Good morning seniors,
I am working in a private company in Delhi and I have a query regarding compensation. One of our employees (covered under ESIC) injured his right index finger while operating the machine on 10th March 2012. I have submitted the accident report to the ESIC dispensary and the local office.
I would like to know:
1. What documents will the surveyor check?
2. Who, the company or ESIC, will provide compensation to the employee?
Regards,
Abhishek Bhardwaj
From India, Delhi
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I am working in a private company in Delhi and I have a query regarding compensation. One of our employees (covered under ESIC) injured his right index finger while operating the machine on 10th March 2012. I have submitted the accident report to the ESIC dispensary and the local office.
I would like to know:
1. What documents will the surveyor check?
2. Who, the company or ESIC, will provide compensation to the employee?
Regards,
Abhishek Bhardwaj
From India, Delhi
Acknowledge(0)Amend(0)
Dear Abhishek,
I think it will pay by ESI if he qualifies below-mentioned rules.
I am sending you ESI Benefit types questions & their answers. I hope it will help you.
SOCIAL SECURITY BENEFITS
Sickness Benefit
14. What does "Sickness Benefit" mean?
Sickness signifies a state of health necessitating medical treatment and attendance and abstention from work on medical grounds. Financial support extended by the Corporation in such a contingency is called Sickness Benefit.
15. What are the Contributory Conditions?
The contribution condition required to be fulfilled for admissibility of sickness benefit during any benefit period is that contributions should have been paid in respect of an insured person in the corresponding contribution period for not less than 78 days.
16. How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate". This rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure "A".
17. What is the duration of Sickness Benefit?
Sickness benefit is payable for a maximum period of 91 days in any two consecutive benefit periods. Benefit is not paid for an initial waiting period of 2 days unless the insured person is certified sick within 15 days of the last spell in which Sickness Benefit was paid.
EXTENDED SICKNESS BENEFIT:
18. What is Extended Sickness Benefit?
Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as mentioned below.
Diseases:
1. Tuberculosis
2. Leprosy
3. Chronic Empyema
4. Bronchiectasis
5. Interstitial Lung disease
6. AIDS
7. Malignant Diseases
8. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/ nephropathy.
9. Monoplegia
10. Hemiplegia
11. Paraplegia
12. Hemiparesis
13. Intracranial space-occupying lesion
14. Spinal Cord Compression
15. Parkinson's disease
16. Myasthenia Gravis/Neuromuscular Dystrophies
17. Immature Cataract with vision 6/60 or less
18. Detachment of Retina
19. Glaucoma
20. Coronary Artery Diseases
21. Congestive Heart Failure-Left, Right
22. Cardiac valvular Diseases with failure/complications
23. Cardiomyopathies
24. Heart disease with surgical intervention along with complications
25. Chronic Obstructive Long diseases (COPD) with congestive heart failure (Cor Pulmonale)
26. Cirrhosis of the liver with ascites/chronic active hepatitis ("CAH")
27. Dislocation of vertebra/prolapse of intervertebral disc
28. Non-union or delayed union of fracture
29. Post-Traumatic surgical amputation of the lower extremity
30. Compound fracture with chronic osteomyelitis
31. (a) Schizophrenia
(b) Endogenous depression
(c) Maniac Depressive Psychosis (MDP)
(d) Dementia
32. More than 20% Burns with infection/complication
33. Chronic Renal Failure
34. Reynaud's disease/Burger's disease.
In addition, extended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority.
19. What are the Contributory Conditions?
Except in the case of disability from the administration of drugs/injections, the insured person should have been in continuous employment for a period of 2 years and should have contributed for at least 156 days in 4 preceding contribution periods.
20. How much is the Benefit rate?
The daily rate of Extended Sickness Benefit is 40% more than the Standard Sickness Benefit rate admissible.
21. How long is the Benefit available?
After exhausting Sickness Benefit payable for 91 days, the ESB is payable up to a further period of 124/309 days that can be extended up to 2 years in special circumstances. Thus, together with the Sickness Benefit for 91 days, it puts a claimant on benefit for an aggregate period of 400 days for all specified diseases and 2 years in chronic suitable cases on the recommendation of the competent authority.
Enhanced Sickness Benefit
22. What is Enhanced Sickness Benefit?
Enhanced Sickness Benefit is a cash benefit for the insured persons undergoing sterilization operation of vasectomy/tubectomy for family planning.
22a. What are the contributory conditions?
The contributory conditions are the same as for claiming sickness benefit.
22b. How much is the benefit rate?
The daily rate of this benefit is double the standard benefit rate. Say, not less than the daily wage.
22c. How Long is the benefit available?
The benefit is available up to 7 days for vasectomy and up to 14 days for tubectomy operations. This period can, however, be extended in cases of post-operative complications or sickness arising out of these sterilization operations. Its duration is not counted towards the total number of 91 days for which the sickness benefit is available during any two consecutive benefit periods.
22d. How to claim Sickness Benefit?
A claim for Sickness Benefit should be supported by a Medical Certificate issued by an Insurance Medical Officer/Insurance Medical Practitioner in the appropriate Form. Medical Certificates are issued at intervals of not more than seven days, except in cases of prolonged sickness, where Special Intermediate Certificates may be issued at longer intervals not exceeding 4 weeks. On the back of each certificate, except the Special Intermediate Certificate, a Claim Form is printed. The Claim Form is essentially a declaration in regard to abstention of the claimant from work during the period of claim. Separate Claim Forms are also available.
The Claim Form should bear the signatures/thumb impression of the claimant and should be submitted to the Local Office personally, by post, through a messenger, or by deposit in certificate boxes, wherever provided. All claims should preferably be submitted to the Local Office within three days. The Receptionist at the Local Office renders all assistance in filling in the claim on your behalf.
Disablement Benefit
23. What is "Disablement"?
Disablement is a condition resulting from employment injury, which may be:
(a) temporary, i.e., rendering an insured person incapable of work temporarily and necessitating medical treatment;
(b) permanent partial, i.e., reducing the earning capacity of the insured person generally for every employment;
(c) permanent total, i.e., totally depriving the insured person of the power to do all work.
24. What constitutes an "Employment Injury"?
Employment injury means a personal injury caused to an employee by an accident or occupational disease arising out of and in the course of his employment in a factory or establishment covered under the Employees' State Insurance Act.
The law relating to Employment injury has been liberalized. Now, an accident arising in the course of employment is presumed also to have arisen out of his employment if there is no evidence to the contrary. Further, an accident brought about by willful disobedience, negligence, or breach of regulations, etc., or an accident happening while traveling in transport provided by the employer or while meeting an emergency is accepted subject to certain conditions, to have arisen in the course of and out of employment. Injuries suffered while under the influence of drinks and drugs take away the right of the employee to this benefit.
A roadside accident caused while commuting between the place of residence and workplace is also treated as a notional extension of employment for the purpose of death or disablement benefit.
25. What are "Occupational Diseases"?
Occupational Diseases are such diseases as are susceptible to being traced back to their occupational origin. 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.
26. What are the Benefits granted?
Temporary Disablement Benefit is paid periodically in arrears as the evidence of incapacity (medical certificate) is produced. Permanent total disablement and permanent partial disablement benefits are paid in the form of pensions. Current employment for wages or engagement in any gainful activities is no bar to payment of permanent disablement benefits. An insured person suffering from an occupational disease is also entitled to full medical care.
27. How much is the Benefit Rate?
The daily benefit rate for permanent total disablement and temporary disablement is 40% more than the Standard Sickness Benefit rate and is roughly equivalent to about 70% of the wage rate. For permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also.
28. What are the Contributory Conditions?
There are no qualifying conditions as to the length of employment or the number of contributions paid. Protection accrues from the very moment of entry into insurable employment.
29. What is the duration of Benefit?
Temporary Disablement Benefit is paid as long as disablement lasts. There is a waiting period of 3 days (excluding the day of the accident), but if incapacity exceeds this period, benefit is paid from the very first day. The permanent disablement benefit is paid for the lifetime of the beneficiary.
30. How is Permanent Disablement assessed?
There is indeed no way of adequately compensating a permanently disabled employee, and yet some method of determining whether an employment injury has resulted in permanent disablement and of assessing the extent of permanent damage caused by that employment injury has to be adopted for the
From India, Delhi
Acknowledge(0)Amend(0)
7I think it will pay by ESI if he qualifies below-mentioned rules.
I am sending you ESI Benefit types questions & their answers. I hope it will help you.
SOCIAL SECURITY BENEFITS
Sickness Benefit
14. What does "Sickness Benefit" mean?
Sickness signifies a state of health necessitating medical treatment and attendance and abstention from work on medical grounds. Financial support extended by the Corporation in such a contingency is called Sickness Benefit.
15. What are the Contributory Conditions?
The contribution condition required to be fulfilled for admissibility of sickness benefit during any benefit period is that contributions should have been paid in respect of an insured person in the corresponding contribution period for not less than 78 days.
16. How much is the Standard Benefit Rate?
The daily rate of Sickness Benefit during any benefit period is the "standard benefit rate". This rate corresponds to the average daily wage of an insured person during the corresponding contribution period and is roughly half of the daily wage rate. Benefit is paid for Sundays also. 28 wage groups have been evolved for working out the daily rate of Standard Sickness Benefit. Standard Benefit rates for 28 wage groups are shown in Annexure "A".
17. What is the duration of Sickness Benefit?
Sickness benefit is payable for a maximum period of 91 days in any two consecutive benefit periods. Benefit is not paid for an initial waiting period of 2 days unless the insured person is certified sick within 15 days of the last spell in which Sickness Benefit was paid.
EXTENDED SICKNESS BENEFIT:
18. What is Extended Sickness Benefit?
Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as mentioned below.
Diseases:
1. Tuberculosis
2. Leprosy
3. Chronic Empyema
4. Bronchiectasis
5. Interstitial Lung disease
6. AIDS
7. Malignant Diseases
8. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/ nephropathy.
9. Monoplegia
10. Hemiplegia
11. Paraplegia
12. Hemiparesis
13. Intracranial space-occupying lesion
14. Spinal Cord Compression
15. Parkinson's disease
16. Myasthenia Gravis/Neuromuscular Dystrophies
17. Immature Cataract with vision 6/60 or less
18. Detachment of Retina
19. Glaucoma
20. Coronary Artery Diseases
21. Congestive Heart Failure-Left, Right
22. Cardiac valvular Diseases with failure/complications
23. Cardiomyopathies
24. Heart disease with surgical intervention along with complications
25. Chronic Obstructive Long diseases (COPD) with congestive heart failure (Cor Pulmonale)
26. Cirrhosis of the liver with ascites/chronic active hepatitis ("CAH")
27. Dislocation of vertebra/prolapse of intervertebral disc
28. Non-union or delayed union of fracture
29. Post-Traumatic surgical amputation of the lower extremity
30. Compound fracture with chronic osteomyelitis
31. (a) Schizophrenia
(b) Endogenous depression
(c) Maniac Depressive Psychosis (MDP)
(d) Dementia
32. More than 20% Burns with infection/complication
33. Chronic Renal Failure
34. Reynaud's disease/Burger's disease.
In addition, extended sickness benefit may also be sanctioned by the prescribed authority, in case of any rare disease or special circumstances on the recommendation of the specified authority.
19. What are the Contributory Conditions?
Except in the case of disability from the administration of drugs/injections, the insured person should have been in continuous employment for a period of 2 years and should have contributed for at least 156 days in 4 preceding contribution periods.
20. How much is the Benefit rate?
The daily rate of Extended Sickness Benefit is 40% more than the Standard Sickness Benefit rate admissible.
21. How long is the Benefit available?
After exhausting Sickness Benefit payable for 91 days, the ESB is payable up to a further period of 124/309 days that can be extended up to 2 years in special circumstances. Thus, together with the Sickness Benefit for 91 days, it puts a claimant on benefit for an aggregate period of 400 days for all specified diseases and 2 years in chronic suitable cases on the recommendation of the competent authority.
Enhanced Sickness Benefit
22. What is Enhanced Sickness Benefit?
Enhanced Sickness Benefit is a cash benefit for the insured persons undergoing sterilization operation of vasectomy/tubectomy for family planning.
22a. What are the contributory conditions?
The contributory conditions are the same as for claiming sickness benefit.
22b. How much is the benefit rate?
The daily rate of this benefit is double the standard benefit rate. Say, not less than the daily wage.
22c. How Long is the benefit available?
The benefit is available up to 7 days for vasectomy and up to 14 days for tubectomy operations. This period can, however, be extended in cases of post-operative complications or sickness arising out of these sterilization operations. Its duration is not counted towards the total number of 91 days for which the sickness benefit is available during any two consecutive benefit periods.
22d. How to claim Sickness Benefit?
A claim for Sickness Benefit should be supported by a Medical Certificate issued by an Insurance Medical Officer/Insurance Medical Practitioner in the appropriate Form. Medical Certificates are issued at intervals of not more than seven days, except in cases of prolonged sickness, where Special Intermediate Certificates may be issued at longer intervals not exceeding 4 weeks. On the back of each certificate, except the Special Intermediate Certificate, a Claim Form is printed. The Claim Form is essentially a declaration in regard to abstention of the claimant from work during the period of claim. Separate Claim Forms are also available.
The Claim Form should bear the signatures/thumb impression of the claimant and should be submitted to the Local Office personally, by post, through a messenger, or by deposit in certificate boxes, wherever provided. All claims should preferably be submitted to the Local Office within three days. The Receptionist at the Local Office renders all assistance in filling in the claim on your behalf.
Disablement Benefit
23. What is "Disablement"?
Disablement is a condition resulting from employment injury, which may be:
(a) temporary, i.e., rendering an insured person incapable of work temporarily and necessitating medical treatment;
(b) permanent partial, i.e., reducing the earning capacity of the insured person generally for every employment;
(c) permanent total, i.e., totally depriving the insured person of the power to do all work.
24. What constitutes an "Employment Injury"?
Employment injury means a personal injury caused to an employee by an accident or occupational disease arising out of and in the course of his employment in a factory or establishment covered under the Employees' State Insurance Act.
The law relating to Employment injury has been liberalized. Now, an accident arising in the course of employment is presumed also to have arisen out of his employment if there is no evidence to the contrary. Further, an accident brought about by willful disobedience, negligence, or breach of regulations, etc., or an accident happening while traveling in transport provided by the employer or while meeting an emergency is accepted subject to certain conditions, to have arisen in the course of and out of employment. Injuries suffered while under the influence of drinks and drugs take away the right of the employee to this benefit.
A roadside accident caused while commuting between the place of residence and workplace is also treated as a notional extension of employment for the purpose of death or disablement benefit.
25. What are "Occupational Diseases"?
Occupational Diseases are such diseases as are susceptible to being traced back to their occupational origin. 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.
26. What are the Benefits granted?
Temporary Disablement Benefit is paid periodically in arrears as the evidence of incapacity (medical certificate) is produced. Permanent total disablement and permanent partial disablement benefits are paid in the form of pensions. Current employment for wages or engagement in any gainful activities is no bar to payment of permanent disablement benefits. An insured person suffering from an occupational disease is also entitled to full medical care.
27. How much is the Benefit Rate?
The daily benefit rate for permanent total disablement and temporary disablement is 40% more than the Standard Sickness Benefit rate and is roughly equivalent to about 70% of the wage rate. For permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also.
28. What are the Contributory Conditions?
There are no qualifying conditions as to the length of employment or the number of contributions paid. Protection accrues from the very moment of entry into insurable employment.
29. What is the duration of Benefit?
Temporary Disablement Benefit is paid as long as disablement lasts. There is a waiting period of 3 days (excluding the day of the accident), but if incapacity exceeds this period, benefit is paid from the very first day. The permanent disablement benefit is paid for the lifetime of the beneficiary.
30. How is Permanent Disablement assessed?
There is indeed no way of adequately compensating a permanently disabled employee, and yet some method of determining whether an employment injury has resulted in permanent disablement and of assessing the extent of permanent damage caused by that employment injury has to be adopted for the
From India, Delhi
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ESIC will pay the compensation and records to submit along with the accident report are:
1. Appointment Letter
2. Attendance details
3. Pay/wages details for the month
4. Temporary ID card from ESIC
5. Government ID Proof
6. Bank details
The same will be verified during the survey.
From India, Bengaluru
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1. Appointment Letter
2. Attendance details
3. Pay/wages details for the month
4. Temporary ID card from ESIC
5. Government ID Proof
6. Bank details
The same will be verified during the survey.
From India, Bengaluru
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