Navigating ESI and Maternity Benefits: How Would You Handle This Complex Case?

Case of ESI Contribution and Maternity Benefit

Recently, I encountered this case. Please share your views on this.

A female staff member has been working with us for the past 9 years. In June 2015, she crossed the salary range of Rs. 15K, so her ESI contribution was stopped from that contribution period. After the ceiling rose to 21K, she again came into the ESI slab and started her contribution from January 2017.

In July 2017, she gave birth to a baby. She received treatment from an ESI hospital and obtained a medical certificate from them. However, when she submitted the certificates to the ESI BO, they refused to pay the maternity benefit, stating that she had not completed the minimum requirement to avail the benefit. They asked her to contact the employer for the Maternity Benefit.

Since the organization has a simple rule that Maternity Benefit is only for Non-ESI employees, she suffered on both ends. Upon noticing this issue, I convinced the top management to consider her case, given her association with us for the past 9 years. I am also in discussions with ESI, as they themselves are unclear about the rules.

In this case, please share your views.

She can write to the employer and ask them to prevail upon ESI authorities for the benefit. If ESI officially refuses, then the employer will have to pay the amount.

Please note that it is admitted that the employee in question is covered under ESI at the time of availing Maternity Benefit. However, ESI has refused to give cash benefits on the grounds that she has not fulfilled the eligibility criteria to receive Maternity Benefit. You can log in to the ESI IP Portal and take a print of entitlement for various benefits provided therein. I am sure that under Maternity Benefit-Not Eligible will be mentioned.

Consequently, the employer is liable to pay Maternity Benefit, even though the employee is covered under ESI. You have to take up the matter with the employer. The employer cannot deny the claim solely on the grounds that the employee is covered under ESI. If the employee is not eligible to claim under ESI for a valid reason, the employer has to honor such a claim.

Thank you.