Employee State Insurance Act, [ESI] 1948




OBJECT OF THE ACT

The Employees* Slate 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


DEFINITIONS. [Section 2]

(3) "confinement" means labour resulting in the issue of a living child or labour after 26 weeks of pregnancy resulting in the issue of a child whether alive or dead;

(4) "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;

(6) "Corporation" means the Employees' State Insurance Corporation set up under this Act;

(6A) "dependant" means any of the following relatives of a deceased insured person, namely,-

(i) a widow, a legitimate or adopted son who has not attained the age of 25 years, an unmarried legitimate or adopted daughter. (2010 amendment) (ia) a widowed mother;

(ii) if wholly dependent on the earnings of the insured person at the time of his death, a legitimate or adopted son or daughter who has attained the age of 25 years and is infirm; (2010 amendment)

(iii) if wholly or in part dependent on the earnings of the insured person at the time of his death,-

(a) a parent other than a widowed mother,
(b) a minor illegitimate son, an unmarried illegitimate daughter or a daughter legitimate or adopted or illegitimate if married and a minor or if widowed and a minor,
(c) a minor brother or an unmarried sister or a widowed sister if a minor,
(d) a widowed daughter-in-law,
(e) a minor child of a pre-deceased son,
(f) a minor child of a pre-deceased daughter where no parent of the child is alive, or
(g) a paternal grand-parent if no parent of the insured person is alive,


(8) "employment injury" means a personal injury to an employee caused by accident or an occupational disease arising out of and in the course of his employment, being an insurable employment, whether the accident occurs or the occupational disease is contracted within or outside the territorial limits of India;


(11) "family" means all or any of the following relatives of an insured person, namely,-

(i) a spouse;
(ii) a minor legitimate or adopted child dependent upon the insured person;
(iii) a child who is wholly dependent on the earnings of the insured person and who is-

(a) receiving education, till he or she attains the age of twenty-one years,

(b) an unmarried daughter;

(iv) a child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity continues;
(v) Dependant parents, whose income from all sources does not exceed such income as may be prescribed by the Central Government;
(vi) in case the insured person is unmarried and his or her parents are not alive, a minor brother or sister wholly dependent upon the earnings of the insured person. (2010 amendment)

(12)"factory" means any premises including the precincts thereof whereon 10 or more persons are employed or were employed on any day of the preceding 12 months, and in any part of which a manufacturing process is being carried on or is ordinarily so carried on, but does not include a mine subject to the operation of the Mines Act, 1952 or a railway running shed. (2010 amendment)

(14A) "managing agent" means any person appointed or acting as the representative of another person for the purpose of carrying on such other person's trade or business, but does not include an individual manager subordinate to an employer;

(14B) "mis-carriage" means expulsion of the contents of a pregnant uterus at any period prior to or during the 26 weeks of pregnancy but does not include any mis-carriage,

(15A) "permanent partial disablement" means such disablement of a permanent nature, as reduces 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:

(22) "wages" means all remuneration paid or payable, in cash to an employee, if the terms of the contract of employment, express or implied, were fulfilled and includes any payment to an employee in respect of any period of authorized leave, lock-out, strike which is not illegal or lay -off and other additional remuneration, if any, paid at intervals not exceeding two months, but does not include-

(a) any contribution paid by the employer to any pension fund or provident fund, or under this Act;

(b) (any travelling allowance or the value of any travelling concession;

(c) any sum paid to the person employed to defray special expenses entailed on him by the nature of his employment; or

(d) any gratuity payable on discharge.


CHAPTER II:

CORPORATION, STANDING COMMITTEE AND MEDICAL BENEFIT COUNCIL


ESTABLISHMENT OF EMPLOYEES’ STATE INSURANCE CORPORATION. [Section 3]

central government establishes the Corporation to be known as the Employees' State Insurance Corporation. This corporation will be having following characteristics
  • separate corporate body.
  • Having perpetual succession. (no death)
  • Have a common seal.
  • Employees' State Insurance Corporation can sue. (file a suit in court on other)
  • Other can sue Employees' State Insurance Corporation.

THE CORPORATION SHALL CONSIST OF THE FOLLOWING MEMBERS. [Section 4]


(a) Chairman, Vice-Chairman to be appointed by the Central Government;

(b) not more than 5 persons to be appointed by the Central Government;

(c) one person each representing each of the States in which this Act is in force to be appointed by the State Government concerned;

(d) one person to be appointed by the Central Government to represent the 3Union Territories;

(e) 10 persons representing employers to be appointed by the Central Government in consultation with such organisations of employers.

(f) 10 persons representing employees to be appointed by the Central Government in consultation with such organisations of employees.

(g) 2 persons representing the medical profession to be appointed by the Central Government in consultation with such organisation of medical practitioners.

(h) 3 members of Parliament of whom two shall be members of the House of the People (Lok Sabha) and one shall be a member of the Council of States (Rajya Sabha) elected respectively by the members of the House of the People and the members of the Council of States; and

(i) The Director-General of the Corporation ex-officio.


TERM OF OFFICE OF MEMBERS OF THE CORPORATION. [Section 5]


Members referred to in clauses (f), (g), (h) shall be four years, commencing from the date on which their appointment or election. The members of the Corporation referred to in clauses (a),(b),(c) and (e)of Sectiontion 4 shall hold office during the pleasure of the government appointing them.


CONSTITUTION OF STANDING COMMITTEE. [Section 8]


Standing Committee of the Corporation shall be constituted from among its members, consisting of

(a) A Chairman, appointed by the Central Government;

(b) three members of the Corporation appointed by the Central Government;

(bb) three members of the Corporation representing such three State Governments thereon as the Central Government may, by notification Gazette, specify from time to time;

(c) eight members elected by the Corporation as follows-

(ii) 3 members from among the members of the Corporation representing employers;
(iii) 3 members from among the members of the Corporation representing employees;
(iv) 1 member from among the members of the Corporation representing the medical profession; and
(v) 1 member from among the members of the Corporation elected by Parliament;

(d) the Director General of the Corporation, ex officio


TERM OF OFFICE OF MEMBERS OF STANDING COMMITTEE. [Section 9]

  • a member of the Standing Committee shall cease to hold office when he ceases to be a member of the Corporation.
  • the term of office of a member of the Standing Committee, other than a member referred to in clause (a) or clause (b) or clause (bb) of Section 8, shall be two years from the date on which his election.
  • A member of the Standing Committee referred to in clause (a) or clause (b) or clause (bb) of Section 8 shall hold office during the pleasure of the Central Government.

MEDICAL BENEFIT COUNCIL. [Section 10](2010 AMENDMENT)

(a) the Director General, the Employees' State Insurance Corporation, ex officio as Chairman;

(b) The Director General, Health Services, ex officio as Co-chairman;".

(c) one member each representing each of the States

(d) 3 members representing employers to be appointed by the Central Government in consultation with such organisations of employers.

(e) 3 members representing employees to be appointed by the Central Government in consultation with such organisations of employees.

(f) 3 members, of whom not less than one shall be a woman, representing the medical profession, to be appointed by the Central Government.


DUTIES OF MEDICAL BENEFIT COUNCIL. [Section 22]
  • advise the Corporation and the Standing Committee on matters relating to the administration of medical benefit, the certification for purposes of the grant of benefits and other connected matters;
  • have such powers and duties of investigation as may be prescribed in relation to complaints against medical practitioners in connection with medical treatment and attendance; and
  • perform such other duties in connection with medical treatment and attendance.

CESSATION OF MEMBERSHIP. [Section 12]

  • 3 members of Parliament of whom 2 shall be members of the House of the People (Lok Sabha) and one shall be a member of the Council of States (Rajya Sabha) shall cease to be a member of the Corporation when he ceases to be a Member of Parliament.
  • Other members Membership of Employees' State Insurance Corporation, Standing Committee or the Medical Benefit Council will be ended when that person ends representing such employers, employees, or the medical profession.

Disqualification. [Section 13]

A person shall be disqualified for being chosen as or for being a member of the Corporation, the Standing Committee or the Medical Benefit Council-
  • if he is declared to be of unsound mind by a competent court; or
  • if he is an undischarged insolvent; or
  • If he a shareholder or a partner of company.
  • If he has been convicted of an offence involving moral turpitude.

FEES AND ALLOWANCES. [Section 15]


Members of the Corporation, the Standing Committee and the Medical Benefit Council shall receive such fees and allowances as may from time to time be prescribed by the Central Government.


PRINCIPAL OFFICERS. [Section 16]


The Central Government may, in consultation with the Corporation, appoint a director general and a financial commissioner.
  • The director general shall be the chief executive officer of the Corporation.
  • The director general and the financial commissioner shall be whole-time officers of the Corporation and shall not undertake any work unconnected with their office without the sanction of the Central Government and of the Corporation.
  • The director general or the financial commissioner shall hold office for such period, not exceeding five years, as may be specified in the order appointing him. An outgoing director general or financial commissioner shall be eligible for re-appointment if he is otherwise qualified.
  • The director general or the financial commissioner shall receive such salary and allowances as may be prescribed by the Central Government.

STAFF. [SECTION 17]


The Corporation may employ such other permanent or temporary staff of officers and servants as may be necessary for monthly salary basis.


CHAPTER III:

FINANCE AND AUDIT



EMPLOYEES’ STATE INSURANCE FUND. [Section 26]
  • All contributions paid under this Act and all other moneys received on behalf of the Corporation shall be paid into a fund called the Employees' State Insurance Fund.
  • The Corporation may accept grants, donations and gifts from the Central or any State Government, local authority, or any individual or body whether incorporated or not, for all or any of the purposes of this Act.
  • All money received will be paid in to reserve bank of Indian or government approved bank credited to the account of the Employees’ State Insurance Fund.
  • account shall be operated on by such officers as may be authorised by the Standing Committee with the approval of the Corporation.

THE EMPLOYEES’ STATE INSURANCE FUND SHALL BE EXPENDED ONLY FOR THE FOLLOWING PURPOSES. [Section 28]


  • Payment of benefits and provision of medical treatment.
  • Payment to insured persons.
  • Payment of medical benefits to insured person families.
  • payment of fees and allowances to members of the Corporation, the Standing Committee and the Medical Benefit Council, the regional boards, local committees and regional and local Medical Benefit Councils.
  • payment of salaries, leave and joining time allowances, travelling and compensatory allowances, gratuities and compassionate allowances, pensions, contributions to provident or other benefit fund of officers and servants of the Corporation.
  • meeting the expenditure in respect of offices and other services set.
  • establishment and maintenance of hospitals, dispensaries and other institutions.
  • Payment of contributions to any State Government, local authority or any private body or individual, towards the cost of medical treatment.
  • Payment of expenses of auditing the accounts of the Corporation and of the valuation of its assets and liabilities.
  • Payment of expenses of the Employees’ State Insurance Courts set up under this Act.
  • Payment of sums under any decree, order or award of any Court or Tribunal against the Corporation.
  • Payment of the cost and other charges of instituting or defending any civil or criminal proceedings arising out of any action taken under this Act;
  • Payment of expenditure, within the limits prescribed, on measures for the improvement of the health and welfare of insured persons and for the rehabilitation and re-employment of insured persons who have been disabled or injured.

HOLDING OF PROPERTY. [Section 29]
  • Employees' State Insurance Corporation can hold both movable property and immovable property.
  • It can sell or transfer the both movable property and immovable property for the purposes for which the Corporation is established.
  • It can raise loans and take measures for discharging such loans.
  • It can provide benefits for its staff.
[Section 30] all the above details or properties, income derived and expenditure incurred should be maintained in the books of the corporation.

ACCOUNTS. [Section 33]


The Corporation should maintain correct accounts of its income and expenditure in such form and in such manner as may be prescribed by the Central Government.

AUDIT. [Section 34]

The accounts of the Corporation should be audited annually by the Comptroller and Auditor-General of India and any expenditure incurred by him in connection with such audit shall be payable by the Corporation to the Comptroller and Auditor-General of India.
  • He has the right to demand the production of books, account, connected vouchers and other documents and papers and to inspect any of the offices of the Corporation.
  • Audit report thereon should be forwarded to the Corporation which shall forward the same to the Central Government along with its comments on the report of the Comptroller and Auditor General.

ANNUAL REPORT. [Section 35]

The Corporation shall submit to the Central Government an annual report of its work and activities.


VALUATION OF ASSETS AND LIABILITIES. [ Section 37]

The corporation should make valuation of its assets and liabilities for every 3 years of period. (2010 amendment)


CHAPTER IV:

CONTRIBUTIONS


ALL EMPLOYEES TO BE INSURED. [Section 38]

Factory or establishment having more than 10 employees should be insured under the Employee State Insurance Act


CONTRIBUTION. [Section 39]

  • Employer and employer liable for payment of the contribution to the Employee State Insurance Corporation.
  • The rate of contribution paid by employer and employee will be decided by the central government.
  • Currently, the employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period.
  • If wage is received every month by employee, the Contribution to the ESI Corporation should be made by employer and employee every month without fail.
  • @ 12% of interest per year should be paid If employer delays in payment of the contribution to ESI corporation

PRINCIPAL EMPLOYER TO PAY CONTRIBUTIONS IN THE FIRST INSTANCE. [Section 40]
  • Employer should pay the contribution to ESI Corporation of behalf of his employee.
  • Employer may deduct employee contribution from employee wage for payment of contribution to ESI Corporation.
  • Employer may recover the employee contribution paid from the wage of the employee which should not exceed the amount equivalent to employer contribution.
  • Employer will become responsible for the payment to the ESI contribution after deduction of the employee contribution from the employee wage
  • Employer should bear the expenses occurred in payment of contributions to the Corporation.

GENERAL PROVISIONS AS TO PAYMENT OF CONTRIBUTIONS. [Section 42]
  • No employee's contribution shall be payable by or on behalf of an employee whose average daily wages during a wage period are below such wages as may be prescribed by the Central Government.
  • The average daily wages of an employee shall be calculated in such manner as may be prescribed by the Central Government.
For Andhra Pradesh Employees in receipt of a daily average wage up to Rs.70/- are exempted from payment of contribution.


METHOD OF PAYMENT OF CONTRIBUTION. [Section 43]

The ESI Corporation can make following rules and regulation in payment and collection of contributions payable under this Act.
  • The manner of payment of contribution
  • The time of payment of contribution.
  • Fixation of stamps for payment of contribution.
  • Benefits distributed in the case of the insured persons by the corporation.
  • Maintenance of books and cards of contribution of insured person by ESI Corporation.
  • The issue, sale, custody, production, inspection and delivery of books or cards and the replacement of books or cards which have been lost, destroyed or defaced.

EMPLOYERS TO FURNISH RETURNS AND MAINTAIN REGISTERS IN CERTAIN CASES. [Section 44]


Every principal and immediate employer should submit to the Corporation or to such officer of the Corporation as it may direct such returns in such form and containing such particulars relating to persons employed by him.

Every principal and immediate employer shall maintain such registers or records in respect of his factory or establishment


SOCIAL SECURITY OFFICERS, THEIR FUNCTIONS AND DUTIES. [SECTION 45] (2010 amendment)


The Corporation may appoint such person as Social Security Officers, as it thinks fit, for the purposes of this Act. The following are his functions and duties.
  • Enquiring into the correctness of any of the particulars stated in any return referred to in Section 44.
  • Social Security Officers can demand any principal or immediate employer to furnish to him such information as he may consider necessary for the purposes of this Act.
  • Social Security Officers can at any reasonable time enter any office, establishment, factory or other premises for inspection of examine such accounts, books and other documents relating to the employment of persons and payment of wages or to furnish to him such information as he may consider necessary.
  • He can examine the employer, his agent or servant or any person found in such factory, establishment, and office.
  • He can make copies of, or take extracts from, any register, account book or other document maintained in such factory, establishment, office or other premises.
  • He can do re-inspection whether the records and returns submitted under Section 44 are correct or not.

[Section 45A] (2010 amendment)


If no records or particular of employed persons are not maintain as required under this act by the his employer, social Security officer by order, determine the amount of contributions payable in respect of the employees of that factory or establishment. No order shall be passed by the Corporation in respect of the period beyond 5 years from the date on which the contribution shall become payable.

CHAPTER V

BENEFITS

The following benefits will be paid to insured persons or to their dependents [Section 46]
  • Periodical payments to any insured person in case of his sickness certified by a duly appointed medical practitioner.
  • 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.
  • periodical payments to an insured person suffering from disablement as a result of an employment injury
  • periodical payments to such dependants of an insured person who dies as a result of an employment injury
  • medical benefits

FUNERAL BENEFIT. [Section 46]


As prescribed by the central government,

an amount of Rs. 5000/- is payable to the dependents or to the person who performs last rites from day one of entering insurable employment.

SICKNESS BENEFIT. [Section 49]


As prescribed by the central government,

Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance with abstention from work on medical grounds. Sickness benefit is roughly 60% of the average daily wages and is payable for 91 days during 2 consecutive benefit periods.

Qualifying Conditions
  • To become eligible to Sickness Benefit, an Insured Person should have paid contribution for not less than 78 days during the corresponding contribution period.
  • A person who has entered into insurable employment for the first time has to wait for nearly 9 months before becoming eligible to sickness benefit, because his corresponding benefit period starts only after that interval.

Extended Sickness Benefit (ESB)

IPs suffering from long term diseases was experiencing great hardship on expiry of 91 days Sickness benefit. Often they, though not fit for duty, pressed for a Final certificate. Hence, a provision for paying Sickness Benefit for an extended period (Extended Sickness Benefit)of up to 2 years in a ESB period of 3 years.

An Insured Person suffering from certain long term diseases is entitled to ESB, only after exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable, is reviewed by the Corporation from time to time. The list was last reviewed on 5.12.99 and revised provisions of ESB became effective from 1.1.2000 and at present this list includes 34 diseases which are grouped in 11 groups as per International Classification of diseases and the names of many existing diseases have been changed as under :-

I Infectious Diseases
1. Tuberculosis
2. Leprosy
3. Chronic Empyema
4. AIDS

II Neoplasms
5. Malignant Diseases

III Endocrine, Nutritional and Metabolic Disorders
6. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.

IV Disorders of Nervous System
7. Monoplegia
8. Hemiplegia
9. Paraplegia
10. Hemiparesis
11. Intracranial Space Occupying Lesion
12. Spinal Cord Compression
13. Parkinson’s disease
14. Myasthenia Gravis/Neuromuscular Dystrophies

V Disease of Eye
15. Immature Cataract with vision 6/60 or less
16. Detachment of Retina
17. Glaucoma

VI Diseases of Cardiovascular System
18. Coronary Artery Disease:-
a. Unstable Angina
b. Myocardial infraction with ejection less than 45%
19. Congestive Heart Failure- Left , Right
20. Cardiac Valvular Diseases with failure/complications
21. Cardiomyopathies
22. Heart disease with surgical intervention alongwith complications

VII Chest Diseases
23. Bronchiectasis
24. Interstitial Lung Disease
25. Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale)

VIII Diseases of the Digestive System
26. Cirrhosis of liver with ascities/chronic active hepatitis

IX Orthopaedic Diseases
27. Dislocation of vertebra/prolapse of intervertebral disc
28. Non union or delayed union of fracture
29. Post Traumatic Surgical amputation of lower extremity
30. Compound fracture with chronic osteomyelitis

X Psychoses
31. Sub-group under this head are listed for clarification
a. Schizophrenia
b. Endogenous depression
c. Manic Depressive Psychosis (MDP)
d. Dementia

XI Others
32. More than 20% burns with infection/complication
33. Chronic Renal Failure
34. Reynaud’s disease/Burger’s disease.

In addition to the above list, Director General/Medical Commissioner are authorised to sanction ESB for a maximum period up to 730 in cases of rare but treatable diseases or under special circumstances, such as, adverse reaction to drugs which have not been included in the above list, depending on the merits of each case, on the recommendations of RDMC/AMO or either authorised officers running the medical scheme.

To be entitled to the Extended Sickness Benefit an Insured Persons should have been in continuous employment for 2 years or more at the beginning of a spell of sickness in which the disease is diagnosed and should also satisfy other contributory conditions.

According to Section 69, employer shall be liable for payment of excess sickness benefit, if the sickness to the insured person/ employee is caused by the negligence and improper maintenance & no cleanliness of factory or establishment.


50. MATERNITY BENEFIT.

As prescribed by the central government,
Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:-
  • Confinement-payable for a period of 12 weeks (84 days)
  • Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days) from the date following miscarriage.
  • Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period not exceeding one month.
  • In the event of the death of the Insured Woman during confinement leaving behind a child, Maternity Benefit is payable to her nominee
  • Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to the average daily wage..

51. DISABLEMENT BENEFIT.


As prescribed by the central government
  • Temporary disablement benefit (TDB)
Eligibility for TDB:
  • The benefit is not subject to any contributory conditions. An Insured Person is eligible from the day he joins the insurable employment.
  • TDB Rate is 40% over and above the normal sickness benefit rate. This works out to nearly 85% of the average daily wages.
Duration of TDB:

There is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a Temporary Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid sickness benefit, if otherwise eligible.

Permanent Disablement Benefit (PDB)


PDB is payable to an Insured Person who suffers permanent residual disablement as a result of EI (including Occupational Diseases) and results in loss of earning capacity. The PDB rate is calculated as percentage of loss of earning capacity as assessed by the Medical Board.

Employer will be liable for the accidents caused to his employer in the following circumstance
  • Accident caused to an employee even if he obeyed the safety instruction of his employer [Section 51B]
  • Accident caused to employee while travelling in employer’s transportation vehicles. [Section 51C]
  • At the time of employment the accident caused to the employee while protection or rescuing other employer from occurring accident. [Section 51D]
  • An accident occurring to an employee while commuting from his residence to the place of employment for duty or from the place of employment to his residence after performing duty, shall be deemed to have arisen out of and in the course of employment. [Section 51E] (2010 amendment)

DEPENDANTS' BENEFIT. [Section 52]

As prescribed by the central government,

the dependants’ benefit is payable to the dependants in cases where an Insured Person dies as result of Employment Injury. The minimum rate of dependants’ benefit w.e.f 1.1.90 is Rs.14/- per day and these rates of the dependants’ benefit are increased from time to time. The latest enhancement is with effect from 01.08.2002


MEDICAL BENEFIT. [Section 56]


As prescribed by the central government,

Employer or his family members are entitled to the medical benefit. In case of the retirement of the employer his spouse shall be eligible to receive medical benefit subject to payment of contribution. In case of permanent disablement by the employee, he can get medical benefit till the date of his retirement. Maximum age for the retirement is 60 years.

Benefit not assignable or attachable. [Section 60]
  • The right to receive any payment of any benefit under this Act shall not be transferable or assignable.
  • No cash benefit payable under this Act shall be liable to attachment or sale in execution of any decree or order of any Court.

[Section 59B]

The Corporation can establish medical colleges, nursing colleges and training institutes for its Para-medical staff and other employees with a view to improve the quality of services provided under the Employees' State Insurance Scheme.


RECIPIENTS OF SICKNESS OR DISABLEMENT BENEFIT TO OBSERVE CONDITIONS. [Section 64]

A person who is in receipt of sickness benefit or disablement benefit (other than benefit granted on permanent disablement)-
  • should remain under medical treatment at a dispensary, hospital, clinic or other institution provided under this Act and shall carry out the instructions given by the medical officer or medical attendant in charge thereof;
  • should not while under treatment do anything and have chances of recovery;
  • shall not leave the area in which medical treatment provided by this Act is being given, without the permission of the medical officer, medical attendant or such other authority as may be specified in this behalf by the regulations; and
  • Should allow himself to be examined by any duly appointed medical officer or other person authorized by the Corporation in this behalf.


BENEFITS NOT TO BE COMBINED. [Section 65]


(1) An insured person shall not be entitled to receive for the same period-

(a) both sickness benefit and maternity benefit;

(b) both sickness benefit and disablement benefit for temporary disablement; or

(c) both maternity benefit and disablement benefit for temporary disablement.

(2) Where a person is entitled to more than one of the benefits mentioned in sub-Section (1), he shall be entitled to choose which benefit he shall receive.


EMPLOYER NOT TO DISMISS OR PUNISH EMPLOYEE DURING PERIOD OF SICKNESS, ETC. [Section 73]


No employer shall dismiss, discharge, or reduce or otherwise punish an employee during the following circumstances
  • sickness
  • maternity leave
  • pregnancy or confinement
  • under the treatment in the hospital
  • temporary disablement

CHAPTER VI

ADJUDICATION OF DISPUTES AND CLAIMS




CONSTITUTION OF EMPLOYEES' INSURANCE COURT. [Sec 74]
  • The Court shall consist of such number of Judges as the State Government may think fit.
  • Any person who is or has been a judicial officer or is a legal practitioner of 5 years' standing shall be qualified to be a Judge of the Employees' Insurance Court.
  • The State Government may appoint the same Court for two or more local areas or 2 or more Courts for the same local area.
  • Where more than one Court has been appointed for the same local area, the State Government may by general or special order regulate the distribution of business between them.

75. MATTERS TO BE DECIDED BY EMPLOYEES' INSURANCE COURT.


If any question or dispute arises as to-
  • Payment of pay the employee's contribution
  • Payment of benefits and duration.
  • the rate of contribution payable by a principal employer in respect of any employee
  • dispute between a principal employer and the Corporation, or between a principal employer and an immediate employer or between a person and the Corporation or between an employee and a principal or immediate employer,

[Section 75 (2A)]

The following claims shall be decided by the Employees' Insurance Court, namely:-
  • claim for the recovery of contributions from the principal employer;
  • claim by a principal employer to recover contributions from any immediate employer;

[Section 77 (1A)]


Every such application shall be made within a period of three years from the date on which the cause of action arose.

[Section 82 (3)]


Appeal can be made to high court after the ESI courts. The period of limitation for an appeal to the high court of that state should be within 60days when there is question law.

CHAPTER VII:

PENALTIES

 

SECTION

REASON

PENALITY

84

  • Whoever, for the purpose of causing any increase in payment
  • Whoever, for the purpose of causing any payment or benefit to be made where no payment
  • Whoever, for the purpose of avoiding any payment to be made by himself under this Act
  • Whoever, enabling any other person to avoid any such payment, knowingly makes
  • Whoever, made any false statement or false representation,


punishable with imprisonment for a term which may extend to 6 months, or with fine not exceeding 2000/- rupees, or with both.

 

PROVIDED that where an insured person is convicted under this Section, he shall not be entitled for any cash benefit under this Act for such period as may be prescribed by the Central Government.

85

fails to pay any contribution which under this Act he is liable to pay

imprisonment for a term which may extend to 3 years but which shall not be less than one year,

in case of failure to pay the employee's contribution which has been deducted by him from the employee's wages

fine of 10,000/-  rupees and imprisonment which shall not be less than six months

  • fails or refuses to submit any return required by the regulations, or makes a false return,
  • deducts or attempts to deduct from the wages of an employee the whole or any part of the employer's contribution,
  • obstructs any Inspector or other official of the Corporation in the discharge of his duties,

Imprisonment for a term which may extend to one year or with fine which may extend to 4000/- rupees, or with both.

85A

Repeated failure by the employer to pay any contribution which under this Act he is liable to pay,

Imprisonment for a term which may extend to 5 years but which shall not be less than 2 years and shall also be liable to fine of 25,000/- thousand rupees.



POWER OF STATE GOVERNMENT TO MAKE RULES. [Section 96]

The State Government may, after consultation with the Corporation, subject to the condition of previous publication, make rules not inconsistent with this Act in regard to all or any of the following matters, namely-
  • the constitution of Employees' Insurance Courts, the qualifications of persons who may be appointed Judges thereof, and the conditions of service of such Judges;
  • the procedure to be followed in proceedings before such Courts and the execution of orders made by such Courts;
  • the fee payable in respect of applications made to the Employees' Insurance Court, the costs incidental to the proceedings in such Court, the form in which applications should be made to it and the particulars to be specified in such applications;
  • the establishment of hospitals, dispensaries and other institutions, the allotment of insured persons or their families to any such hospital, dispensary or other institution;
  • the scale of medical benefit which shall be provided at any hospital, clinic, dispensary or institution, the keeping of medical records and the furnishing of statistical returns; the nature and extent of the staff, equipment and medicines that shall be provided at such hospitals, dispensaries and institutions;
  • the conditions of service of the staff employed at such hospitals, dispensaries and institutions; and
  • any other matter which is required or allowed by this Act to be prescribed by the State Government.