Understanding ESI Leave Benefits: Eligibility for Extended Leave due to Accident-Related Injuries

Two employees were commuting to the office for "A" shift duty. Unfortunately, they met with a road accident. One employee sustained multiple fractures on his hand and leg, while the other had a head injury and a leg fracture. Thankfully, the head injury was not severe. They have been receiving treatment under ESI and the treatment is ongoing. According to ESI, an employee can avail sickness benefit for a maximum of 91 days in two benefit periods. The employee with multiple fractures may need treatment for up to 6 to 8 months. Will he be eligible for ESI Leave until the completion of the treatment period? Please clarify my doubt.

The Employees' State Insurance (ESI) scheme provides sickness benefits to insured individuals who are unable to work due to sickness, injury, or disability. As per the ESI Act, an employee can avail of sickness benefits for a maximum of 91 days in two consecutive benefit periods.

However, in the case of an accident resulting in a temporary disablement, the ESI scheme provides Temporary Disablement Benefit. This benefit is payable from day one of entering insurable employment and for the subsequent period of disablement. This means that if the employee is unable to work due to the accident-related injuries, he is eligible to receive this benefit for the entire duration of his disablement, irrespective of the length of his service.

Therefore, the employee with multiple fractures who may need treatment for 6 to 8 months would be eligible for the Temporary Disablement Benefit under the ESI scheme, and not just the sickness benefit. This would cover the period of his treatment and recovery.

Please note that the above information is based on the ESI Act and its provisions, which may vary depending on the specific circumstances of the case. It would be advisable to consult with an HR professional or legal expert for detailed guidance.

Sickness benefit is different from accident benefit. This will come under accident benefits. Sickness benefit which is normally given for 91 days is for sickness other than employment injury. This being an employment injury, the employees will continue to get it as recommended by the Medical Board.

Dear Mr.Anand,

Please do refer below mentioned 2 points which will help you out.
1. Medical Benefit : Full medical care is provided to an Insured person and his family members from the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured Person or his family member. Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of Rs.120/- .

2. Sickness Benefit(SB) : Sickness Benefit in the form of cash compensation at the rate of 70 per cent of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness benefit the Insured Person is required to contribute for 78 days in a contribution period of 6 months.

1. Extended Sickness Benefit(ESB) : SB extendable upto two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80 per cent of wages.

2. Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for family planning upto 7 days/14 days for Vasectomy and Tubectomy respectively.

https://esic.gov.in/information-benefits