An Employee was transferred on 01st Nov from ESIC covered area to non ESIC covered area & while returning home he met with an accident. Now ESIC is giving him treatment but my question is will ESIC pay him for this duration of treatment as he is still under benefit period or as employer co. need to pay him?
From India, Taramani
1. The important aspect is whether at the time of accident whether the injured employee was working in "insured or insurable employment" ?. If the injured employee was employed at a place where there was no coverage under ESI Act, then in such case there is no liability on the part of ESIC to provide any benefit except medical benefit to which he will be entitled only upto some duration on the basis of his compliance made in earlier place of employment.
2. In above situation, in my opinion, the injured employee can claim compensation under the Employees' Compensation Act, 1923, if otherwise covered under said Act.

From India, Noida
Dear Girish,
As per my knowledge "YES"he is eligible for ESIC...
For any reason ,if employees stop deducting his/her ESIC,still employees are eligible for all benefits under ESIC act for 3 month, after submission of his/her last month ESIC..
Eg..Last ESIC paid month was October..
He can claim his MEDICAL till Jan 31st..

From India, Vadodara
1. Since the said employee, as reported was not working in insured/insurable employment, he is not entitled for temporary disablement benefits or any permanent disablement benefits on account of said accident. In order to be entitled for benefits as a result of accident, the person must be "employee" on the date of accident. I am not sure as to under which provisions of ESI Act, 1948 and rules/regulations framed thereunder Mr./Mrs.Pramanik has remarked as above that the said employee is entitled for all benefits under said Act. I will request Mr./Mrs. Parmanik to indicate the provisions of said Act so that I may be able to form my views accordingly.
2. In my opinion, the said employee can avail only medical facilities and that too only upto some duration.
3. For compensation and leaves etc., if any, the said employee will be entitled under Employees' Compensation Act, 1923 if otherwise eligible under said Act.

From India, Noida
Dear Girish,
Greetings for the day,
As you have asked the simple question related to esic benefit period my answer is also very simple that benefit period is related with the contribution period i.e if the contribution period will be 1st April to 30th Sept. then the benefit period will be 1st Jan of the following year to 30th June, If the contribution period will be 1st Oct to 31st March of the year following, then the benefit period will be 1st July to 31st December.
Thanks & Regards,
Sumit Kumar Saxena

From India, Ghaziabad
If the ESI contribution 1.75% was deducted from employee as per eligibility of wage coverage, then ESI has to follow the usual norms for accident relief. If such obligation of ESIC was opposed on the grounds of 'Non implemented area' (code-6) or 'Area outside the coverage'; it is not the fault of the employee. In his appointment order, a clause states that 'You may be shifted to any of our branches or sites anywhere in the county'. If this is obeyed, then employer should either obey the ESIC benefits or any other alternative in lieu of ESIC till the corresponding benefit period lapses.

As long as the deduction / remittance was done as usual, it is the obligation of the employer to act in lieu of ESIC if the later denies. As long as the employee / IP was not allotted a code of exclusion in the monthly contribution file, he continues to enjoy all benefits.

This can be challenged in the court on the very grains of 'Denial of social security act' either by ESIC or Employer. This will be an eye opener to all erring employers and ESIC in future. Let's see for any other opinion from learned friends.



From India, Madras
Dear Friends,
The question by quriest is as under:
Answer to him in simple word is:
Yes, ESI will pay for treatment during benefit period however, ESI will not pay any compensation including leave as stated by Shri. Harsh Kumar, because the injured person is not an IP at the time of accident.
Shri. Harsh Kumar has also correctly said that injured employee can claim compensation from his employer under the Employees' Compensation Act, 1923.

From India, Mumbai
Dear Korgaonkar ji,
With reference to your remarks as above, I may like to correct your goodself that on the date of injury/accident, the said person was a "Insured Person", but was not an "employee", because as per facts, the said person was transferred to some non-implemented area. In order to be entitled for "disablement benefit", the injury / disablement should have been as an "employee" Kindly see Rule 57 of ESI (Central) Rules, 1950. The term "insured person" is a wider term and I will request you to go through the definitions of these words in ESI Act, 1948.

From India, Noida
Dear Harsh Kumar ji,
Thank you so much for giving me an opportunity of correct my self. The injured person is a "Insured Person" as said by you within the definition u/s 2(14). I would have used the word "not an employee" instead of "not an IP".
Rest what I have said is perfectly right, I hope.

From India, Mumbai
Girish, I have a question for you. Did the accident happen (on the way back) after the employee was transferred on 1-Nov, or on the day before ? Your note does not specify the date when the accident happened. Did it happen on the 31-Oct or 1-Nov ?
Every employee is supposed to be covered either under ESIC (provided you est. falls in that territory) or under WC Act. It is mandatory on the part of the employer to ensure that all the employees are covered under one of these 2 acts. If your employee met with an accident on 1-Nov, the benefits as per provisions under ESIC will not be applicable except for the medicals, and hence he should claim compensation under WC Act. However, if has met with an accident on the 31-Oct, he still is covered under ESIC and can hence avail all the benefits.

From India, Mumbai

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