ESI - is it true to one should avail a minimum of 6 months to get the benefits of ESIC?

Dear Sir,

I would like to share an incident from my company. One of our contractual employees joined us four months ago. One day, while on his way home, he met with a serious accident and was immediately admitted to a nearby hospital. However, due to his financial constraints, he was unable to be treated at a private hospital. He was unconscious and partially paralyzed. Additionally, he was denied benefits through ESIC as he had not completed the required six months of service.

Could you please advise me if it is true that one must be employed for a minimum of six months to be eligible for ESIC benefits?

Thank you.

Dear Rdas78@Ymail.Com,

The Employees' State Insurance Corporation cannot deny medical benefits, i.e., full medical care, to the employee (referred to as IP). An employee (IP) is entitled to medical benefits from the day they enter insurable employment. However, they may not receive sickness benefits in the form of cash compensation for their absence from duty or disablement benefits.

Thank you.

1. Sir, ESIC does not reject any case for treatment in its hospitals or dispensaries provided the claimant shows his identity card (Pehchan Card as issued by ESIC appropriate Branch Office) at the time he appears in any such institution to claim treatment or claim benefit from Branch Office, and also that he/she should be entitled to said benefits.

2. As per the provisions of the ESI Act, 1948, and the rules/regulations framed thereunder, the entitlement for Medical Benefit as well as Employment Injury Benefits - i.e., temporary disablement, etc. - starts immediately after the employee is taken on employment, the declaration form is submitted, his insurance number is obtained, and the TIC is handed over to him/her. At present, an online procedure is in place, and ESIC has extended such facility of issuing TIC at the level of employers itself.

3. The employer, in order to make the worker entitled to disablement benefits, should have submitted the Accident Report to the appropriate branch office as well as to the ESIC dispensary immediately after the accident. Now, a period of 4 months has elapsed, as reported by the initiator of this thread.

4. The requirement of a 6-month waiting period for other benefits appears to be incorrect. In the case of new employees in the ESI scheme, the benefit period starts "on the expiry of the period of 9 months from the date of such employment" (Regulation 4 of ESI (Regulations), 1952).

5. Accidents happening while commuting to the place of work and vice versa are covered as employment injury cases (Section 51-E of the said Act). It is the legal right of the employee to get his benefits by virtue of his membership and entitlement to the said scheme, and the issue that the said employee was "financially weak" has no relevance.

He is eligible for treatment benefits, and ESIC cannot reject to admit such cases. He can take up the issues through the court of law if you have all the proof and evidence against the ESIC. Treatment and medical benefits start from day 1 of joining the scheme.

MSKRISHNAN
9944479275

Hi, I have a query: what happens if someone crosses the limit of eligibility (in terms of salary, say, he is earning more than Rs. 15,000 basic)? Can he still be a member of the ESIC, and if yes, what formalities is he required to complete? For better understanding, the company has stopped deducting his share of ESIC amount for the above reason. Any guidance in this regard will be highly appreciated. Best regards, Ravinder Verma

Rainier,

It is not only the basic salary that is considered as wages for ESIC. If a person's salary crosses Rs. 15,000 per month during the contribution period, deductions shall continue until the end of the contribution period. After that, he is excluded from ESIC.

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He can only take medical benefits, i.e., medicines to some extent. Since he has not completed six months, he is not eligible for cash benefits or sickness benefits. The ESI Act clearly states the above.

Madanagopalaswamy,

May I request you to kindly re-look at your above statement and provide a corrected version?

Dear [Login to view],

I made a mistake here. By virtue of the Amendment of 2010 by inserting a new section 51E in the ESI Act, an accident occurring to an employee while commuting from his residence to the place of employment for duty, or from the place of employment to his residence after performing duty, is to be deemed to have arisen out of and in the course of employment if the nexus between the circumstances, time, and place in which the accident occurred and the employment is established. Therefore, the injured employee is also eligible for sickness benefit in the form of cash compensation for his absence from duty and disablement benefit.

You need to approach the ESI Branch office with the facts of the matter to get the benefits for the injured employee immediately. Our esteemed member Harsh Kumar correctly answered your query, but somehow I missed it.

Dear Harsh Kumar ji,

I made a mistake, but you would have pointed it out in specific words. Anyway, thanks for your correct answer.

1. Sir, one of the participants in this thread has expressed his views as "ACCIDENT HAPPENED WITHIN A RADIUS OF ONE KM, THE SAME CAN BE CONSTRUED THAT ACCIDENT ARISING OUT OF AND IN THE COURSE OF EMPLOYMENT." I may submit that there is no such condition or rule in the ESI Act, 1948, and rules/regulations framed thereunder. Every case has separate facts and separate merits, and I think the same is examined accordingly by the concerned authorities. When the employer had not submitted the accident report and not complied with the procedure as laid down, including medical certification, I think, due to these reasons and the elapse of such a long time, there is hardly any scope for acceptance of the case as that of employment injury. Please see Regulation 68 of ESI (General) Regulations, 1952. However, the matter can be discussed with the appropriate authorities of ESIC as mentioned by me in my remarks on the prepage.

2. Being an ex-officer in ESIC, I always try to indicate my opinion based on various provisions of Acts and rules/regulations. It is, however, up to the participants to evaluate my views in whichever way they desire. Sometimes, I had also felt that the views expressed by me on subjects other than ESIS were not in accordance with the procedure/rules or practice followed in a particular set of situations. I am thankful to all participants for appreciating my views in this thread.