Seeking Advice: How to Handle ESIC Benefits for Off-Duty Accident Involving Company Driver?

Dear Seniors, Kindly advise me on an accident case. Our company driver was involved in an accident on 08.12.2013, but he was not on duty at that time.

Accident Report Submission

1. Should I submit his Accident Report to the nearest branch office so that he can receive ESIC benefits?
2. Should I indicate in the reports that he was off duty at the time of the accident?

Your guidance on this matter would be greatly appreciated.

Thank you.

Regards,
BANDNA JAMWAL

The following documents need to be submitted to the ESIC office immediately:

1. Accident report (Online)
2. Witness statement

The ESIC inspector may ask for further documents. You can show him while on office duty, but ensure you have proof such as a signature on the attendance register (if movement is done from the office) and records stating that he is in an office job.

Regards,

Accident Circumstances and Legal Considerations

What was he actually doing at the time of the accident? There are already many court judgments that have stated that traveling to and from work is considered an accident in the course of employment. Does your case fall into this category?

I think that this case doesn't fall into this category because he had come back after dispatching the goods at the destination. He had returned to the factory. After that, there were no goods to dispatch until night. In between, he went to his home for personal work, which is far from the factory, just 3 to 4 km away. He then went from his home to his farm for his own work. He was on a bike when he was hit by a car and injured.

Seeking Advice on ESIC Benefits Manipulation

Kindly advise me on whether it is right to manipulate a case to receive ESIC benefits. If no, then why? If yes, then why? Kindly help me.

Thanks & Regards,
Bandna Jamwal

I think this case might fall under the rule since he was on his way home from work (being officially allowed to leave). Manipulation of records is not something I condone, but it's done all the time when management wants to help out a worker at no cost to himself.

This is not a case of an accident arising out of employment, as clarified by you, since he was on a private visit to his farm when the accident occurred. The presumptions under Section 51-A as well as 51-E are not applicable in this matter. It would be ethically and morally wrong to give a false statement, besides being punishable under Section 84 of the ESI Act, 1948.

Regards,
KK

Mr. K. K. Nair is correct. Converting it into an employment injury is not correct, as it may invite action by the ESC against the employer under Section 84 of the ESI Act.

Regards,
Varghese Mathew
[Phone Number Removed For Privacy Reasons]

Whether he is on duty, coming for duty, or going from duty, he is liable for ESIC. Otherwise, you can show he is on duty by using the punching or attendance register. In lieu of this, you can benefit from it by registering an online accident report form no. 12.

Regards,
Tejbhan

The accident did not happen during duty time. He may receive treatment at the ESI hospital, but he cannot claim any benefits except for leave benefits.

If the accident happened during non-duty hours, he may seek treatment at an ESIC Hospital. However, he is not eligible for other benefits except for leave benefits.

Are you talking about free treatment? If free treatment and leave are available, then what is left?

You are clearly admitting that your company driver was not on duty. I think you also know that this case is not eligible for receiving benefits from ESIC. Then why are you trying to create fake records to get benefits from ESIC? ESIC can take penal action against you when the real facts come forward during the investigation, and it will create a bad impression about you and your organization as well.

Regards,
Prakash Salunkhe

I fully endorse the views of Mr. Nair & Mr. Mathew as stated above because the submission of any false information or false claim is an offense punishable under Section 84 of the Employees' State Insurance Act, 1948.

Furthermore, it should not be overlooked that the ESIC Branch Manager, upon receiving the Accident Report, will request you to submit a copy of the FIR registered with the Police Authorities and also the Investigation Report/findings of the Police Authorities.

He can take medical benefits from ESIC and leave benefits, but you must not submit any accident report as he was not on duty. You have a duty towards your employees but not at the cost of ESIC. If he did not die or have any permanent disability, then what other benefits are you looking for?

Thanks

As per the situation, he was not on duty when the accident happened. However, you can directly meet the branch manager of ESIC and provide all the correct details about his death. Since he is covered under ESIC, ESIC cannot deny giving benefits to his dependents. I agree that it did not occur during the course of employment, but you can bring all relevant documents that prove he was working with your organization.

There is no need to create fake records. Just go and meet the branch manager for clarification.

Regards.

All seniors, thank you very much for your support. I have submitted the accident report to ESIC and presented a clear picture in front of the Branch Manager. He is also saying that he is not eligible for getting a claim, but he can get leave benefits.

Understanding Leave Benefits from ESIC

Please, can you explain what is the actual rate of leave benefits from ESIC? The Branch Manager said that they will send the case to the head office. If the case is acceptable by the head office, then what kind of benefits can he get?

Thanks & Regards,
BANDNA

Understanding Leave Benefits under the ESI Act

Leave Benefit, as you have mentioned, is called "Sickness Benefit" under the ESI Act and is payable at 70% of the Standard Benefit Rate (Rule 55 of ESI (Central) Rules, 1950). The Standard Benefit Rate is further defined as the average daily wages obtained by dividing the total wages paid during the relevant contribution period by the number of days for which these wages were paid (Rule 2(7A)). Furthermore, there is a limitation of 90 days for the payment of said benefit in the same Rule.

In case the accident case is admitted as that of "employment injury" (which, I think, is not possible as you have mentioned as per the views of the Branch Manager), then it can be called "Temporary Disablement Benefit" (TDB). The TDB rate is 90% of the Standard Benefit Rate as mentioned above (Rule 57). If there is any permanent disability, then the case can further be sent to the medical board to assess the permanent disability as laid down in the said Act.

I suggest you go through the provisions of the ESI Act, 1948, and the rules/regulations framed therein and also study the literature on ESIC. You can download the same from the website of ESIC as well. Perhaps, this will remove your doubts in the matter for the future also.

Regards

Dear Seniors, there is another question in my mind. Suppose the injured person's daily wage is Rs. 291/- (from May-11 to Sep-11), then according to leave benefits, he can get 70% benefit from ESIC. His contribution period is from May 2011 to then. How much amount can he get from the ESIC as a sickness benefit? Please guide me in calculating it.

Thanks & regards,
BANDNA JAMWAL

Thank you for your reply. The ESI Branch has not issued any slip to the employee. The employee has submitted his ESI leave at the branch office, which was given by the doctor from the ESI dispensary on a weekly basis.

Thanks & Regards,
BANDNA JAMWAL