Is It Legal to Use ESIC Benefits and Maternity Leave After Resigning from a Job?

My wife was working for a private school for three academic years with ESIC benefits before her resignation in March 2016. She was three months pregnant when she resigned in March. She joined another school in April 2016 without ESIC benefits as her salary in the latter school was higher. She was told to resign in the seventh month of pregnancy as she was still in the probation period. She resigned in July 2016. Until the seventh month, she was seeing a private doctor. In the eighth month, she visited the ESI hospital where she was accepted, and she gave birth to a baby in September. She applied for maternity leave from October 2016 to December 2016, which was also accepted, and the amount was credited to her bank account.

My question is, was it legal or illegal to avail ESI benefits at the hospital and apply for maternity leave six months after resigning from the first school?

Dear member, I think before answering the question, you or your claimant wife must have gone through Regulation 4 of ESI (General) Regulations, 1950. Based on the facts you mentioned, your wife had contributed in her old job up to March 2016. Therefore, the corresponding benefit period for this contribution period starts from July 2016 and lasts until 31st December 2016. Thus, I believe your wife has rightly claimed benefits from ESIC provided she was otherwise eligible as per the terms and conditions of eligibility under the ESI Act and rules/regulations framed thereunder.

I would like to submit that as per Regulation 87, an insured woman can claim maternity benefits from the appropriate branch office of ESIC. The term "insured person" has been defined under section 2(14) of the ESI Act, 1948. According to Regulation 4 of ESI (General) Regulations, 1950, mentioned above, benefits cannot be paid until the start of the benefit period or until the 9 months period as per the above Regulation. Hence, even after leaving the job, the entitlement of a person remains until the close of his benefit period.

However, the above position does not apply to accident cases. For such accidental benefit cases, the person must be an "employee" at the time and date of his accident. This is in reference to various sections in Chapter V of the said Act.

Thank you, Mr. Harsh, for the immediate response; it was invaluable. I recently learned that what she had done might not be legal. So, there was nothing wrong on her part for claiming paid maternity leave even after a gap of 9 months after resignation. Therefore, we will not have legal problems to face in the future if verified later.

ESIC covers medical expenses of an employee until their recovery, and this coverage also extends to maternity benefits. Therefore, since she was pregnant when she resigned, she is eligible for the payment. There is nothing illegal.

Thank you for appreciating my earlier remarks. However, I would like to reiterate that everything depends on the entitlement of an insured person. If he/she has contributed and is entitled to benefits within the specified benefit period, he/she deserves to receive the required benefits. I believe this is the legal framework under which a contributory social security scheme like ESIS operates. ESIC now has everything online, and they have a clear idea of an insured person's entitlement before making benefit payments.

Best wishes.

Hi Harsh Kumar Mehta,

First of all, I would like to appreciate your efforts. You have explained the ESIC benefit period concept very well, and I was unaware of it. Could you please help me in solving one query?

An employee has recently joined on 20.04.2017 and is covered under ESIC. What will be his benefit period?

Can you please explain briefly with an example about the Contribution period and Benefit period?

Please advise.

Thanks & Regards,
Supriya

Dear member, thank you for your appreciation as mentioned above. However, I would like to submit that if you read Regulation 4, as referenced by me earlier, you will find the answer to the question/issue you raised. The proviso of the said Regulation states, "the corresponding benefit period for him shall commence on the expiry of the period of 9 months from the date of such employment." I hope you will calculate the 9-month period from 20.4.2017.

However, this is subject to the fulfillment of conditions for the minimum contribution days as stipulated for different benefits under the said Act/Rules/Regulations. Without further elaboration, I would also like to mention that the appropriate office responsible for defining and certifying the eligibility of an insured person for various benefits under the aforementioned Act is the respective Branch Office and Regional Office of ESIC (Regulation 51).

Hi,

My wife is currently eight months pregnant. She left her job on July 5th, 2017, after working for one year and six months for a company. Is it possible for her to claim ESI benefits now?

Thank you.

Our employee left the service in May 2018. Her ESIC benefits continued after nine months of resignation. Currently, her father is ill, and she wants to take benefits from ESIC. Is this possible or not?

Dear member, the eligibility for benefits under the ESI Act, 1948, is determined by the authorities disbursing or providing such benefits. It would be better if the matter is discussed with the in-charge of the ESI dispensary to which your employee is attached. It is correct that the benefits under the said Act (except those relating to accidents) continue until the close of the relevant benefit period. However, there are many issues involved, such as whether the employee was entitled due to their contributions in the relevant contribution period, or whether the illness falls under super-specialty treatment, etc. Therefore, it would be better to contact the authorities regarding this issue.