ESI Coverage Dilemma: Does a Salary Increase Affect Benefits for a Disabled Employee?

If an employee who is entitled to ESI from 2008 gets disabled during working hours in 2010 and crosses the salary ceiling for ESI (i.e. 15000/-), will he continue to remain covered under the ESI Act? Will he be eligible for ESI benefits or not? If yes, what is the procedure for that.

Rahim Pardewala
Surat

Please elaborate on your query. How does an employee who has exceeded their salary ceiling for ESI continue to be covered under the ESI Act? If the salary increase occurs between April-September/October-March and the employee is still covered under ESI, and an accident takes place during that period, then, in my opinion, the employee can receive disability benefits. Let's wait for further input from senior members.

As mentioned by Mr. Saji above, the issue raised by the member in this thread is not clear. When a person has crossed the prescribed wage limit (subject to his continuance as an employee up to the close of the contribution period, if applicable), he is no longer an "employee" under the ESI Act, 1948, and is not entitled to disablement benefits under the said Act.

Furthermore, the eligibility of any person to receive ESI benefits under the said Act/rules/regulations depends on his contributions for the minimum periods as prescribed. To examine this, the Branch Office of ESIC is the appropriate authority.

In my opinion, it would be better if the member who raised this thread or the person who wants to know his eligibility contacts the appropriate branch office of ESIC along with his identity card and relevant records of his contributions to ascertain the correct position.

Thank you.

Thanks for your reply. Till now, I am entitled to ESI. However, soon I will be crossing the wage limit (₹15,000). I have learned about two benefits provided to disabled persons by ESIC:

1. Incentive to employers in the private sector for offering regular employment to individuals with disabilities (Wage limit ₹25,000).
2. Medical benefits for retired and disabled individuals.

Regarding the first point, I have spoken to the SRO at ESIC Surat, but they only have the circular about this and are unaware of the procedure. I have also discussed this with my Head Office, and they mentioned that this benefit is for new employees, not for active employees with disabilities.

Concerning the second point, today I discovered that ESIC provides Medical Benefits to retired and disabled individuals, but I am unaware of the procedure. I would like to know more about the process.

Please advise on the procedure.

Regards

Sir, sorry for the late follow-up; my mother is hospitalized so I can't reply. I have been with my company since 2008. On 4th August 2010, while returning home from my office, I had an accident. Following that, for one and a half years, I underwent treatment. During this period, I resumed my job on 8th March 2011. However, the last operation was performed by the doctors on 15th July 2011, and they informed me that I would have a disability for a lifetime. This is a brief history of mine.

Benefits Provided by ESIC to Disabled Persons

Now, I would like to know the benefits provided by ESIC to disabled persons. I have come across a few:

1. Lifetime pension (after the medical board of ESIC approves the disability) [I am receiving this].
2. Wage limit up to 25,000 (Incentive to employers in the Private Sector for providing regular employment to persons with disabilities for three years and wage limit up to 25,000) [I would like more details on this].

If there are any other benefits provided by ESIC, please specify. I hope I have now clarified what my exact point is.

Regards,
Rahim Pardewala

I hope you have reviewed the provisions of Rule 50 of the ESI (Central) Rules, 1952. The proviso to the said Rule states that "the wage limit for coverage of an employee who is a person with a disability under the Persons with Disabilities (Equal Opportunities Protection of Rights and Full Participation) Act, 1955 (1 of 1966), and under the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities Act, 1999 (44 of 1999) respectively shall be..."

Based on these provisions, it appears that ESIC may not be able to assist you in continuing your coverage under the said Act if your current wages exceed the coverage limit of Rs. 15,000 per month.

You may need to contact the relevant authorities in your area established under either of the above two enactments (based on your disability) to obtain the necessary disability certificate. Afterward, you can request your current employer to maintain your coverage under the ESI Act until the prescribed wage ceiling of Rs. 25,000 per month, as currently specified for individuals with disabilities.

If you have any uncertainties, I recommend presenting your case in writing to the Regional Director (Benefit Branch) of ESIC in your area with all the relevant details and requests.

According to Rule 51-A of the aforementioned rules, the employers' share of contribution in such instances is to be reimbursed to the ESIC by the Central Government. Therefore, in my view, it is vital to obtain a disability certificate under either of the above-mentioned enactments (as applicable to you).

Thank you.

To be eligible for ESI benefits for disability, the employee must be an IP on the date of disablement (injury), and contributions should have been payable for that day. For disablement benefits, contribution-benefit periods have no relevance.

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