EMPLOYEES STATE INSURANCE ACT, 1948
1. Whether the establishment has been registered within the time frame and in the manner specified in the regulations made under the Act?
Section 2 A *
2. Whether all the conditions under the Act with regard to contribution, to be paid by the employer to the Corporation have been complied with.
• The contribution shall comprise contribution payable by the employer and contribution payable by the employee
• The amount of contribution for a wage period shall be, in respect of:
(a) employer’s contribution, a sum (rounded to the next higher multiple of 1 Rupee) equal to 4.75 percent of the wages payable to our employee; and
(b) employee’s contribution, a sum (rounded to the next higher multiple of 1 Rupee) equal to 1.75 percent of the wages payable to an employee.
• average daily wages during a wage period for exemption from payment of employee’s contribution under section 42 shall be upto and inclusive of Rs 40.
Section 39 *
3. Where the company is the principal employer*, whether the employer’s contribution and employee’s contribution are being paid?
Are the deducted sums being remitted to the Corporation?
Section 40 *
4. Where the company is the principal employer which has paid contribution in respect of an employee employed in respect of an employee employed by or through an immediate employer, has the amount been recovered from the immediate employer?
Section 41 *
5. Has the company ensured that no employee’s contribution is payable by or on behalf of an employee whose average daily wages during a wage period are below such wages as are prescribed in the rules?
Section 42 *
6. Whether the employer has furnished returns and maintained registers in such form and containing such particulars relating to persons employed by it in the establishment.
Section 44 *
7. Has the company ensured that the employee’s salaries and other benefits are not reduced, merely because of contributions payable under this Act?
Section 72 *
8. Has the company ensured that no employee is dismissed, discharged or otherwise punished during the period, the employee is in receipt of sickness benefit, maternity benefit, disablement benefit for temporary disablement, or is under medical treatment for sickness or is absent from work as a result of illness?
Section 73 *
9. Has any matter been referred to the Employee’ Insurance Court?
(Check the status) Section 75 *
* ‘principal employer’ means :
(i) in a factory, the owner or occupier of the factory and includes managing agent of such owner or occupier, and where a person has been named as the manager of the factory under the Factories Act, 1948, the person so named;
(ii) in any establishment under the control of any department of any Government in India, the authority appointed by such Government in this behalf or where no authority is so appointed, the Head of the Department;
(iii) in any other establishment, any person responsible for the supervision and control of the establishment;
10. Whether any class of employees have been exempted from the purview of this Act?
Section 88 *
11. Since the plant may have been acquired by the company, in the event that there is any outstanding liabilities by way of contribution payable under the Act, in respect of periods upto the date of such acquisition, whether the company has paid the outstanding amount, if any, are due.
Section 93(a) *
EMPLOYEE’S STATE INSURANCE
(GENERAL) REGULATIONS, 1950
No Section/ Regulation
Yes No NA
1. Whether the establishment has been allotted an Employer’s Code Number?
Regulation 10-B *
Whether the employee has furnished within the time frame of fifteen days, a declaration of registration in writing in Form OI?
Whether an Employee State Insurance Fund has been established as per the provisions of the Act, for the establishment?
2. Whether the employer has ensured that every employee has furnished a declaration in Form I giving particulars?
Regulation 11 *
3. Whether the employee has produced a Temporary Identity Card, the particulars of which shall be entered into the Declaration Form by the employer?
Regulation 12 *
4. Whether the employer has sent to the appropriate office, all Declaration Forms alongwith the temporary identification certificate, with a return in duplicate in Form 3 within 10 days from the date on which the particulars for the Declaration Forms were furnished?
Regulation 14 *
5. Whether Insurance Numbers to each person, in respect of whom the Declaration Forms have been received, have been allotted?
Regulation 15 *
Whether the employer has entered the Insurance Number allotted to an employee and indicated in the copy of Form 3, on the Contribution Card of such employee?
6. Once the identity card has been prepared in Form 4 by the appropriate office, whether the employer has delivered the same to the employees for which he should have received a receipt from the said employees?
Regulation 17 *
7. In the event that an insured person happens to need medical care before the Temporary Identification Certificate is issued, whether the employer has issued a certificate of employment in the form specified by the Director General?
Regulation 17-A *
8. Whether the employer has sent a return of contribution in quadruplicate in Form 6 alongwith receipted copies of challans for the amounts deposited in the Bank, to the appropriate office to reach the said office:
(a) within 42 days of the termination of the contribution period to which it relates
(b) within 21 days of the date of permanent closure of the factory/establishment
(c) within 7 days of the date of receipt of requisition in that behalf
Regulation 26 *
9. Whether the employer has issued a certificate of contribution paid in respect of an insured person in the form prescribed by the Director General?
Regulation 27 *
10. Whether the employer has paid the contributions within 21 days of the last day of the calendar month in which the contribution falls due?
Regulation 31 *
11. In the event of failure to pay contributions within the period stipulated, whether the employer has paid interest at the rate of 12 percent per annum in respect of each day of default/delay in payment of contribution.
Regulation 31 A *
12. Is a register in Form 7 being maintained in respect of every employee?
Regulation 32 *
13. Whether the benefits payable under the Act, have been paid within the following time periods:
(a) in case of sickness benefit not later than 7 days
(b) in case of funeral expenses, not later than 15 days
(d) in the case of the first payment in respect of Temporary Disablement Benefit, not later than one month
(e) in case of first payment of Dependant’s benefit, not later than 3 months. Regulation 52 *
ESI ACT, 1948- Implications, Benefits and Procedure
APPLICATION OF ACT
1. It is applicable to non-seasonal power using factories employing 10 or more persons and non-power using factories employing 20 or more persons.
2. The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatre, road motor transport undertakings and newspaper establishment employing 20 or more persons.
3. The existing wage-limit for coverage under the Act, is Rs.10000/- per month (with effect from 1.10.2006).
The employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period.
CONTRIBUTION PERIOD AND BENEFIT PERIOD
There are two contribution periods each of six months duration and two corresponding benefit periods also of six months duration as under.
Contribution period Corresponding Cash Benefit period
1st April to 30th Sept. 1st January of the following year to 30th June.
1st Oct. to 31st March 1st July to 31st December of the year following
BENEFITS UNDER ESI SCHEME
1. MEDICAL BENEFITS
The Employees’ State Insurance Scheme provides full medical care in the form of medical attendance, treatment, drugs and injections, specialist consultation and hospitalization to insured persons and also to members of their families where the facility for Specialist consultation, hospitalization has been extended to the families.
For the families, this benefit has been divided into two categories as under:-
FULL MEDICAL CARE
EXPANDED MEDICAL CARE
MEDICAL BENEFITS (EXPLAINATION)!!!
FULL MEDICAL CARE
This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients.
EXPANDED MEDICAL CARE
This consists of consultation with the specialists and supply of special medicines and drugs as may be prescribed by them in addition to the out-patient care. This also includes facilities for special laboratory tests and X-Ray examinations.
MEDICAL BENEFITS (EXPLAINATION)!!!
System of treatment:
Generally, the allopathic system of medicine is used for providing Medical Benefit. However, where a substantial number of workers demand treatment by Indian system of medicine and Homoeopathy (ISM & H) other than Allopathy. The various ISM &H systems of treatment in vogue are:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy.
MEDICAL BENEFITS – Scale of Medical Benefit!!!
To Insured Persons:- IPs are entitled to avail treatment in ESI dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:-
Domiciliary treatment by visits at their residences.
Free supply of drugs dressings and artificial limbs, aids and appliances.
Imaging and laboratory services.
Integrated family welfare, immunisation and MCH Programme and other national health programme etc.
Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.
Medical Certification and
MEDICAL BENEFITS (EXPLAINATION)!!!
To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of the following scales of Medical Benefits:-
"FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.
"EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.
2. SICKNESS BENEFITS EXPLAINED!!!
Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance with abstention from work on medical grounds.
Sickness benefit is roughly 50% of the average daily wages and is payable for 91 days during 2 consecutive benefit periods.
TYPES OF SICKNESS BENEFITS!!!
EXTENDED SICKNESS BENEFITS
An IP suffering from certain long term diseases is entitled to ESB, only after exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable is as follows
Nutritional and Metabolic Disorders,
Disorders of Nervous System,
Disease of Eye,
Diseases of Cardiovascular System,
Diseases of the Digestive System,
Others (More than 20% burns with infection/complication, Chronic Renal Failure, and Reynaud’s disease/Burger’s disease)
Enhanced Sickness Benefits (w.e.f 1.8.1976 )
Insured Persons eligible to ordinary sickness benefit are paid enhanced sickness benefit at double the rate of sickness benefit i.e., about full average daily wage for undergoing sterilization operations for family welfare. Duration of enhanced Sickness Benefits is
Up to 7 days in the case of Vasectomy and
Up to 14 days in the case of the Tubectomy
from the date of operation or from the date of admission in the hospital as the case may be. The period is extendable in case of post operative complications.
3. Maternity Benefit (Explained)!!!
a) Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-
b) Confinement-payable for a period of 12 weeks (84 days)
c) Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage-on the basis of Form 20 and 23.
d) Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month-on the basis of Forms 8, 10 and 9.
e) In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee .
f) Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage
DISABILITY BENEFITS (EXPLAINED)!!!
Temporary Disability Benefit (TDB)
Duration of TDB
There is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a Temporary Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs may resist taking a Final Certificate especially before 3 days for fear of loss of TDB.
PERMANENT DISABILITY BENEFIT
PDB is payable to an IP who suffers permanent residual disablement and results in loss of earning capacity.
The duration of PDB may be for the period given by Medical Board, if assessment is provisional or for entire life if assessment is final.
PDB Rate: The PDB rate is calculated as percentage of loss of earning capacity as assessed by the Medical Board/MAT/EI Court in relation to TDB. List of injuries deemed to result in permanent total disablement. The maximum rate of PDB can be equal to the rate of TDB.
DEPENDANT’S BENEFIT (Explained)!!!
The dependants’ benefit is payable to the dependants in cases where an IP dies as result of EI.
The minimum rate of DB is Rs.14/- per day and these rates of the DB are increased from time to time. (The latest enhancement is with effect from 01.08.2002)
Funeral expenses not exceeding Rs. 2500/- is payable towards expenditure on the funeral of a deceased IP.
ESI RELATED FORMS!!!
FORM 0- EMPLOYERS’ REGISTRATION FORM
FORM 1- DECLARATION FORM
FORM 1 A- FAMILY DECLARATION FORM
FORM 1 B-CHANGES IN FAMILY DECLARATION FORM
FORM 3- RETURN OF DECLARATION FORMS
FORM 6- RETURN OF CONTRUBUTIONS
FORM 12- SICKNESS OF TEMPORARY BENEFITS
FORM 12 A- MATERNITY BENEFIT FOR SICKNESS
FORM 13 – SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 13 A- MATERNITY BENEFIT FOR SICKNESS
FORM 14- SICKNESS OR TEMPORARY DISABLEMENT OR MATERNITY BENEFIT FOR SICKNESS
FORM 14 A- MATERNITY BENEFIT FOR SICKNESS
FORM 16- ACCIDENT REPORT FROM EMPLOYER
FORM 17-DEPENDANT’S OR FUNERAL BENEFIT (DEATH CERTIFICATE)
FORM 18- DEPENDANT’S BENEFIT (CLAIM FORM)
FORM 18 A- DEPENDANT’S BENEFIT (CLAIM FOR PERIODICAL PAYMENTS)
FORM 19- MATERNITY BENEFIT (NOTICE OF PREGNANCY)
FORM 20- MATERNITY BENEFIT (CERTIFICATE OF PREGNANCY)
FORM 21- MATERNITY BENEFIT (CERTIFICATE OF EXPECTED CONFINEMENT)
FORM 22- CLAIM FOR MATERNITY BENEFIT
FORM 23- MATERNITY BENEFIT (CERTIFICATE OF CONFINEMENT OR MISCARRIAGE)
FORM 24- MATERNITY BENEFIT (NOTICE OF WORK)
FORM 25- CLAIM FOR PERMANENT DIABLEMENT BENEFIT
FORM 26- CERTIFICATE FOR PERMANENT DISABLEMENT BENEFIT
FORM 27- DECLARATION AND CERTIFICATE FOR DEPENDANT’S BENEFIT
Hope this is useful and a ready recokner 15th June 2007 From India, Pune