ESI
ESI (Employee’s State Insurance)
The Employee’s State Insurance Act, of 1948 was introduced as a health insurance scheme that provides financial funds for industrial workers in cases of sickness, maternity, and employment injuries in factories. The scheme applies to non-seasonal factories that use electricity and have 10 or more employees and for non-electricity factories having more than 20 employees. In this article, we look at the Employee’s State Insurance scheme in detail.
Scheme Objective
- To improve the health and welfare of the insured employees.
- To intervene in the recovery and re-employment of the disabled and the injured.
- To appoint inspectors for the act.
- To determine contribution and for verification purposes.
Applicability
The scheme is applicable under the following criteria:
- All the factories and shops that have 20 or more employees.
- Government-specified enterprises.
The scheme is not applicable for
- Seasonal factories that produce cotton ginning, cotton or jute pressing, ground nuts decoration, coffee manufacturing, indigo, lac, rubber, sugar, and tea.
- Factories, not more than seven months since started and have been employed in blending, packing, or repacking tea or coffee, or in other processes as authorized by Central Government
- Factories that are spared as seasonal from the provisions of the act.
- Mines, railway running sheds, government factories, or establishments.
- Indian naval, military, or air force.
- Other governments notified enterprises.
Scheme Contribution
The funding for the scheme is made by the employers and by the employees. The employers have to contribute 4.75% of the payable wages whereas the employees have to contribute 1.75% of their wages. There is no requirement when the average daily wage in a wage period is equal to or less than Rs. 40. It is the employer’s responsibility to deposit his contribution as well as his employee’s contribution to the ESI account. All contributions have to be made properly and non-availability of funds cannot be accepted for non-availability of funds. There are no ways to ignore contributions, damages, and interests. The employer has to register the factory or the enterprise within 15 days with the ESI Corporation, once the act is applicable to the company. In addition to this, the employer has to obtain the employer’s code number. This code number is issued by the regional office that has to be quoted in documents and correspondence.
Medical Benefit
Full medical care is provided to all persons registered under ESI and their family members – from the day the person enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured Person or his family member. Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of Rs.120/-.
Sickness Benefit
Sickness benefit in the form of cash compensation at the rate of 70% of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. To qualify for sickness benefits, the insured worker is required to contribute for 78 days in a contribution period of 6 months. Workers suffering from malignant and long-term diseases can claim extended sickness benefit for up to two years at an enhanced rate of 80% of wages. Also, 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.
Maternity Benefit
Maternity benefit for confinement/pregnancy is provided for three months, which is extendable by a further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year.
Disablement Benefit
From the day of entering insurable employment and irrespective of having paid any contribution, 90% of the wage is payable so long as the temporary disability continues. Permanent disablement benefit is payable at the rate of 90% of wage in the form of the monthly payment, in case of permanent disablement based on the extent of loss of earning capacity as certified by a Medical Board.
Dependant Benefit
Dependant benefit is paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased insured person, in cases death occurs due to employment injury or occupational hazards.
Funeral Expenses
An amount of Rs.10,000/- is payable to the dependents or to the person who performs the last rites from day one of entering insurable employment.
Unemployment Allowance
Under the Rajiv Gandhi Shramik Kalyan Yojana, unemployment allowance is payable to an insured person who becomes unemployed after being insured for three or more years, due to closure of factory/establishment, retrenchment, or permanent invalidity. The applicable unemployment allowances provided are:
- Unemployment Allowance is equal to 50% of wage for a maximum period of up to one year.
- Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives unemployment allowance.
- Vocational Training provided for upgrading skills – Expenditure on fee/traveling allowance borne by ESIC.
Adjudication of Dispute and Claims
- Employees Insurance Court
- Institutions of proceedings, etc
- Powers of employees’ Insurance Court
- Reference to High Court
- Appeal
- Stay of payment during pending the appeal
Offenses and Penalties
Depending on the offenses committed by the employees, the penalty charges vary. They are given below:
- If there is a false statement or false representation, then the employee shall be punished by imprisonment or with a fine of Rs. 2000, sometimes both.
- If a person fails to pay any liable contribution, then the employee shall be punished with 3 years of imprisonment.
- If a person engages in violations such as dismissing, discharging, or punishing an employee, shall be punished with 4 years of imprisonment or with a fine of Rs. 4000, sometimes both.
- If an employer does not obey an order given by the court, then the employer shall be punished with imprisonment and a fine of Rs. 1000 per day.
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