The Employees' State Insurance Act, provides for certain benefits to employees in case of sickness, maternity and employment injury.
The Act extends to the whole of India. It applies to all factories (including Government factories but excluding seasonal factories) employing ten or more persons and carrying on a manufacturing process with the aid of power or employing 20 or more persons and carrying on a manufacturing process without the aid of power and such other establishments as the Government may specify.
A factory or other establishment to which this Act applies, shall continue to be governed by its provisions even if the number of workers employed therein falls below the specified limit or the manufacturing process therein ceases to be carried on with the aid of power, subsequently
The Act does not apply to the following:
The appropriate Government may exempt any factory or establishments or class of factories or establishments or any employee or class of employees from the provisions of this Act.
Every employee (including casual and temporary employees), whether employed directly or through a contractor, who is in receipt of wages upto Rs. 6,500 p.m. is entitled to be insured under the E.S.I. Act. However, apprentices engaged under the Apprentices Act are not entitled to the E.S.I. benefits. Coverage of part time employees under the ESI Act will depend on whether they have contract of service or contract for service with the employer. The former is covered, whereas the latter is not covered under the E.S.I Act.
Besides, in the following cases, the employees have been held to be covered under the Act:
An employer/establishments covered under the E.S.I. Act is exempt from the provisions of Maternity Benefit Act and Workmen's Compensation Act. It is specifically provided that when a person is entitled to any of the benefits provided by the Act, then he shall not be entitled to recover any similar benefits admissible under the provisions of any other enactment.
The employer is required to contribute at the rate of 4.75% of the wages paid/payable in respect of every wage period. The employees are also required to contribute at the rate of 1.75% of their wages, except when the "average daily wages in a wage period" are equal to or less than Rs. 40. Employees earning less than and upto Rs. 40 per day are exempted from payment of contribution.
It is the employer's responsibility to deposit his own as well as employee's contributions in respect of all employees including the contract labour, into the E.S.I. Account.
The employer may deduct the employees contribution from his wages in respect of the period for which the contribution is payable.
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:-
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:
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.
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 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,
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 the medical examination etc., as prescribed for sickness benefit.
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.
However, disablement benefit for temporary disablement shall be allowed to an employee for any day on which he remains on strike, if:
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-
The employee shall be entitled to choose any one of the aforesaid benefits, at his discretion .
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.
If an employee dies during any period for which he is entitled to a cash benefit, the amount of such benefit shall be payable up to and including the day of his death. The amount of benefit shall be paid to the nominee or, where there is no nomination, to the heir or legal representative of the deceased employee.
If an insured employee dies, the eldest surviving member of his family or the person who incurs the expenditure of funeral of the deceased employee, is entitled to reimbursement of such expenditure subject to a maximum of Rs. 1,500. The claim for the payment of funeral expenses should be submitted in the prescribed form along with prescribed documents within 3 months of the death of the insured employee.
In case of the death of an insured employee at the place of employment, the employer should immediately report to the local office and to the nearest E.S.I dispensary or hospital.
The E.S.I. Corporation may appoint Inspectors to carry out the purposes of the Act, within the local limits assigned to each of them.
The duties of an Inspector are:
Such other duties as may be authorised by the Corporation or specified in the regulations.
The Inspectors are vested with following powers to carry out their duties and functions aforesaid:
Obligations of Employers
EMPLOYEES STATE INSURANCE CORPORATION
The Employees State Insurance Scheme is administered by the Employees' State Insurance Corporation, which is constituted by the Central Government. It consists of representatives of the Central Government, medical profession and members of Parliament. The Corporation is vested with the following powers.
EMPLOYEES INSURANCE COURT
Any dispute arising under the Act shall be decided by the Employees Insurance Court and not by a Civil Court. It is constituted by the State Government for such local areas as may be specified and consists of such number of judges, as the Government may think fit. It shall adjudicate on the following disputes and claims.
Disputes as to-
Claims as to-
No dispute shall be admitted unless the employer deposits with the Court 50% of the amount due from him as claimed by the Corporation.
An appeal shall lie to the High Court within 60 against an order of the Employees' Insurance Court if it involves a substantial question of lawCopyright 2022 – Helpline Law - HLL001
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