ESI Guide

Applicability

To all establishments engaging more than 20 workers (establishments are covered only if the area is a ‘Notified Area’ under the scheme.

Wages

Applicable to those persons earning wages of upto Rs 15,000/- (Includes Basic, DA and all allowances payable as cash)

Supreme Court Case Law – ESI Not applicable on Conveyance Allowance

Contributions

4.75     of wages by employer

1.75 % of wages by employee

Time for payment of contribution

An employer who is liable to pay contributions in respect of any employee shall pay those contributions within 21 days of the last day of the calendar month in which the contributions fall due;

ESI RETURNS

Return of contributions to be sent to appropriate office

Return of contributions to be submitted in quadruplicate in Form 6 – Returns of Contribution along with receipted copies of challans for the amounts deposited in the Bank, to the appropriate office by registered post or messenger, in respect of all employees for whom contributions were payable in a contribution period, so as to reach that office within 42 days of the contribution period to which it relates.

Register of employees

Every employer shall maintain a register in Form 7 in respect of every employee of his factory or establishment.

BENEFITS

Benefits under ESI Act

1. Sickness Benefit
2. Maternity Benefit
3. Disablement Benefit
4. Dependants Benefit
5. Funeral Expenses

What is Sickness benefit ?

A person shall be qualified to claim sickness benefit for sickness occurring during any benefit period if the contribution in respect of him were payable for not less than 78 days in the corresponding contribution period and shall be entitled to receive such benefit at the daily standard benefit rate for the period of his sickness:

In case of a person who becomes an employee within the meaning of the Act for the first time and for whom a shorter contribution period of less than 156 days is available, he shall be qualified to claim sickness benefit if the contribution in respect of him were payable for not less than half the number of days available for working in such contribution period:

Sickness benefits shall not be paid to any person for more than ninety-one days in any two consecutive benefit periods.

The daily rate of sickness benefits in respect of a person during any benefit period shall be the “standard benefit rate” specified in rule 54 corresponding to the average daily wages of that person during the corresponding contribution period.

What is Dependants’ benefits ?

(1) Dependants’ benefit shall be paid to the dependants of the insured person who dies as a result of an employment injury, in the following manner:–

(A) In the case of death of the insured person, the dependants’ benefits shall be payable to his widow,  children and widowed mother as follows:–

(a) to the widow during life until remarriage, an amount equivalent to three-fifths of the full rate and, if there are two or more widows, the amount payable to the widows as aforesaid shall be divided equally between the widows;

(b) to each legitimate or adopted son, an amount equivalent to two-fifths of the full rate until he attains the age of eighteen years:

PROVIDED that in the case of a legitimate or adopted son who is infirm and who is wholly dependent on the earnings of the insured person at the time of his death, dependants’ benefits shall continue to be paid while the infirmity lasts;

(c) to each legitimate or adopted unmarried daughter, an amount equivalent to two-fifths of the full rate until she attains the age of eighteen years or until marriage, whichever is earlier:

PROVIDED that in the case of legitimate or adopted unmarried daughter who is infirm and is wholly dependent on the earnings of the insured person at the time of his death, dependants’ benefit shall continue to be paid while the infirmity lasts and she continues to be unmarried:

PROVIDED FURTHER that if the total of the dependants’ benefit distributed among the widow or widows and legitimate or adopted children and widowed mother of the deceased person as aforesaid exceeds at any time the full rate, the share of each of the dependants shall be proportionately reduced, so that the total amount payable to them does not exceed the amount of disablement benefits at the full rate.

(d) to the widowed mother during life an amount equivalent to two-fifth of the full rate.

(B) In case the deceased person does not leave a widow or legitimate or adopted child or widowed mother, dependant’s benefit shall be payable to other dependants as follows:

(a) to a parent other than the widowed mother or grand-parent, for life, at an amount equivalent to three-tenths of the full rate and if there are two or more parents (other than widowed mother) or grand-parents the amount payable to the parents (other than widowed mother) or grand-parents as aforesaid shall be equally divided between them;

(b) to any other–

(i) male dependant, until he attains the age of eighteen years,

(ii) female dependant, until she attains the age of eighteen years or until marriage, whichever is earlier or if widowed, until she attains eighteen years of age or remarriage, whichever is earlier;

at an amount equivalent to two-tenths of the full rate:
PROVIDED that if there be more than one dependant under clause (b), the amount payable under this clause shall be equally divided between them.

(2) (a) The daily rate of dependant’s benefit shall be forty per cent more than the “standard benefit rate” specified in rule 54 rounded off to the next higher multiple of five paise corresponding to the average daily wages in the contribution period corresponding to the benefit period in which the employment injury occurs.

(b) Where an employment injury occurs before the commencement of the first benefit period in respect of a person, the daily rate of dependant’s benefit shall be :

(i) where a person sustains employment injury after the expiry of the first wage period in the contribution period in which the injury occurs, the rate, forty per cent more than the standard benefit rate rounded off to the next higher multiple of five paise corresponding to the wage group in which his average daily wages during that wage period fall;

(ii) where a person sustains employment injury before the expiry of the first wage period in the contribution period in which the injury occurs, the rate, forty per cent more than the standard benefit rate, rounded off to the next higher multiple of five paise corresponding to the group in which wages actually earned or which would have been earned had he worked for a full day on the date of accident/fall.

Explanation : Dependant’s benefit rate calculated as aforesaid shall be called “full rate”.

Funeral expenses

The amount of funeral expenses for the purpose of clause (f) of sub-section (1) of section 46 of the Act was two thousand and five hundred rupees and now has been enhanced to Rs. 5000/-.

Disablement benefits

A person shall be qualified to claim disablement benefits for temporary disablement for not less than three days (excluding the days of accident) for the period of such disablement sustained as an employee under the Act.

A person shall be qualified to claim periodical payment for permanent disablement sustained as an employee under the Act, whether total or partial, for such disablement:

PROVIDED that where permanent disablement, whether total or partial, has been assessed provisionally for a limited period or finally, the benefit provided under this rule shall be payable for that limited period, or as the case may be, for life.

(3) (a) The daily rate of disablement shall be forty per cent more than the standard benefit rate specified in rule 54 rounded to the next higher multiple of five paise corresponding to the average daily wages in the contribution period corresponding to the benefit period in which the employment injury occurs.

(b) Where an employment injury occurs before the commencement of the first benefit period in respect of a person, the daily rate of disablement shall be–

(i) where a person sustains employment injury after the expiry of the first wage period in the contribution period in which the injury occurs, the rate, forty per cent more than the standard benefit rate rounded off to the next higher multiple of five paise corresponding to the wage group in which his average daily wages during that wage period fall;

(ii) where a person sustains employment injury before the expiry of the first wage period in the contribution period in which the injury occurs, the rate, forty per cent more than the standard benefit rate, rounded off to the next higher multiple of five paise corresponding to the group in which wages are actually earned or which would have been earned, had he worked for a full day on the date of accident, fall.

(4) The disablement benefits shall be payable to insured person as follows:

(a) for temporary disablement, at the full rate;

(b) for permanent total disablement, at the full rate;

(c) for permanent partial disablement resulting from an injury specified in Part II of the Second Schedule, at such percentage of the full rate which would have been payable in the case of permanent total disablement, as specified in the said Schedule as being the percentage of the loss of earning capacity caused by the injury;

(d) for permanent partial disablement resulting from an injury not specified in Part II of the Second Schedule, at such percentage of the full rate payable in the case of permanent total disablement as is proportionate to the loss of earning capacity permanently caused by the injury.

Explanation : Where more injuries than one are caused by the same accident, the rate of benefit payable under clauses (c) and (d) shall be aggregated but not so in any case as to exceed the full rate and in cases of disablement not covered by clauses (a), (b), (c) and (d) at such rate, not exceeding the full rate, as may be provided in the regulations

Maternity benefits

An insured woman shall be qualified to claim maternity benefits for a confinement occurring or expected to occur in a benefit period, if the contributions in respect of her were payable for not less than seventy days in the immediately preceding two consecutive contribution periods.

Subject to the provisions of the Act and the regulations, if any, an insured woman who is qualified to claim maternity benefits in accordance with sub-rule (1) shall be entitled to receive it at the daily rate specified in sub-rule (5) for all days on which she does not work for remuneration during a period of twelve weeks of which not more than six weeks shall precede the expected date of confinement:

PROVIDED that where the insured woman dies during her delivery or during the period immediately following the date of her delivery for which she is entitled to maternity benefits, leaving behind in either case, the child, maternity benefits shall be paid for the whole of that period but if the child also dies during the said period, then for the days up to and including the day of the death of the child, to the person nominated by the insured woman, in such manner as may be specified in the regulations, and if there is no such nominee, to her legal representative.

(3) An insured woman who is qualified to claim maternity benefits in accordance with sub-rule (1) shall, in case of miscarriage or medical termination of pregnancy, be entitled, on production of such proof, as may be required under the regulations, to maternity benefits at the rates specified in sub-rule (5), for all days on which she does not work for remuneration during a period of six weeks immediately following the date of her miscarriage or medical termination of pregnancy.

Declaration by persons in employment on appointed day

The employer in respect of a factory or an establishment shall require every employee in such factory or establishment to furnish and such employee shall on demand furnish to him either before or on the appointed day correct particulars required for the purpose of Form 1 (hereinafter referred to as the Declaration Form).  Such employer shall enter the particulars in the Declaration Form including the temporary Identification Certificate, and obtain the signature or the thumb-impression of such employee and also complete the form as indicated thereon.

Declaration by persons engaged after the appointed day

(1) The employer in respect of a factory or an establishment shall, before taking any person into employment in such factory or establishment after the appointed day, require such person (unless he can produce an Identity Card or other document in lieu thereof issued to him under these regulations) to furnish and such person shall on demand furnish to him correct particulars required for the Declaration Form including the Temporary Identification Certificate.  Such employer shall enter the particulars in the Declaration Form including the Temporary Identification Certificate and obtain the signature or the thumb-impression of such person and also complete the form as indicated thereon.

(2) Where an Identity Card is produced under such sub-regulation (1), the employer shall make relevant entries thereon.

Declaration form to be sent to appropriate office

The employer shall send to the appropriate office by registered post or messenger, all declaration forms without detaching the temporary identification certificate prepared under these regulations together with a return in duplicate in Form 3 within 10 days of the date on which the particulars for the declaration forms were furnished.

Allotment of insurance number

On receipt of the return required under regulation 14, the appropriate office shall promptly allot an insurance number to each a person in respect of whom the Declaration Form has been received unless it finds that the person had already been allotted an insurance number.  The temporary identification certificate with insurance numbers marked thereon shall be detached and returned to the employer along with one copy of Form 3.  The employer shall deliver the temporary identification certificate to the employee to whom it relates, after obtaining his signature or thumb-impression thereon except in the case of an employee to whom a certificate of employment has been issued under Regulation 17A.  The Insurance Number allotted by the regional office to an employee and indicated in the copy of Form 3 returned to the employer, shall be entered by the employer on the register of employees (Form 7) and return of contributions.

Registration of families

On the issue of notification under regulation 95A, specifying the date from which the family of an insured person shall also be entitled to medical benefit under the Act, every insured person who has not furnished the particulars of his family at the time of his registration under the Act, shall furnish to the employer correct particulars in respect of his family in Form 1A.  The employer  shall enter the particulars in the form and obtain the signature or the thumb-impression of such person and complete the form as indicated thereon and send it to the appropriate office within 10 days of the date on which the particulars were furnished.

Changes in family particulars

An insured person shall intimate all changes in the membership of the family as defined under the Act, to the employer within 15 days of such change having occurred and the employer shall enter such particulars in Form 1B and shall forward it to the appropriate office within 10 days of the date on which the particulars were furnished.

Identity cards

The appropriate office shall arrange to have an identity card prepared in Form 4 for each person in respect of whom an insurance number is allotted and shall include in such card the particulars of the family entitled to medical benefit under regulation 95A and shall send all such identity cards to the employer.  Such employer shall if and when the employee has been in his service for 3 months,  obtain the signature or thumb-impression of the employee on the identity card and shall after making relevant entries thereon, deliver the identity card to him. The employer shall obtain a receipt from the employee for the Identity Card.  The Identity Card in respect of an employee who has left employment before 3 months shall not be given to him, but shall be returned to the appropriate office as soon as possible.  The Identity Card shall not be transferable.