Dear All
One of our employee has lost his leg above knee while leaving for home from his working site. We have paid his full salary for that month and adjusted his leaves. And 15 days extra leaves as advance leaves. As he was covered under ESIC, i want to know is he eligible for and pension from ESIC....??? for losing his leg. Our organisation is covered under shops & establishment act Delhi.
From India, Delhi
1One of our employee has lost his leg above knee while leaving for home from his working site. We have paid his full salary for that month and adjusted his leaves. And 15 days extra leaves as advance leaves. As he was covered under ESIC, i want to know is he eligible for and pension from ESIC....??? for losing his leg. Our organisation is covered under shops & establishment act Delhi.
From India, Delhi
Dear Umesh,
he is eligible for benefits as under :
Eligibility for Medical Benefit :
Duration and Scale of Medical Benefit :
Delivery of Medical Benefit :
An insured person (IP) and his/her family member become eligible for primary &
secondary medical benefit under the ESI Scheme from day one of entering insurable
employment. Section 56 (3) of ESI Act, 1948 provides, “A person shall be entitled to
medical benefit during any period for which contributions are payable in respect of
him or in which he is qualified to claim sickness benefit or maternity benefit (or is in
receipt of such disablement benefit as does not disentitle him to medical benefit under
the regulations)”.
Duration and Scale of Medical Benefit :
The insured person/family member of an insured person can avail the medical
treatment under this Scheme till the insured person is in insurable employment. Full
medical care (all facilities including hospitalization) for insured person and their
family members is provided.
Delivery of Medical Benefit :
As per the provisions of ESI Act, 1948, the State Governments are responsible for
providing the medical benefits through the network of ESI Dispensaries (for primary
medical services) and ESI Hospitals (for secondary medical services). However, the ESI
Corporation provides medical care directly, in Delhi and Noida area. Besides these
two area, the Corporation is also running 34 ESIC Hospitals directly which includes
ESIC Model Hospitals, at least one in each State. The beneficiaries are provided OPD
services, in-patient services, diagnostic facilities, free drugs and dressings etc. in all
ESI medical delivery institutions.
Medical Benefit for Old Age and for Permanent Disabled Beneficiaries :
The Medical Benefit has further been extended to the
insured persons who go out of employment on
account of attaining the age of superannuation (Old
Age) or on account of permanent disability (arising out
of employment injury). The Medical care is provided
in ESI institutions only, to such insured persons and
their spouse on payment of a lump sum amount for
one year at the rate of ` 10/- per month.
Provision of Artificial Limbs and Appliances :
Artificial limbs, artificial dentures, spectacles, hearing
aids, cardiac pacemaker, walking caliper, surgical
boots, spinal support, cerebral collar, intraoccular
lens etc. are provided free of cost to those patient
beneficiaries, who requires such appliances.
Rgds
From India, Mumbai
he is eligible for benefits as under :
Eligibility for Medical Benefit :
Duration and Scale of Medical Benefit :
Delivery of Medical Benefit :
An insured person (IP) and his/her family member become eligible for primary &
secondary medical benefit under the ESI Scheme from day one of entering insurable
employment. Section 56 (3) of ESI Act, 1948 provides, “A person shall be entitled to
medical benefit during any period for which contributions are payable in respect of
him or in which he is qualified to claim sickness benefit or maternity benefit (or is in
receipt of such disablement benefit as does not disentitle him to medical benefit under
the regulations)”.
Duration and Scale of Medical Benefit :
The insured person/family member of an insured person can avail the medical
treatment under this Scheme till the insured person is in insurable employment. Full
medical care (all facilities including hospitalization) for insured person and their
family members is provided.
Delivery of Medical Benefit :
As per the provisions of ESI Act, 1948, the State Governments are responsible for
providing the medical benefits through the network of ESI Dispensaries (for primary
medical services) and ESI Hospitals (for secondary medical services). However, the ESI
Corporation provides medical care directly, in Delhi and Noida area. Besides these
two area, the Corporation is also running 34 ESIC Hospitals directly which includes
ESIC Model Hospitals, at least one in each State. The beneficiaries are provided OPD
services, in-patient services, diagnostic facilities, free drugs and dressings etc. in all
ESI medical delivery institutions.
Medical Benefit for Old Age and for Permanent Disabled Beneficiaries :
The Medical Benefit has further been extended to the
insured persons who go out of employment on
account of attaining the age of superannuation (Old
Age) or on account of permanent disability (arising out
of employment injury). The Medical care is provided
in ESI institutions only, to such insured persons and
their spouse on payment of a lump sum amount for
one year at the rate of ` 10/- per month.
Provision of Artificial Limbs and Appliances :
Artificial limbs, artificial dentures, spectacles, hearing
aids, cardiac pacemaker, walking caliper, surgical
boots, spinal support, cerebral collar, intraoccular
lens etc. are provided free of cost to those patient
beneficiaries, who requires such appliances.
Rgds
From India, Mumbai
1. Sir, you have not mentioned complete particulars / facts which are required in order to offer any comments.
2. Please indicate (a) whether the unit in which the said employee was /is working on the date of accident is covered under provisions of ESI Act, 1948 and rules/regulations framed thereunder, (b) whether the employee who sustained injuries was covered on the date of accident under said Act and compliance was being made.(c) whether accident report as required under above Act was submitted to the appropriate Branch Office of ESIC online or manually as desired by Branch Office of ESIC and If so what is the decision of said Office, (d) whether the injured person has his Insurance Number and ESIC Identity Card (e) whether after accident FIR was lodged with the police authorities & (f) whether medical certificates obtained from concerned ESIC Dispensary to which the insured person was attached.
3. I hope, you will indicate above aspects before any opinion is expressed in the matter.
From India, Noida
2. Please indicate (a) whether the unit in which the said employee was /is working on the date of accident is covered under provisions of ESI Act, 1948 and rules/regulations framed thereunder, (b) whether the employee who sustained injuries was covered on the date of accident under said Act and compliance was being made.(c) whether accident report as required under above Act was submitted to the appropriate Branch Office of ESIC online or manually as desired by Branch Office of ESIC and If so what is the decision of said Office, (d) whether the injured person has his Insurance Number and ESIC Identity Card (e) whether after accident FIR was lodged with the police authorities & (f) whether medical certificates obtained from concerned ESIC Dispensary to which the insured person was attached.
3. I hope, you will indicate above aspects before any opinion is expressed in the matter.
From India, Noida
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BENEFITS UNDER ESI.ppt
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