Employees' Benefits

Sickness Benefit

Every insured employee is entitled to the cash benefit for the period of sickness occurring during any benefit period and certified by a duly appointed medical practitioner if the contributions in respect of him were payable for not less than (78 days) in the corresponding contribution period.

However, in the case of a newly appointed employee, eligible for the first time who has got shorter contribution period of less than 156 days, he shall be entitled to claim sickness benefit if he pays contribution for not less than half the number of days available for working in such contribution period. The benefit is payable at the standard benefit rate, corresponding to his daily average wages. The benefit is, however, not payable for any day on which the employee works, remains on leave, holiday or strike, in respect of which he receives wages.

Sickness benefit shall be allowed to an employee for any day on which he remains on strike, if:

1. he is receiving medical treatment and attendance as an indoor patient in any E.S.I. hospital or a hospital recognised by the E.S.I. Corporation for such treatment.
2. he is entitled to receive extended sickness benefit for any of the diseases for which such benefit is admissible.
3. he is in receipt of sickness benefit immediately preceding the date of commencement of notice of the strike given by the Employees’ Union to the Management of the factory/establishment.

No sickness benefit shall be payable for the first two days of sickness following, at an interval of not more than 15days, after the sickness in respect of which sickness benefits were last paid.

Further no sickness benefit shall be payable to any person for more than 91 days in any two consecutive benefit periods.

Conditions To Be Observed

Any person in receipt of sickness benefit:

1. shall remain under medical treatment at the ESI dispensary or hospital and carry out the instructions of the medical officer;
2. shall not do anything which retards or reduces his chances of recovery;
3. shall not leave the area where medical treatment is provided without medical officer’s permission;
4. shall get himself examined by the medical officer.

Maternity Benefit

A periodical cash benefit is payable to an insured woman employee, in case of confinement, miscarriage, medical

termination of pregnancy, premature birth of a child, or sickness arising from pregnancy, miscarriage, etc., occurring or expected to occur in a benefit period, if the contributions, in respect of her were payable for atleast (70 days) in the two immediately preceding contribution periods.

The benefit is payable at twice the standard benefit rate or Rs. 20, whichever is higher, for all days on which the she does not work for remuneration during the period prescribed as under.

Medical Bonus

Rs. 250 on account of confinement expenses shall be paid to an insured woman and an insured person in respect of his wife, if confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.

Disablement Benefit

Disablement benefit is payable in the form of cash installments, to an employee who is injured in the course of his employment and is, permanently or temporarily, disabled, or contacts any occupational disease. It is sufficient if it is proved that the injury was caused by an accident arising out of, and in the course of employment, no matter when it occurred, and where it occurred.

The accident shall be deemed to have arisen out of and in the course of employment unless there is evidence to the contrary,

1. where an accident happens while the employee is travelling in employer’s transport, to or from his place of work;
2. where an accident happens in or about any premises at which the employee is employed for the purposes of his employer’s trade or business, while the employee is taking steps, in an emergency, to rescue, secure or protect persons who are injured or imperiled or to avert or minimize serious damage to property;
3. where the employee is at the time of the accident acting in contravention of any law or any safety rules and instructions, if the employee is acting for the purpose of, and in connection with, the employer’s trade or business.
4. The employee claiming any disablement benefit is required to furnish a medical certificate as prescribed under the regulations. The employee is also required to observe certain conditions as to medical examination etc., as prescribed for sickness benefit.
5. The benefit for temporary disablement is, however, not payable for any day on which the employee works, remains on lease, holiday or strike, in respect of which he receives wages.
6. However, disablement benefit for temporary disablement shall be allowed to an employee for any day on which he remains on strike, if:
7. he is receiving medical treatment and attendance as an indoor patient in any ESI hospital or a hospital recognised by the ESI corporation, for such treatment; or
8. is in receipt of such disablement benefit immediately preceding the date of commencement of notice of the strike given by the Employee’s Union to the management of the factory/establishment.

Notice Of Injury

The insured employee who sustains an employment injury should give a notice of the same to the employer or manager or supervisor or foreman, etc., by means of entry in the Accident Book or otherwise in writing or even orally. This notice is very important for claiming the disablement benefit.

Accident Report By The Employer

In case of an accident in the establishment, the employer should prepare an ‘Accident Report’ in Form 16 (in triplicate) and submit to the local office and the Insurance Medical Officer. The third copy is the office copy. The reports are to be submitted within 48 hours in ordinary cases and immediately in death cases.

Employer To Arrange First Aid

The employer shall make arrangements for the first aid and medical treatment and transport as an insured person may require, in case of an accident.

Benefits Not To Be Combined

An employee shall not be entitled to receive for the same period-

1. both sickness benefit and maternity benefit; or
2. both sickness benefit and disablement benefit for temporary disablement; or
3. both maternity benefit and disablement benefit for temporary disablement.
4. employee shall be entitled to choose any one of the aforesaid benefits, at his option.

Abstention Verification

The employer should furnish and verify the particulars in Form 28, in respect of the abstention of an employee from work, for which sickness/maternity/temporary disablement benefit has been claimed.