The Employees State Insurance Act,1948

Benefits available to insured employee

The purpose of the Employee State Insurance Act is to provide benefits as detailed in the Act to the insured persons or their dependants.
The following benefits are provided Sickness benefit Maternity benefit Disablement benefit Dependents benefit Medical benefit Funeral expenses

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BENEFIT PERIOD

Benefit period means such period, being not less than 25 but not more than 27 consecutive weeks or 6 consecutives months corresponding to the contribution period as may be specified in the regulation framed uner the Act.

BENEFITS
Sickness benefit (a) periodical payments to any insured person in case of his sickness certified by a duly appointed medical practitioner. Maternity benefit [(b) periodical payments to an insured woman in case of confinement or miscarriage or sickness arising out of pregnancy, confinement, premature birth of child or miscarriage, such woman being certified to be eligible for such payments by an authority specified in this behalf by the regulations. Disablement benefit (c) periodical payments to an insured person suffering from disablement as a result of an employment injury sustained as an employee under this Act and certified to be eligible for such payments by an authority specified in this behalf by the regulations.

Sickness benefit
Definition of sickness : Sickness signifies a state of health necessitating Medical treatment and attendance and abstention from work on Medical grounds.

Condition for sickness benefit :The recipient of sickness and disablement benefit must observe the following condition. i) He must carry out the instruction of the medical officer and must be under medical treatment at a dispensary, hospital, clinic or other institution provided under the Act; ii) While under treatment ,he must not do anything which will aggravate the chance of recovery; iii)He must not leave the area where the medical treatment is provided under the Act;

iv) He must allow himself to be examined by any duly appointed officer of a sick visitor authorized by corporation.

Eligibility for sickness benefit

Every insured employee is entitled to the cash benefit for the period of sickness 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. Cash benefit takes the form of periodical payment made to an insured person which is payable for maximum numbers of 91 days in any two consecutive benefit periods. The benefit is not paid for the first two days of sickness which is treated as the waiting period. Insured persons suffering from long term diseases like T.B., leprosy, mental, heart etc. and who have been continuous employment for two years are entitled to get sickness benefit period up to 309 days.

Standard benefit rate

The daily rate which sickness benefit is payable to an insured employee during the period of his sickness. Lowest rate is Rs. 14/Highest rate is Rs. 195/-

New sickness benefit rates

The sickness benefit rate has been increased by 25% from the stanar benefit rate.
This rate is admissible to all cases of this category which arises on or after that date.

The sickness benefit period has been raised from 56 days to 91 days.

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 etc. confinement means labour resulting in the issue of a living child, or labour after twenty-six weeks of pregnancy resulting in the issue of a child whether alive or dead. "MISCARRIAGE" has been defined in the Act means "expulsion of the contents of a pregnant uterus at any period prior to or during the twentysixth week of pregnancy but does not include any miscarriage, the causing of which is punishable under the Indian Penal Code."

Claim for Maternity Benefit

Eligibility For entitlement to maternity benefit, the insured woman should have contributed for not less than 80 days in the immediately preceding two consecutive contribution periods prior to actual or expected date of confinement as the case may be. To obtain maternity benefit, the insured woman must get certificates of pregnancy, of the expected ate of confinement and of actual confinement and send them to the local office to which she is attached. Insured women is entitled to receive maternity benefit for confinement for a period of 12 weeks for all the days on which she does not work for remuneration.

Daily rate of benefit

The daily rate of maternity benefit will be twice the standard benefit rate corresponding to the average daily wages in respect of the insured woman during the corresponding contribution period or rupees twenty whichever is higher. Insured women Died during confinement period or within 6 weeks thereafter, leaving the child, The person nominated by the deceased insured woman If there is no such nominee, the legal representative shall be paid.

In case of sickness arising out of pregnancy, premature birth, or miscarriage ,maternity benefit is payable, subject to the usual rules ,for an additional period not exceeding one month.

Disablement benefit

It is payable to an employee who is injured in the course of his employment and is permanently or temporarily disabled or contacts any occupational disease. Employment injury Employment Injury means personal injury to an employee caused by an accident or by an occupational disease arising out of employment, being an insurable employment, whether the accident occurs is contacted within or outside the territorial limits of India .

Accidents
Accident has been defined as an unlooked for mishap event which is not expected or designed. Accidents happening while travelling in employer's transport An Accident happening while an insured person is, with the express or implied permission of his employer travelling as a passenger by any vehicle to or from his place of work shall, notwithstanding that he is under no obligation to his employer to travel by that vehicle, be deemed to arise out of and in the course of his employment, if (a) the accident would have been deemed so to have arisen had he been under such obligation; and (b) at the time of the accident, the vehicle

(i) is being operated by or on behalf of his employer or some other person by whom it is provided in pursuance of arrangement made with his employer, and (ii) is not being operated in the ordinary course of public transport service. The term 'vehicle' also includes a vessel and an air craft."

Contd
Accident while meeting Emergency :if an accident happens to an insured person in or about any premises at which he is for the time being employed for the purpose of his employers trade or business, he shall be deemed to arise out of an in the course of his employment , provided it happens while he is taking steps on an actual or supposed emergency at those premises:

i) To rescue,succor,or protect person who are .or are thought to be or possibly to be, injured or; ii) To avert or minimize serious damage to property

Occupational Diseases

Some people tend to produce particular kind of diseases . These are specified under Schedule III of the Employees State Insurance Act, which enumerates the compensable Occupational Diseases and the corresponding industrial processes involving exposure to the diseases are thus recognized without any further evidence.

Temporary disablement Benefit (TDB)

Temporary Disablement Benefit is payable to an employee who suffers from temporary disability arising out of an employment injury or occupational disease for the period so certified by an Insurance Medical Officer / Practioner for which the insured person does not work for wages.

Permanent partial Benefit (PPB)

Disablement of a permanent nature, as reduce the earning capacity of an employee in every employment which he was capable of undertaking at the time of the accident resulting in the disablement . Example: (the loss of one eye, the other being normal )

Permanent total Benefit (PTB)

Disablement of a permanent nature as it incapacitates an employee for all work he has capable of performing at the time of the accident resulting in such disablement. Part of 1 of the second schedule to the act contains a list of injuries which are deemed to produce Permanent total disablement.(e.g. loss of both hand or both eyes)

Part II of the same schedule lay down what is the percentage loss of earning capacity in each of injury.

Thank You
ALL THE
BEST