Claiming Compensation Under the Employees Compensation Act, 1923
To successfully stake a claim for compensation under the Employees Compensation Act, 1923, the following facts should be present and proved with appropriate documentary and other evidence:
1. **Applicability of the Act of 1923:** It is crucial that the victim of the accident or workman should not have been covered by the Employees' State Insurance Act, 1948. It is possible that, by virtue of the ceiling on wages, some employees can be excluded from the coverage of the ESI Act, 1948.
2. **Employee Status:** To claim compensation under the EC Act, 1923, the victim of the employment accident must be an "employee" as defined under section 2(1)(dd) read with Schedule II of the Act. Here, the nomenclature of the employee's designation does not matter, but only the capacity of the employment as mentioned in the list contained in the Schedule. The list is exhaustive, not illustrative. In other words, if the victim's capacity of employment is not included in the list, they are out of the purview of the Act and hence cannot seek any remedy under the Act. So, Deepali, you have to ensure that you were an "employee" as per the Act at the time of the accident.
3. **Employment Accident:** The injury or death of the employee should have been caused by an employment accident. Neither the term "accident" nor the phrase "employment accident" is defined in the Act. They have to be inferred from the language of Section 3 of the Act, which prescribes the employer's liability for compensation. In other words, the liability of the employer to compensate will arise only when the personal injury or death of the employee is due to an accident arising out of and in the course of their employment. The phrase "ARISING OUT OF AND IN THE COURSE OF EMPLOYMENT" does not stop with its literal meaning alone and is capable of extending beyond the zone of employment with reference to time and space. So, Deepali, if the accident occurred while you were traveling in the vehicle arranged by the company, it is a sure case of an employment accident.
4. **Disability Assessment:** The injury sustained in the employment accident should have resulted in partial disablement, permanent partial disablement, or total disablement of the employee. Partial disablement is of a temporary nature so as to reduce the earning capacity of the employee in any employment in which they were engaged at the time of the accident. Permanent partial disablement is of a permanent nature so as to reduce the earning capacity of the employee in every employment which they were capable of undertaking at the time of the accident. Every injury specified in Part II of Schedule I should be deemed to result in permanent partial disablement. Total disablement is such disablement, whether of a temporary or permanent nature, incapacitating the employee for all work they were capable of performing at the time of the accident. The injuries specified in Part I of Schedule I independently constitute permanent total disablement. However, if the aggregate percentage of the loss of earning capacity of any combination of the injuries in Part I and those of Part II amounts to 100% or more, it will also be construed as permanent total disablement. Therefore, the assessment of disability by a qualified medical practitioner and the issue of a disability certificate is an important step prior to making a claim for compensation. Deepali, it is better that you get yourself examined by an orthopedician and a neurologist and get separate disability certificates for rib fractures and brain injury.
5. **Medical Expenses Reimbursement:** As per the amendments effective from 18-01-2010, the newly inserted section 4(2A) provides that the employee shall be reimbursed the actual medical expenditure incurred by them for the treatment of injuries caused during the course of employment. So, collect the original medical bills you paid and add up the expenses to the compensation claim.
6. **Permanent Total Disability:** If the physical problems you allege to suffer even now are true, yours is a genuine case of permanent total disability. So the matter of your resignation could be another reasonable point substantiating your claim for compensation.
The limitation period for filing the claim is not yet over. Therefore, engage an experienced counsel in employees' compensation and get the claim filed before the area Commissioner for Employees' Compensation.
Wishing you good luck!