Understanding ESIC Benefit Period and Employee Coverage: Key Insights Revealed

An employee was transferred on the 1st of November from an ESIC-covered area to a non-ESIC covered area. While returning home, he met with an accident. Now, ESIC is providing him with treatment. My question is: will ESIC pay for this duration of treatment since he is still under the benefit period, or does the employer company need to pay for it?

Sir,

The important aspect is whether at the time of the accident, 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 the ESI Act, then in such a case, there is no liability on the part of ESIC to provide any benefit except medical benefit to which he will be entitled only up to some duration based on his compliance made in the earlier place of employment.

In the above situation, in my opinion, the injured employee can claim compensation under the Employees' Compensation Act, 1923, if otherwise covered under the said Act.

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 months after submission of his/her last month ESIC. For example, if the last ESIC paid month was October, he can claim his MEDICAL till January 31st.

Sir,

Since the said employee, as reported, was not working in insured/insurable employment, he is not entitled to temporary disablement benefits or any permanent disablement benefits on account of the said accident. In order to be entitled to benefits as a result of the accident, the person must be an "employee" on the date of the accident. I am not sure under which provisions of the ESI Act, 1948, and rules/regulations framed thereunder Mr./Mrs. Pramanik has remarked as above that the said employee is entitled to all benefits under the said Act. I will request Mr./Mrs. Parmanik to indicate the provisions of the said Act so that I may be able to form my views accordingly.

In my opinion, the said employee can avail only medical facilities, and that too only up to some duration.

For compensation, leaves, etc., if any, the said employee will be entitled under the Employees' Compensation Act, 1923 if otherwise eligible under the said Act.

Dear Girish,

Greetings for the day.

As you have asked a simple question related to ESIC benefit period, my answer is also straightforward. The benefit period is connected to the contribution period. For example, if the contribution period is from 1st April to 30th September, then the benefit period will be from 1st January of the following year to 30th June. Similarly, if the contribution period is from 1st October to 31st March of the following year, then the benefit period will be from 1st July to 31st December.

Thanks & Regards,

Sumit Kumar Saxena

If the ESI contribution of 1.75% was deducted from the employee as per the 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 the employer should either obey the ESIC benefits or any other alternative in lieu of ESIC until 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 latter 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 court on the very grounds of 'Denial of the Social Security Act' either by ESIC or the Employer. This will be an eye-opener to all erring employers and ESIC in the future. Let's see for any other opinion from learned friends.

Regards,

Chandrasekar

Dear Friends,

The question by the querist is as follows:

The simple answer to this is: Yes, ESI will pay for the treatment during the 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 the accident.

Shri. Harsh Kumar has also correctly stated that the injured employee can claim compensation from his employer under the Employees' Compensation Act, 1923.

Dear Korgaonkar ji,

With reference to your remarks as above, I would like to correct you that on the date of the injury/accident, the said person was an "Insured Person" but was not an "employee". This is because, based on the facts, the said person had been transferred to a non-implemented area. To be entitled to "disablement benefit," the injury/disablement should have occurred while the individual was an "employee." Please refer to Rule 57 of the ESI (Central) Rules, 1950 for clarification. The term "insured person" is broader, and I suggest you review the definitions of these terms in the ESI Act, 1948.

Thank you.

Dear Harsh Kumar ji,

Thank you so much for giving me an opportunity to correct myself. The injured person is an "Insured Person" as you mentioned within the definition under section 2(14). I would have used the phrase "not an employee" instead of "not an IP."

The rest of what I have said is perfectly right, I hope.

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 your establishment falls in that territory) or under the WC Act. It is mandatory on the part of the employer to ensure that all the employees are covered under one of these two 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 the WC Act. However, if he met with an accident on 31-Oct, he is still covered under ESIC and can hence avail all the benefits.

Dear,

I have some problem with ESIC contributions. I opened a new ESIC code in June 2014 but did not make any contributions from June 2014 to December 2015 as I did not have any business during that period, and no employees were working with us. I now plan to resume work from January 2016. Could you please provide suggestions on how to reset the ESIC and PF contributions for the period mentioned above?

Please reply to me via email.