UMESH KUMAR HR
1

Dear All
One of our employee has lost his leg above knee while leaving for home from his working site. We have paid his full salary for that month and adjusted his leaves. And 15 days extra leaves as advance leaves. As he was covered under ESIC, i want to know is he eligible for and pension from ESIC....??? for losing his leg. Our organisation is covered under shops & establishment act Delhi.

From India, Delhi
UMESH KUMAR HR
1

Hey Everyone can anyone please help me out regarding above thread.
From India, Delhi
abhay_011
19

Dear Umesh,

he is eligible for benefits as under :

Eligibility for Medical Benefit :

Duration and Scale of Medical Benefit :

Delivery of Medical Benefit :

An insured person (IP) and his/her family member become eligible for primary &

secondary medical benefit under the ESI Scheme from day one of entering insurable

employment. Section 56 (3) of ESI Act, 1948 provides, “A person shall be entitled to

medical benefit during any period for which contributions are payable in respect of

him or in which he is qualified to claim sickness benefit or maternity benefit (or is in

receipt of such disablement benefit as does not disentitle him to medical benefit under

the regulations)”.

Duration and Scale of Medical Benefit :

The insured person/family member of an insured person can avail the medical

treatment under this Scheme till the insured person is in insurable employment. Full

medical care (all facilities including hospitalization) for insured person and their

family members is provided.

Delivery of Medical Benefit :

As per the provisions of ESI Act, 1948, the State Governments are responsible for

providing the medical benefits through the network of ESI Dispensaries (for primary

medical services) and ESI Hospitals (for secondary medical services). However, the ESI

Corporation provides medical care directly, in Delhi and Noida area. Besides these

two area, the Corporation is also running 34 ESIC Hospitals directly which includes

ESIC Model Hospitals, at least one in each State. The beneficiaries are provided OPD

services, in-patient services, diagnostic facilities, free drugs and dressings etc. in all

ESI medical delivery institutions.

Medical Benefit for Old Age and for Permanent Disabled Beneficiaries :

The Medical Benefit has further been extended to the

insured persons who go out of employment on

account of attaining the age of superannuation (Old

Age) or on account of permanent disability (arising out

of employment injury). The Medical care is provided

in ESI institutions only, to such insured persons and

their spouse on payment of a lump sum amount for

one year at the rate of ` 10/- per month.

Provision of Artificial Limbs and Appliances :

Artificial limbs, artificial dentures, spectacles, hearing

aids, cardiac pacemaker, walking caliper, surgical

boots, spinal support, cerebral collar, intraoccular

lens etc. are provided free of cost to those patient

beneficiaries, who requires such appliances.

Rgds


From India, Mumbai
Harsh Kumar Mehta
923

1. Sir, you have not mentioned complete particulars / facts which are required in order to offer any comments.

2. Please indicate (a) whether the unit in which the said employee was /is working on the date of accident is covered under provisions of ESI Act, 1948 and rules/regulations framed thereunder, (b) whether the employee who sustained injuries was covered on the date of accident under said Act and compliance was being made.(c) whether accident report as required under above Act was submitted to the appropriate Branch Office of ESIC online or manually as desired by Branch Office of ESIC and If so what is the decision of said Office, (d) whether the injured person has his Insurance Number and ESIC Identity Card (e) whether after accident FIR was lodged with the police authorities & (f) whether medical certificates obtained from concerned ESIC Dispensary to which the insured person was attached.

3. I hope, you will indicate above aspects before any opinion is expressed in the matter.

From India, Noida
varghesemathew
910

He will get benefits from ESI if contribution is payable in respect of him on the date of accident and conditions of sec 51 E of ESI Act is fulfilled . Varghese Mathew
From India, Thiruvananthapuram
abhay_011
19

Is this your genuine problem in your company..or you are sitting here to take exams of seniors? Rgds
From India, Mumbai
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