Saswatabanerjee
Partner - Risk Management
Harsh Kumar Mehta
Consultant In Labour Laws/hr
Simple Bob
Business
+1 Other

#Anonymous

My wife was working for a private school for 3 academic years, with ESIC Benefits, before her resignation in March 2016. She was 3 months pregnant when she resigned in March. She joined another school in April 2016 without ESIC Benefits as her salary in the latter school was higher. She was told to resign in 7th month of pregnancy, as she was still in probation period. She resigned in July 2016. Till 7 the month she was seeing a private doctor, in 8th month she visited esi hospital, she was accepted, she gave birth to a baby in September, she applied for maternity leave from October 2016 to December 2016, that too was accepted and the amount got credited into her bank account. My question is, was this legal or illegal to avail esi benefits at hospital and apply for maternity leave 6 months after resigning the first school ?
20th April 2017 From India, Secunderabad
1. Dear member, I think, before answering the question , you/ your claimant wife must have gone through Regulation 4 of ESI (General) Regulations,1950. As per facts, you mentioned, your wife had contributed in her old job upto March, 2016. Therefore, the corresponding benefit period for this contribution period starts from July, 2016 and lasts upto 31st December, 2016. Therefore, I think, your wife has rightly claimed benefits from ESIC provided she was otherwise eligible as per terms and conditions of eligibility under ESI Act and rules/regulations framed thereunder.

2. I may, however, submit that as per Regulation 87, an insured woman can claim maternity benefit from the appropriate branch office of ESIC. The term "insured person" has been defined under section 2(14) of ESI Act, 1948. When as per Regulation 4 of ESI (General) Regulations, 1950 as mentioned above, the benefits cannot be paid till start of benefit period or till 9 months period as per above Regulation, hence even after leaving of job, the entitlement of a person remains till the close of his benefit period.

3. However, the above position is not there in respect of accident cases, because for such accidental benefit cases, the person must be an "employee" on the time and date of his accident. This is with reference to various sections in Chapter V of said Act.
20th April 2017 From India, Noida
Thank you Mr. Harsh for the immediate response, it was invaluable. I came to know about it recently that what she had done might not be legal. So there was nothing wrong on her part for claiming paid maternity leave even after a gap of 9 months after resignation, so we will not have legal problems to face in future if verified later ???
20th April 2017 From India, Secunderabad
ESIC covers medical expenses of an employee till the recovery. And this is also extended to maternity benefits. Therefore since she was pregnant when she resigned, she is elibilge for the epayment. There is nothing illegal
21st April 2017 From India, Mumbai
Sir, thanks for appreciating my above remarks. I may, however, again submit that every think depend upon entitlement of an insured person. If he/she has/had contributed and her entitlement is there within the set of benefit period, he/she must get the required benefit to which he/she deserve. I think, this is the legal framework within which a contributory social security scheme like ESIS works. ESIC, now has every think, online and they get a fair idea of entitlement of an insured person before making payments of such benefits. With best wishes.
21st April 2017 From India, Noida
@ Harsh Kumar Mehta,
Sir, First of all would like to appreciate your efforts. Very well explained about this ESIC benefit period concept, i was unaware about it. Please help me in solving 1 query.
An Employee has recently Joined on 20.04.2017 and is covered under ESIC. Then what will be his benefit period ??
Can you please explain in brief with example about Contribution period & Benefit period ?
Please advise.
Thanks & Regards
Supriya
22nd April 2017 From India, New Delhi
1. Dear member, thanks for appreciations as above. However, I may submit that if you will read Regulation 4 as mentioned by me above, you will find the answer of the question/issue raised by you. The proviso of the said Regulations says " ...........the corresponding benefit period for him shall commence on the expiry of the period of 9 months from the date of such employment". I hope, you will calculate the period of 9 months from 20.4.2017.
2. However, this is subject to fulfilment of conditions of minimum contribution days as laid down in respect of different benefits under said Act/Rules/Regulations. Without making further comments, I will also like to say that the appropriate office for defining and certifying eligibility of an insured person for various benefits under above Act is the appropriate Branch Office and appropriate Regional Office of ESIC (Regulation 51).
23rd April 2017 From India, Noida
Hi,
My wife is pregnant now, (8th month) she left job on July 5th 2017. She worked 1 year 6 months for compeny. is it possible to claim the ESI benefits now...???
4th March 2018
our employee left the service in may,2018 her esic benefit continued after nine month of resignation, at present her father is ill and she wants to take benefits from esic , is this possible or not
29th August 2018 From India, New Delhi
Dear member, the eligibility for benefits under ESI Act, 1948 are decided or determined by the authorities disbursing or giving such benefits. It will be more better if the matter is discussed with the incharge of ESI dispensary to which your said employee is attached. It is correct that the benefits under said Act (except relating to accidents) continue till close of the relevant benefit period, but there are so many issues involved like whether the employee was entitled due to her contributions in relevant contribution period. Whether the illness is such which falls under superspeciality treatment etc. etc. Therefore, it will be more better if the authorities are contacted on the issue.
31st August 2018 From India, Noida
Dear member let me know rules, continue benit of Esic after retirement.
5th January 2019 From India, Delhi
hi sir please confirm use of benefits after resignation
my contribution last 2018 September
14th January 2019 From India, Gurgaon
1. Dear member, by virtue of your self being covered under contribution period ending September, 2018 you can avail ESIS medical facilities till close of corresponding Benefit Period provided your contribution in contribution period is as per requirement. The corresponding benefit period has started January,2019 and will close on 30th June, 2019. After close of benefit period you will not be entitled for this medical benefit from ESIS.
2. However, in case you want to continue ESIS medical facilities, you can opt for action under Rule 61 of ESI (Central) Rules, 1950 vide which after paying some nominal charges, you can continue getting medical facilities as a RETIRED INSURED PERSON. In order to complete above formalities, you are required to contact the ESIC Branch Manager of the branch office to which you are attached. Wish you happy retired life.
30th January 2019 From India, Noida
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