Employee Lost a Leg: Is He Eligible for ESIC Pension Benefits?

One of our employees has lost his leg above the knee while leaving for home from his working site. We have paid his full salary for that month and adjusted his leaves, along with 15 days of extra leaves as advance leave. As he was covered under ESIC, I want to know if he is eligible for any pension from ESIC for losing his leg. Our organization is covered under the Shops and Establishment Act in Delhi.

Regards

He is eligible for benefits as under:

Eligibility for Medical Benefit:

An insured person (IP) and his/her family member become eligible for primary and secondary medical benefits under the ESI Scheme from day one of entering insurable employment. Section 56 (3) of the 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 of medical treatment under this Scheme till the insured person is in insurable employment. Full medical care (all facilities including hospitalization) for insured persons and their family members is provided.

Delivery of Medical Benefit:

As per the provisions of the ESI Act, 1948, the State Governments are responsible for providing 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 areas. Besides these two areas, 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, intraocular lens, etc., are provided free of cost to those patient beneficiaries who require such appliances.

Regards

Sir, you have not mentioned complete particulars or facts that are required in order to offer any comments.

Please Indicate:

(a) Whether the unit in which the said employee was/is working on the date of the accident is covered under the provisions of the ESI Act, 1948, and the rules/regulations framed thereunder.

(b) Whether the employee who sustained injuries was covered on the date of the accident under the said Act and compliance was being made.

(c) Whether the accident report as required under the above Act was submitted to the appropriate Branch Office of ESIC online or manually as desired by the 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 the accident an FIR was lodged with the police authorities.

(f) Whether medical certificates were obtained from the concerned ESIC Dispensary to which the insured person was attached.

I hope you will indicate the above aspects before any opinion is expressed on the matter.

He will receive benefits from ESI if the contribution is payable in respect of him on the date of the accident and the conditions of Section 51E of the ESI Act are fulfilled.

Regards,
Varghese Mathew

Is this your genuine problem in your company, or are you sitting here to take exams of seniors?

Regards