Preliminary

Object of the act:

To provide for certain benefits to employees in case of sickness, maternity and injury during employment and
to make provision for certain other matters in relation thereto.

The employees state insurance act,1948

Applicability of the act:

Under Section 2(12) The Act is applicable to the factories employing 10 (Ten) or more persons irrespective
of whether power is used in the process of manufacturing or not.

Under Section 1(5) of the Act, the Scheme has been extended to shops, hotels, restaurants, cinemas
including preview theatre, road motor transport undertakings and newspaper establishment employing
20 (Twenty) or more persons.

Further, u/s 1(5) of the Act, the Scheme has been extended to Private Medical Institution and Educational
Institutions employing 20 (Twenty) or more persons in certain States .

The existing wage-limit for coverage under the Act, is Rs.15,000/- per month (excluding remuneration for
overtime) w. e. f:- May 01, 2010.

** Sec.2(12) :The definition of factory has segregated factories in two categories for coverage. Those
running with power and those without power. Those with power were included even though they
employed ten or more persons but those running without power were included only when they employ
twenty or more persons. This distinction has been removed and all those factories are covered if they
employ ten or more persons irrespective whether run with power or without power.

The employees state insurance act,1948
Applicability of the act:

AREAS COVERED

The ESI Act is applicable across the length and breadth of the India.

STATES
All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram.

UNION TERRITORIES
Delhi and Chandigarh

The employees state insurance act, 1948

Act does not apply to:

Seasonal factories engaged exclusively in any of the activities like: cotton ginning, cotton or jute pressing,
decoration of ground nuts, manufacturing coffee, indigo, lac, rubber, sugar, or tea or any manufacturing
process incidental to or connected with any of the afore said activities, and including factories engaged
 for a period not exceeding seven months in a year in blending, packing or repackaging tea or coffee, or in
such other processes as may be specified by the central govt.

The factories exempted as seasonal from the provisions of the act.

** Sec.2(9) The definition of employee excluded apprentices appointed under standing orders also
besides the apprentices appointed under the Apprentices Act 1961 The definition of employee now
includes apprentices appointed under standing orders but excludes only the apprentices appointed
under the Apprentices Act 1961.

The employees state insurance act, 1948

Act does not apply to:

Mines

Railway running sheds

Govt. factories or establishments and Indian naval, military, or air force

Other Govt. notified exempted establishments

The employees state insurance act, 1948

ACT AUTHORISATION

1. To Promote and measure for health and welfare of INSURED EMPLOYEES (IE)

2. Intervene for the rehabilitation and re-employment for disabled / injured

3. To appoint inspectors for purposed of the act

4. To determine the amount of contribution and relevant verification

The employees state insurance act, 1948

Employees state insurance corporation

Sec. 3 of this act provides for the establishment of ESIC by the central govt. for administration of the ESIS
according to the provision of this act. Such corporation shall be the body corporate having perpetual
succession and a common seal and can sue or be sued by on the said name.

Constitution:- sec.(4)

The Central govt. appoints a chairman, vice chairman, and other members of interest of employees,
employers, state govt./union territories, medical profession. 3 members of parliament and director general of
corporation are its ex- officio members.

The employees state insurance act, 1948

Employees state insurance corporation

POWERS AND DUTIES:-

 Sec. (19) empowers to promote measures for improvement of the health and welfare of the insured person
and rehabilitation and re- employment of insured person who have been disabled or injured and incur in respect
of such measure expenditure from the fund of the corporation within such limits as may be prescribed.

sec.(29) empowers:- (a) to acquire and hold property both movable and immovable, sell or otherwise transfer
the said property; (b) it can invest and re-invest moneys which are not immediately required for expenses and/or
realize such investment; (c) it can raise loan and discharge such loan with the previous section of the central
govt.; (d) it may constitute for the benefits of its staff or any class of them such provident or other benefit fund as
it may think fit. However power u/s 29 can be exercised subject to such conditions as may be prescribed by the
central govt.

The employees state insurance act, 1948

Employees state insurance corporation

WINGS OF ESIC:

1. STANDING COMMITTEE

2. MEDICAL BENEFITS COUNCIL

The employees state insurance act, 1948

Standing committee

Constitution: (sec. 8)

This is the committee of ESIC. It shall be constituted among its members, consisting of;

a) A Chairman appointed by the central govt.

b) 3 members of the ESIC appointed by the central govt.

bb) 3 members of the corporation representing such 3 state govt. thereon as the central govt. may, by
notification in the official gazette, specify from time to time.

c) 8 members elected by the corporation:-

- 3 members from among the members of ESIC representing the employers;

- 3 members from among the members of ESIC representing the employees;

- 1 member from among the members of ESIC representing the medical professional;

- 1 member from among the members of ESIC elected by parliament

d) The director general of ESIC, ex- officio.

The employees state insurance act, 1948

Standing committee

Empowered to:-
 1. Shall administer the affair of the corporation

2. Shall submit the consideration and decision of the corporations

3. Have discretion on other issues of corporation

the employees state insurance act, 1948
Medical Benefit Council

Duties :- sec. (22)

1. Advise to administration on Medical Benefit, purpose of grants and related matter

2. Have power and duties of INVESTIGATION as may be prescribed in relation to complaint against
Medical practitioner, its treatment and attendance

3. Perform other duties

The employees state insurance act, 1948

Inspectors- Duties- Powers

Duties -

1. Inquiring into the correctness in any return of contribution

2. Ascertaining Provision of the Act has been complied

3. Other authorized / specified duties by the corporation.

Powers -

1. To collect require and relevant information of employer / contractor or both

2. To enter org / contractor premises at reasonable time and examined relevant account books and
relevant documents, payment of wages etc.

3. To examine employer, contractor, his agent / servant or IE in factory / office

4. To make copies of extracts from any registrar, account books and other books of maintenance of org.

** Sec. 45 : It provides for appointment of Inspectors for implementing the provisions of the Act Now
these Inspectors are called Social Security Officers.

The employees state insurance act, 1948

Employer/ Employees Contribution

It is the principle employers responsibility to deposit his own as well as employees contribution in
respect of all employees including the contract labor, into the E.S.I. Account. Non-availability of funds
cannot be a ground for non-payment of contributions under the act. There is no provision to waive the
contribution, damages and interest.
 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.100/-.

The employees state insurance act, 1948

Employer/ Employees Contribution

The employer should get his factory or establishments registered with the E.S.I. Corporation within 15
days after the Act becoming applicable to it, and obtain the employers Code Number. The regional
officer will allot a code number to the employer, which must be quoted in all documents and
correspondence.

The employees state insurance act, 1948

Contribution Deposit & Due Date:

The amount of contribution (Employees and Employers share) is to be deposited with the authorized
bank (State Bank Of India) through Online Generated Challan, on or before 21st day of the Succeeding
month, of month following the calendar month.

If the employee is drawing up to Rs.100/- as daily average wage, he is exempt from the payment of his
share of contribution. The employer is however to pay employer's share of 4.75% of the salary received
by the employee.

The State Govt. bears one-eight share of expenditure on medical benefits with in the per capita ceiling of
Rs.1500/- per I.P. family per annum & all additional expenditure beyond the ceiling.

The employees state insurance act, 1948

Contribution Deposit & Due Date:

There are two contribution periods each of six months duration and two corresponding benefit periods
also of six months duration as under.

Contribution period Corresponding Cash Benefit period:-

The employees state insurance act, 1948

Benefits available to insured employee

The purpose of the Employee State Insurance Act is to provide benefits as detailed in the Act particularly
in section 46, to the insured persons or their dependants.

The following benefits are provided under section 46:-

1. Sickness benefit

2. Maternity benefit

3. Disablement benefit

4. Dependents benefit
 5. Medical benefit

6. Funeral expenses

The employees state insurance act, 1948

Sickness benefit

Every insured employee is entitled to the cash benefit for the period of sickness 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 (i.e. 6 months).

Cash benefit takes the form of periodical payment made to an insured person which is payable for
maximum numbers of 91 days in any two consecutive benefit periods. The benefit is not paid for the
first two days of sickness which is treated as the waiting period.

Insured persons suffering from long term diseases like T.B., leprosy, mental, heart etc. and who have
been continuous employment for two years are entitled to get sickness benefit period up to 309 days.

The employees state insurance act, 1948

Sickness benefit

Claim form under ESI Act:- Form - 09

Extended Sickness Benefit:

Extended Sickness Benefit is a Cash Benefit paid for prolonged illness due to any of the 34 specified diseases as
per (Annexure A).

Eligibility for SB:- 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.

Maximum Duration of ESB:- ESB shall be payable for a period of 124 days initially and may be extended up to
309 days in chronic suitable cases by Regional Dy. Medical Commissioner/Medical Referee/Administrative
Medical Officer/Chief Executive of the E.S.I. Scheme in the State or his nominee on the report of the specialist(s).

The employees state insurance act, 1948

Sickness benefit

Enhanced Sickness Benefit:

Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7
days/14 days for male and female workers respectively.

The employees state insurance act, 1948

Maternity benefit
 A periodical cash benefit is payable to an insured woman employee, in cash of confinement, miscarriage,
medical termination of pregnancy, premature birth of a child or sickness arising from pregnancy etc.

Eligibility for MB:-

The contribution condition is the same as for Sickness Benefit. The daily benefit rate is double the Sickness
Benefit rate and is thus roughly equivalent to the full wages. Benefit is paid for Sundays also.

The employees state insurance act, 1948

Maternity benefit

The Benefit is paid as follows:-

(a) For Child Delivery:- For a total period of 12 weeks beginning not more than

6 weeks before the expected date of child birth. (form 21& 23)

(b) For Miscarriage:- payable for 6 weeks from the date following miscarriage (Form 20 & 23)

(c) For Sickness arising out of pregnancy, confinement, premature birth of child or miscarriage:- For an
additional period of up to 04 weeks. (form 8, 9, &10)

Medical Bonus:-

Medical Bonus is lump sum payment made to an insured woman or the wife of an insured person in case she
does not avail medical facility from an ESI hospital at the time of delivery. The amount of Bonus is Rs. 5000/-.

The employees state insurance act, 1948

Disablement benefit

It is payable to an employee who is injured in the course of his employment and is permanently or
temporarily disabled or contacts any occupational disease.

Temporary disablement:-

1) A person who sustains temporary disablement for not less than 3days(excluding the day of accident) shall be
entitled to periodical payment as may be prescribed by the central govt.

2) From day one of entering insurable employment & irrespective of having paid any contribution in case of
employment injury. Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability
continues.

The employees state insurance act, 1948

Disablement benefit

Permanent disablement:-

the benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent
of loss of earning capacity as certified by a Medical Board.
 the daily benefit rate for commutation from Rs. 5 to Rs. l0 and the maximum commuted value of Rs.
30000 to Rs. 60000/- at the time of commencement of final award of permanent disability.

Claim form under ESI Act:-

For Temp. Disablement:- Form 09

For Per. Disablement:- Form 14

The employees state insurance act, 1948

Dependents benefit

Dependents benefit is paid as family pension to the dependants of a deceased insured person in the event
of death due to employment injury or occupational disease and is equivalent to about 90% of the wages.

Eligible Members:

A widow can receive this benefit on a monthly basis for life or till her re-marriage.

A son or daughter can receive this benefit till twenty five years of age.

Other dependants like parents including a widowed mother etc. can also receive this benefit under certain
conditions.

The first installment is payable within a maximum of three months following the death of an insured
person and therefore, on a regular monthly basis.

The employees state insurance act, 1948

Dependents benefit

Claim form under ESI Act:- Form 15 & 16

** Sec.2(6-A) :

The definition of dependant included only a minor legitimate or adopted son.

However, the scope of the definition has been widened to include legitimate or adopted son who has not
attained the age of twenty five years.

** Sec.2(11) :

The definition of family included only those parents who are dependant of the insured person. it excluded a
minor brother or sister even though they were wholly dependent up on the earnings of the insured person. The
definition of family now includes also those parents who have some source of income subject to a limit
prescribed by the Central government as well as a minor brother or sister if their parents are not alive and the
insured person is not married and they are wholly dependent up on the earnings of the insured person.
 The employees state insurance act, 1948
Medical benefit

The ESI Scheme provides full range of Medical Care to all Insured person and their family, through a
network of ESI Dispensaries, Hospitals & Panel clinics, Diagnostic centers & Super Specialty.

Super- Specialty treatment such as:- Open Heart Surgery, Neuro Surgery, Bone Marrow Transplant,
Kidney Transplant or specialized investigations like CAT scan, MRI, Angiography etc.

Eligibility for MB:- An employee who is covered under the Scheme for the first time is eligible for medical
care for a period of three months. If employee contributes at least for 78 days in a contribution period the
eligibility is there up to the end of the corresponding benefit period.

Claim form under ESI Act:- Form - 09

The employees state insurance act, 1948

Funeral Expenses

Funeral expenses are in the nature of a lump sum payment unto a maximum of Rs. 10,000/- (revised w.e.f
:- May 2010) made to defray the expenditure on 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.

Claim form under ESI Act:- Form 22

Others Benefits:-

1. Rehabilitation Allowance:- Rehabilitation in case of disabled insured persons under 45 years of age
with 40 percent or more disablement.

2. Free Supply:- Free Supply of physical aids and appliances such as crutches, wheelchairs, dentures,
spectacles and other such physical aids.

3. Old Age Medical Care:- Old age Medical care for self and spouse at a nominal contribution of Rs. 120/-
per annum.

4. Rajiv Gandhi Shramik Kalyan Yojana:- Unemployment Allowance is payable to those workers facing
involuntary unemployment due to closure of factory or non-employment injury. Benefit rate which is just above
50% of the daily wages for max 01 year.

** Rule 59 : Existing limit of funeral expenses is Rs. 5000/- Revised to Rs.10000/-

The employees state insurance act, 1948

Adjudication of dispute & claims

The employees state insurance act, 1948

Adjudication of dispute & claims

Employees Insurance Court

 Institutions of proceedings, etc.

Powers of employees Insurance Court

Reference to High Court

Appeal

Stay of payment during pending of appeal

The employees state insurance act, 1948

Offences and penalties

Punishment for false statement:- In this case any false statement or false representation, shall be
punishable with imprisonment or fine up to Rs.2000 or with both

Punishment for failure to pay contributions:- if any person fails to pay any contribution which under to
this act he is liable to pay, he shall be punishable with imprisonment up to three years.

Punishment for other contravention:- in contraventions like dismisses, discharges, reduces or otherwise
punishes an employee, shall be punishable with imprisonment up to one year or with fine up to Rs.4000
or with both

The employees state insurance act, 1948

Offences and penalties

Power to recover damages:- If employer fails to pay the amount of contribution then corporation may
recover from the employer by way of penalty.

Power of court to make orders:- If court makes order for employer- if employer is not able to make this
order within period then employer shall be punishable with imprisonment in respect thereof U/S.85 and
shall also be liable to pay fine up to Rs.1000 for everyday.

The employees state insurance act, 1948

Miscellaneous Provisions

Exemption of a factory or establishment:- (sec.87)

Exemption may be granted to any factory or establishment for maximum period of one year.

Any exemption granted shall be notified by the notification in the Official Gazette.

The appropriate Govt. while granting exemption can improve any terms and conditions upon the
factory/establishment.

If required any exemption can be renewed for max. one year

Before granting any exemption Corp. must be given opportunity to make representation which has to be
considered by the Govt.

Exemption of persons or class of persons (sec.88)

 App. Govt. is authorized to exempt any person or class of person from the operation of the act

Any exemption granted shall be notified by the notification in the Official Gazette.

Such person or class of persons must be working in a factory/establishment

Any exemption granted shall be accompanied with such conditions as the appropriate Govt. may think fit
to impose

Exemption of a factory or establishment belonging to Govt./any local authority

App.Govt. must consult the Corporation

Any exemption granted shall be notified by the notification in the Official Gazette.

Exemptions shall always be subj. to the conditions imposed by the Govt.

Exemptions shall always be in order only if the employees in any such factory/establishment are already
in receipt of benefits substantially similar or superior to the benefits provided under this act.

Exemption from one or more provisions of the act (sec.91)

Exemption may be granted to any factory or establishment or any person or class of person by
App.Govt.

Any exemption granted shall be notified by the notification in the Official Gazette.

Any exemption granted under the sec.87,88,90 or 91 in respect of any person or class of person may be
enforced either prospectively or retrospectively the date of its enforcement has to be specified (sec.91-A)

The employees state insurance act, 1948

Obligation of the Employers

1). Get your Factory / establishment registered with in 15 days after the Act becomes applicable. Submit Form 01
to the Regional office for this purpose. Obtain Employers code No. for use in all ESIC Forms / documents and
correspondence with the offices of the ESI Corporation.

2). Fill up Declaration Forms in respect of all coverable employees and submit the same to the Regional Office/
Local Office of the corporation well before the Appointed Day and obtain insurance Numbers from the
concerned Local Office/ Regional Office, In respect of newly appointed employees, fill up the declaration form
soon after appointment of such employees and submit the same to the Local Office Concerned.

The employees state insurance act, 1948

Obligation of the Employers

3). Pending receipt of identity cards/ identity certificates you may issue certificate of employment in Form 86 to
the covered employee(s) enabling them to avail cash/medical Benefits

4). Pay ESI contribution (Employee's Share @4.75% and the Employers share @ 1.75% of the wages) with in 21
days of the month following, in which the wages fall due.
5).Maintain an Accident Book as prescribed under the Factory Act / ESI Act.

The employees state insurance act, 1948

Obligation of the Employers

6).Submit an Accident Report to the Local Office / ESI Dispensary concerned immediately in respect of accidents
that could result in death or disablement and within 24 hours of its occurrence otherwise. Minor accidents which
do not cause absence from work need not be reported

7).Grant leave to insured employees on the basis of sickness certificates issued by any authorized ESI doctor.