EMPLOYEES STATE INSURANCE CORPORATION (ESIC)

PRESENTED BY: Sanju Pal G. Beldon Shekhar Jalgaonkar

INDEX INDEX
ESIC - FUNCTIONS & DUTIES COVERAGE AND INFRASTRUCTURE ADMINISTRATION OF THE SCHEME CONSTITUTION OF CORPORATION IMPLEMENTATION OF RIGHT TO INFORMATION IN ESIC BENEFITS UNDER THE ACT RECEIPT & DISPOSAL OF REQUESTS FOR INFORMATION & APPEALS (ALL OFFICES) ANNUAL ACTION PLAN (RTI) - 2011-12 CHALLENGES & OPPURTINITIES

ESIC - FUNCTIONS & DUTIES

ESI ACT, 1948 PROMULGATED BY PARLIAMENT IN THE YEAR 1948 IS THE FIRST MAJOR LEGISLATION ON SOCIAL SECURITY FOR INDUSTRIAL WORKERS. IT PROVIDES MEDICAL CARE & CASH COMPENSATION TO WORKERS IN INSURABLE EMPLOYMENT IN EVENTUALITIES SUCH AS SICKNESS, MATERNITY, DISABLEMENT OR DEATH DUE TO EMPLOYMENT INJURY OR OCCUPATIONAL DISEASES. THE ESI SCHEME IS BASED ON THE PRINCIPLE OF POOLING OF RISKS & RESOURCES IN WHICH EVERY CONTRIBUTOR, AT ANY GIVEN POINT OF TIME, EMERGES AS A BENEFICIARY OR A BENEFACTOR AND SOCIETY, AT LARGE, IS THE NET GAINER.

COVERAGE AND INFRASTRUCTURE

1.55 CRORE INSURED PERSONS, 6.02 CRORE BENEFICIARIES. 4.06 LACS FACTORIES & ESTABLISHMENTS IN 787 INDUSTRIAL CENTRES. 29 STATES & UTs COVERED. 57 REGIONAL/SUB-REGIONAL/DIVISIONAL OFFICES, AND 799 BRANCH AND PAY OFFICES. 149 HOSPITALS, 42 ANNEXES (27739 BEDS), 1402 DISPENSARIES AND 44 ISM UNITS AND 1540 PANEL DOCTORS PROVIDE MEDICAL CARE.

ADMINISTRATION OF THE SCHEME

NON-SEASONAL FACTORIES EMPLOYING 10 OR MORE EMPLOYEES, SHOPS, HOTELS, RESTAURANTS, CINEMAS INCLUDING PREVIEW THEATRES, ROAD MOTOR TRANSPORT AGENCIES & NEWSPAPER ESTABLISHMENTS EMPLOYING 20* OR MORE EMPLOYEES ARE COVERED. EDUCATIONAL INSTITUTIONS AND PRIVATE MEDICAL INSTITUTIONS EMPLOYING 20* OR MORE EMPLOYEES ARE BEING COVERED. MEDICAL SERVICES IN THE SCHEME ARE ADMINISTERED BY THE STATE GOVERNMENTS UNDER SECTION 58 OF ESI ACT. IN DELHI & NOIDA SCHEME IS RUN DIRECTLY BY ESI CORPORATION. EMPLOYEES & THEIR FAMILIES ARE ENTITLED TO MEDICAL CARE FROM DAY ONE OF JOINING INSURABLE EMPLOYMENT. MEDICAL BENEFIT IS UNIFORM & NEED BASED. CASH BENEFITS ARE PAID AS PER ENTITLEMENT. WORKERS DRAWING WAGES UPTO Rs. 15000/ p.m. ARE COVERED. *Note: The threshold limit in respect of shops and other establishments has been brought down to 10 by eleven State Governments and other states are in the process of doing so.

CONSTITUTION OF CORPORATION
THE CORPORATION COMPRISES REPRESENTATIVES OF EMPLOYEES, EMPLOYERS, THE CENTRAL GOVT., STATE GOVTs, MEDICAL PROFESSION & THE PARLIAMENT. STANDING COMMITTEE CONSTITUTED FROM AMONG MEMBERS OF THE CORPORATION ACTS AS EXECUTIVE BODY. THE MEDICAL BENEFIT COUNCIL, A STATUARY BODY, ADVISES THE CORPORATION ON MATTERS RELATED TO MEDICAL CARE TO THE BENEFICIARIES. THE DIRECTOR GENERAL ACTS AS THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION.

IMPLEMENTATION OF RIGHT TO INFORMATION IN ESIC

ESIC IS A PUBLIC AUTHORITY UNDER RTI ACT,2005. PROVISIONS OF THE ACT HAVE BEEN IMPLEMENTED IN ESIC SINCE 12/10/2005. PUBLIC INFORMATION OFFICERS & APPELLATE AUTHORITIES HAVE BEEN DESIGNATED IN HQRS. AND FIELD UNITS REGIONAL/SUB-REGIONAL/DIVISIONAL & BRANCH OFFICES, AND ESIC HOSPITALS & DISPENSARIES etc. LIST OF CPIOs / APPELLATE AUTHORITIES IS AVAILABLE ON ESIC WEBSITE.

BENEFITS UNDER THE ACT

SIX KINDS OF BENEFITS ARE PROVIDED UNDER THE ACT: SICKNESS BENEFIT MATERNITY BENEFIT DISABLEMENT BENEFIT DEPENDENTS BENEFIT MEDICAL BENEFIT FUNERAL EXPENSES

BENEFITS UNDER THE ACT

SICKNESS BENEFIT : INSURED EMPLOYEES IS ENTITLED TO RECEIVE FOR THE PERIOD OF HIS SICKNESS AS THE DAILY STANDARD BENEFIT RATE. MINIMUM 78 DAYS OF THE CORRESPONDING CONTRIBUTION IS MUST. BENEFIT IS NOT AVAILABLE FOR THE FIRST 2 DAYS OF SICKNESS. MAXIMUM PERIOD FOR BENEFIT IS 91 DAYS IN ONE YEAR. STANDARD BENEFIT RATE : THE DAILY RATE WHICH SICKNESS BENEFIT IS PAYABLE TO AN INSURED EMPLOYEE DURING THE PERIOD OF HIS SICKNESS.

MATERNITY BENEFIT : CONFINEMENT, MISCARRIAGE OR MEDICAL TERMINATION OF PREGNANCY, SICKNESS ARISING OUT OF PREGNANCY, CONFINEMENT, PREMATURE BIRTH OF CHILD OR MISCARRIAGE OR MEDICAL TERMINATION OF PREGNANCY. MINIMUM 80 DAYS IN THE IMMEDIATELY PRECEDING TWO CONSECUTIVE CONTRIBUTION PERIODS IS MUST. MAXIMUM PERIOD FOR BENEFIT IS 91 DAYS IN ONE YEAR.
DISABLEMENT BENEFIT : PERMANENT DISABLEMENT, WHETHER TOTAL OR PARTIAL, AS A RESULT OF AN EMPLOYMENT INJURY ( PERSONAL INJURY CAUSED BY AN ACCIDENT ARISING OUT OF AND IN THE COURSE OF EMPLOYMENT). BENEFIT FOR THE WHOLE OF LIFE.

BENEFITS UNDER THE ACT

DEPENDENTS BENEFIT : WHEN AN INSURED EMPLOYEE DIES AS A RESULT OF AN EMPLOYMENT INJURY, HIS WIDOW AND CHILDREN AND IN CASE THE EMPLOYEE DOES NOT LEAVE BEHIND HIM A WIDOW OR CHILDREN, HIS OTHER DEPENDANTS, ARE ENTITLED TO RECEIVE PERIODICAL PAYMENTS.
MEDICAL BENEFIT : SICKNESS OF INSURED EMPLOYEE OR (WHERE MEDICAL BENEFITS IS EXTENDED TO HIS FAMILY) A MEMBER OF HIS FAMILY. AVAILABLE TO THE EMPLOYEE DURING ANY PERIOD FOR WHICH CONTRIBUTIONS ARE PAID IN RESPECT OF HIM OR IN WHICH HE CAN CLAIM SICKNESS BENEFIT. FUNERAL EXPENSES : IN CASE OF DEATH OF AN INSURED EMPLOYEE, THE ELDEST SURVIVING MEMBER OF HIS FAMILY, AND IF THE EMPLOYEE HAD NO FAMILY OR WAS NOT LIVING WITH HIS FAMILY AT THE TIME OF HIS DEATH, THEN THE PERSON WHO ACTUALLY INCURS EXPENDITURE ON THE FUNERAL OF THE EMPLOYEE, IS ENTITLED TO RECEIVE THE A PAYMENT CALLED FUNERAL EXPENSES. MAXIMUM PERMISSIBLE AMOUNT OF SUCH PAYMENT IS RS. 2500/-

FORMS
Forms for employer
Form 01 Employer's Registration Form Form- 01A Annual information of factory/estt submission form Form 3 Return of Declaration forms Form 5 Return of contributions Form 5A Statement of advance payment of contributions Form 6 Register of employees Form 10 Abstention verification Form 11 Accident Register ESIC 37 Certificate of Re-employment / continuing employment

FORMS
Forms for employees Form 1 Declaration Form Form 2 Addition / Deletion in Family declaration form Form 9 Claim form for sickness /TDB/ Maternity Form 14 Claim form for Permanent disablement benefit (PDB) Form 15 Claim form for Dependant Benefit (DB) Form 16 Claim form for periodical payments of DB Form 19 Claim for Maternity benefit Form 20 Claim form for Maternity benefit after death of child Form 22 Claim form for Funeral Expenses Form 23 Life certificate Form 24 Dependant benefits declaration

FORMS
Form for reimbursement of medical expenses ESIC 37 Certificate of Re-employment / continuing employment

RECEIPT & DISPOSAL OF REQUESTS FOR INFORMATION & APPEALS (ALL OFFICES)

year

APPLICATIONS RECEIVED

NO. OF APPLICATION IN WHICH INFORMATION PROVIDED

NO. OF APPLICATION IN WHICH INFORMATION DENIED

AMOUNT RECEIVED (APPLICATION FEE & OTHER CHARGES IN Rs.)

2005-06
2006-07 2007-08 2008-09 2009-10 2010-11

108
840 1615 2142 2940 3669

106
812 1578 2082 2834 3532

2
28 37 60 106 137

6612
32106 47914 41322 53486 57114

ANNUAL ACTION PLAN (RTI) - 2011-12

TO PROVIDE INFORMATION SOUGHT BY THE APPLICANTS WITHIN 30 DAYS. APPLICATIONS SEEKING INFORMATION ON ACTIVITIES RELATING TO OTHER OFFICES BE TRANSFERRED TO CONCERNED OFFICES WITHIN 5 DAYS UNDER INTIMATION TO THE APPLICANT. TO COORDINATE WITH DEEMED CPIOS FOR EXPEDITIOUS DISPOSAL OF REQUESTS. TO ASSIST THE 1ST APPELLATE AUTHORITY (I.C. & M.C.) IN TIMELY DISPOSAL OF APPEALS. TO LIAISE WITH THE OFFICE OF CENTRAL INFORMATION COMMISSION IN CONNECTION WITH APPEALS/COMPLAINTS PREFERRED BY APPELLANTS AND TO COMPLY WITH THE DECISIONS OF THE COMMISSION. TO COMPILE ANNUAL RETURN ON RTI MATTERS AND FORWARD IT TO THE MINISTRY OF LABOR & EMPLOYMENT AND TO CENTRAL INFORMATION COMMISSION. TO UP-DATE INFORMATION RELATED TO RTI ON ESIC WEBSITE.

CHALLENGES & OPPURTINITIES

CHALLENGES: ADHERING TO TIME LIMIT FOR PROVIDING INFORMATION TO THE CITIZENS. DIGITALIZING ALL RECORDS. DISSEMINATION OF ALL INFORMATION ON ESIC WEBSITE. REGULAR UPDATION OF INFORMATION ON THE WEBSITE. OPPURTINITIES: COMPUTERISATION OF RECORDS BY USING INFORMATION TECHNOLOGY. TRANSPARENCY IN ADMINISTRATION AND RESOLVING GRIEVANCES WITHOUT RESORT TO COURT PROCEEDINGS. EMPOWERING STAKEHOLDERS TO PARTICIPATE IN DECISION MAKING PROCESS. ELIMINATING CHANCES OF CORRUPTION.

THANK YOU.