claim for unemployment Allowance shall be submitted by the claimant at any time but not later than six months from the date of retrenchment/ unemployment to the appropriate Branch Office in the Form (UA-1) supported by the documentary evidence (in Form UA-2) proving his/her retrenchment / unemployment/invalidity.

This certificate is to be issued by Inspector of Factories, Asst/Deputy Commissioner, Labour, Workmen Compensation Commissioner or any other authority specified in this regard. Certificate of invalidity will be issued by the medical board constituted by the Central /State Govt.

Mode of Payment of allowance

The allowance is payable by Account Payee Cheque only

Payment in the event of death of IP

The amount of unemployment allowance upto and including date of death of IP, is payable to his/her nominee / legal heir.

Updates for the other information:

1. The Scheme protects all "employees" engaged on a monthly remuneration not exceeding Rs. 15,000/- (w.e.from 1-5-2010) - in a factory/ establishment to which the Act applies.

2. The rates of contribution are prescribed under Rule 51 of ESI (Central) Rules, 1950. The first Schedule to the Act has been repealed from 1-2-91 vide ESI (Amendment) Act, 1989 and the Central Rules from 50 to 62 have brought in to force from 1-2-91.

3. Employees earning average wages not exceeding Rs. 70/- a day are exempted from payment of contribution. The employers share of contribution is, however, payable.

4. Benefit period for the contribution period from 1st October to 31st March is 1st July to 31st December.

5. The daily rate of Sickness Benefit during any benefit period is twenty percent more than the “standard benefit rate" during the corresponding contribution period.

6. There are 99 wage groups in the Standard benefit rate table in Rule 54.

7. The daily rate of disablement benefit is50% more than the Standard Sickness Benefit rate and is roughly equivalent to about '75%of the wage rate.

8. Dependants entitled to the dependant benefit are (from 1st June, 2010)

(a) Widow/Widows during life or until remarriage:

(b) Widowed mother for life;

(c) Legitimate or adopted son until he attains the age of 25 years;

(d) Legitimate or adopted unmarried daughter until her marriage;

(e) If wholly dependent on the earnings of the insured person at the time of his death, a legitimate or adopted son or daughter who has attained the age of twenty five years and is infirm;

In the absence of any widow or legitimate child, the benefit is payable to a parent or grandparent for life, to any other male dependant until age 18 or to an unmarried or widowed female dependant until age 18.

9. Maternity benefit is periodical payments to an insured woman for specified period of abstention from work, due to confinement, miscarriage or sickness arising out of pregnancy, pr-mature birth of child or miscarriage or confinement.



10. An insured woman shall be qualified to claim maternity benefits for a confinement occurring or expected to occur in a benefit period, if the contributions in respect of her were payable for not less than seventy days in the immediately preceding two consecutive contribution periods.The dail rate of Maternity benefit is double the 'Standard benefit rate' during the corresponding benefit period.

11. Medical bonus ( now termed as “confinement expenses”) to an insured woman and an insured person in respect of his wife shall be paid a sum of rupees two thousand five hundred per case on account of confinement expenses PROVIDED that the confinement occurs at a place where necessary medical facilities under the Employees' State Insurance Scheme are not available.

12. Funeral expenses consists of the lump sum amount equal to the actual expenditure, not exceeding Rs. 5000/-towards the funeral of the deceased insured person.
23rd October 2010 From India, Hyderabad
Dear KVRM,
With due respect, i would like to add that due to typographical mistake there might been one mistake in the Unemployment allowance particulars:
Now the I.P., who is entitled for the "Unemployment allowance" is entitled for maximum period of "12 months, i.e. 360 days" instead of "6 months".
And the eligible criteria for is changed from continuous insurable employment for 5 years is reduced to 3 years.......
with regards.....
23rd October 2010 From India, Hyderabad
Dear VSP, Thank you for your timely correction. Now, the unemployment allowance is payable for a maximum period of twelve months either in one spell or in different spells of not less than one month's duration.I have already mentioned that the eligibility criteria has been reduced from 5 years to 3 years continuous insurable employment with effect from 11-9-2009. One more change is the time limit for submission of claim for un-employment allowance has been extended upto nine months with effect from 1st July,.2010.
23rd October 2010 From India, Hyderabad
Dear All
I have referred many sites to know in detail about ESI but i haven't found one information, Can anyone tell the person who has covered under ESI he/she has to get treatment only in ESI or can he/she avail the general treatment like fever,back pain etc even in private hospital.
Regards
Prasad
30th May 2011 From India, Bangalore
ESIC is a waste of money for both employee and employer. Have you ever wondered why companies go in for an additional Mediclaim Policy inspite of having an ESIC??????????..........Instead of talking big about ESIC there should have been GOOD FACILITIES AVAILABLE BEFORE MAKING IT A STATUTORY DEDUCTION...........Why don't some of our Political Superstars and Bureaucrats avail of this facility on those pathetic hospital if it is really really so good?????????..........Making a scheme look good in paper is a child's play.....implementing a really change is what real Men do AND WHAT REAL MEN WANT.................RGRDS
30th May 2011 From India, Mumbai
One of our employee was pregnant, she didn't inform ESI for the pregnancy and now she gave birth to a child in a private hospital. I have two queries :
Is there any process to claim hospital expenses of delivery
Is company is liable to pay his 3 months salary (paid leave benefit) or not - if he didn't got any paid leave benefit from ESI.
Please help.
Thanks
Rajiv Verma
1st June 2011 From India, Delhi
Computerization in ESI
NOW, in a phased manner computerization in ESI is being introduced and in some States the preparation of monthly challan on line has become mandatory. While entering the details of wages for generation of monthly challan, if any mistake is happened in entering the wages that cannot be amended and the system is not allowing to amend the amount of wages which was wrongly entered by oversight or by the mistake of the data entry operator. If a provision is made for amendment in the wages also as like in the case of employees registeration which provides provision for update ip details. Plz through a light on this aspect
sanagapalli VR
5th June 2011 From India, Hyderabad
Dear Mr.VKRM
Can you please let me know whether insured person contributed April to Sep 12. And he is left employment in 15th Jan 13, is he eligible for taking medical benefit, though he exited from that employment.
Request your clarification
21st February 2013 From India, Madras
As he is under ESI as on 30th September.........he is entitled for medical benefit till the end of the respective benefit period, i.e. up 30th June, 2013........ With best wishes......
21st February 2013 From India, Hyderabad
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