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 one incident of my company one of our contractual employee joined 4 months before in our company. One day suddenly while going to his home he met with a serious accident he was immediately admitted to a nearby hospital. But as he was financially weak he was no longer allowed to the private hospital. He was unconscious & partially paralyzed. Moreover, he was declined through ESIC as he had not completed the required 6 or more months. So please suggest to me is it true to one should avail a minimum of 6 months to get the benefits of ESIC.

Dear [Login to view],
The ESI Corporation can not deny medical benefit i.e. full medical care to the employee IP. Employee IP is entitled for medical benefit from the day he enters insurable employment.
However, sickness benefit in the form of cash compensation for his absence from duty and disablement Benefit, he may not get.

1. Sir, ESIC donot 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 claims treatment or claim benefit from Branch Office and also that he /she should be entitled for said benefit.

2. As per provisions of ESI Act, 1948 and 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, declaration form is submitted and his insurance number is obtained and TIC is handed over to him/her. At present online procedure is there and the ESIC has extended such facility of issue of TIC at the level of employers itself.

3.The employer in order to make the worker entitled for disablement benefit should have submitted Accident Report to the appropriate branch office as well as to 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 6 months waiting period for other benefits appears to be not correct. In the case of new employees in ESI scheme, the benefit period starts "on expiry of 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 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 relevancy.

He is eligible for treatment benefits and ESIC cannot reject to admit such cases.
He can take up the issues through court of Law if you have all the proof and evidence
against the ESIC.Treatment and medical benefit starts from day 1 of the 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 earning more than Rs. 15,000 basic). Can he still be a member of the ESIC and if yes what formalities he is required to complete? For better understanding the Company has stopped deduced 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 basic alone that is considered as wages for ESIC.If a person's salary cross Rs15000/-p m during contribution period deduction shall continue till the end of the CP.After that he is excluded from ESIC.

Dear all,
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Rakesh Das
9873966616

He can take only medical benifits i.e. medicines for some extent. Since he has not completed six month he is not eligible for Cash benifit or Sickness benifits. ESI act clearly states the above.

MADANAGOPALASWAMY,
May I request you to kindly re-look at your above statement and give corrected version?
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Dear [Login to view],
I made a mistake here.
By virtue of Amendment of 2010 by inserting new section 51E in 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 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 facts of the matter to get the benefits to the injured employee, immediately.
Our leaned 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 out it in specific words. Any way. Thanks for your correct answer.