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The ESI Act 1948

The employees State insurance act (ESI) extends to the whole of India, including the state of Jammu and Kashmir. the insurance scheme contained in the act has up till  date, been applied to a few selected localities. The act of 1948 was amended by the amendment acts of 1966,1975,1984,1989, and 1997.

The Employees State Insurance Act of 1948 has been enacted with the objective of securing financial relief in cases of sickness, maternity, disablement and for providing medical benefits to employees of factories and establishments, and their dependents. The act is also applicable to non-seasonal factories using power and employing 10 or more employees, and non- power using factories and certain other establishments employing 20 or more employees. Employees and employers contribute to the scheme, and various benefits are given to eligible employees like, sickness benefit, maternity benefit, disablement benefit, etc. All benefits are delivered thereof ESIs hospitals, clinics and approved independent medical practitioners.

DEFINITION OF ESI

  • “appropriate government” means, in respect of establishment under the control of the central government or (a railway administration) or a major port or a mine or oilfield, the central government, and in all other cases, the state government;
  • “Contribution” means the sum of money payable to the corporation by the principal employer in respect of an employee and includes any amount payable by or on behalf of the employee in accordance with the provisions of this Act;
  • “Sickness” means a condition which requires medical treatment and attendance and necessitates abstention from work on medical ground.

OBJECT OF THE ACT

The Employees State Insurance Act (ESI Act) was enacted with the object of introducing a scheme of health insurance for industrial workers. The scheme envisaged by it is one of compulsory State Insurance providing for certain benefits in the event of sickness, maternity and employment injury to workmen employed in or in connection with the work in factories other than seasonal factories. The ESI Act, which has replaced the Workmen’s Compensation.

Duties of the ESI corporation

1. Budget estimates

The corporation shall in each year frame a budget showing the probable receipts and the expenditure which it proposes to incur during the following year and shall submit a copy of the budget for the approval of the central govt. before such date as may be fixed by it in that behalf.

2. Accounts

The corporation shall maintain correct accounts of its income and expenditure in such from and in such manner as may be prescribed by the central govt.

3. Audit

The account of the corporation shall be audited , at such time and in such manner as may be prescribed by the auditor by the central govt.

4. Annual report

The corporation shall submit to the central govt. an annual report of its work and activities .

5. Placement to parliament

The annual repot the audited accounts of the corporation and the budget as finally adopted by the corporation shall be placed before and published in the official gazettes.

Types of benefits under the act

1. Sickness benefit

Sickness benefit represents periodical payments  made to an insured person for the period of certified sickness after completing nine months insurable employment. To quality for this benefits, contribution should have been paid for at least 78 days in the relevant contribution period. The maximum duration for availing sickness benefit is 91 days in two consecutive benefit periods. There is  waiting period of 2 days which I waived if the insured person is certified sic within 15 days of the last spell for which  sickness benefit period was last paid. The daily rate of sickness benefit in respect of a person during any benefit period shall be 20 percent more than “ standard benefit rate”.

2. Maternity benefit

Maternity benefit implies cash payment to an insured woman in case of confinement or miscarriage or sickness arising out of  pregnancy, premature birth of child as certified by a duly appointed medical officer or midwife. For entitlement to maternity benefit, the insured woman should have contributed for not less than 70 days in the immediately preceding two consecutives contribution periods corresponding  to the benefit period in which the confinement occurs or is expected to occur. The daily rate of  benefit double the standard  sickness benefit  rate i.e full wages.

Maternity benefit is normally payable for a maximum period of 12 weeks in case of confinement , 6 weeks in case of miscarriage or medical termination of pregnancy which can be extended up to one additional month in case of sickness arising out of confinement and duly certified by an authorized medical officer. Maternity benefit continues to be payable even in the event of the death of an insured woman, during her  confinement, or during the period of 6 weeks immediately following her confinement leaving behind  a child for the whole of that period , and in case the child also dies, during the said period, until the death of the child.

3. Disablement benefit

In case of temporary disability arising out of an employment injury, disablement benefit is admissible to an insured person for the  entire period so certified by an insurance medical officer/ practitioner   for which  the insured person does not work for wages. the benefit is not subject to any contributory condition and is payable  at the daily rate of 15 percent more than the standard benefit rate. The benefit is, however, not payable if the incapacity is less than 3 days excluding the rate date of accident.

4. Dependent’s benefit

Periodical pension is paid to the dependent of a deceased insured person where death occurs as a result of an employment injury or occupational diseases. The  daily rate of dependent’s shall be 15 percent more than the standard benefit rate. The widow  receives monthly  pension for life or until remarriage, at a fixed rate equivalent to 3/5th of the  disablement benefit rate and each dependent child is paid an amount equivalent  2/5th there of until he/she attains 18 years of ages, provides that , in case of  infirmity, the benefit continues to be  paid till infirmity.

However, it is subject to the condition that the total dependents’ benefit distributed among the widow and legitimate or adopted children of the deceased insured persons, does not exceed , at any time, the full rate of disablement benefit. In case it exceeds the given ceiling, the share of each of the dependents is, proportionately reduced. The benefit is not payable to married daughter.

5. Medical benefit

An insured person and his family member become entitled to medical care from the date he enters the insurable employment and the entitlement continues as long as the insured person is in insurable employment or is qualified to claim sickness, maternity, or disablement benefit. The entitlement to medical care is extended up to  two years to persons suffering from any specified chronic or long-term diseases. medical treatment to persons , who go out of coverage during the period of treatment, is not discontinued till the spell of sickness ends. All insured persons and member of there are entitled to free, full and comprehensive medical care  under the scheme.

The package covers all aspects of health care from comprehensive medical care  facilities, such as

  • Out- patient treatment.
  • X- ray and laboratory investigation.
  • Ambulance service or conveyance.
  • Family welfare services and other national health programmes services.
  • Medical certification and
  • Special provision including super-specialty treatment

6. Funeral benefit

Funeral expenses are in the nature of a lump sum payment up to three thousand rupees made to defray the expenditure of the funeral of deceased insured person. The amount is paid either to the eldest surviving member of the family or, in his absence , to the person who actually incurs the expenditure on the funeral

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