ESI Benefits

The Employees’ State Insurance Act, 1948 is one of the most important laws that provide social security. It contains six kinds of ESI benefits that injured employees can avail. All of these benefits must arise in the course of employment in order to enable workers to access them.

ESI Benefits

Section 46 of the Act describes all benefits that an injured employee can avail. It is important to note that a worker can avail these benefits in the course of employment only.

For example, if a worker suffers an injury, this injury must be an employment injury only.

Section 2(8) says that an employment injury is a personal injury that an employee suffers. Such injury must be the result of an accident or occupational disease that arises out of employment.

Apart from benefits related to injuries and sickness, some ESI benefits can arise after maternity as well. The ESI Corporation provides some compensation and financial support to employees during these periods.

The following are some ESI benefits that employees can avail under the ESI Act

• Medical benefit
• Sickness benefit
• Maternity benefit
• Dependants benefits
• Disablement benefits
• Other benefits

1. Medical benefit

Every insurable employee under the Act gets medical benefits the day he becomes an employee. This benefit extends to his family members as well. This medical benefit has no ceiling in terms of expenditure on healthcare.

Hence, the ESI Corporation takes care of all treatment expenses as per its rules.

Apart from general healthcare benefits, retired and permanently disabled workers also get an annual premium of Rs. 120. This benefit extends to the spouses of the workers as well.

Learn more about the Employees State Insurance Act, 1948 here in detail

2. Sickness benefit

Insurable employees under the Act can draw some cash compensation in case they fall sick. This compensation is generally 70% of their wages during the period of sickness for a maximum of 91 days in a year.

In order to avail this sickness benefit, a worker must pay his contribution for 78 days out of 6 months. Hence, he cannot seek this benefit if he contributes for less than 78 days.

3. Maternity benefit

All female insurable employees can avail maternity benefits under the Act in cases of pregnancy or confinement.

Confinement, in this case, means labour which results in the birth of a living child. It can also mean birth after 26 weeks of pregnancy, whether the child is living or not.

This maternity benefit is generally payable to employees for three months. It may, however, be extendable for one more month depending on medical advice.

The compensation amount in such cases is the full wage amount of the employees. This is payable only if the employee makes a contribution for 70 days in the preceding year.

4. Dependants benefits

ESI benefits extend not only to the employees but to their dependents as well in case of the employee’s death. Such death, however, must occur in the course of an employment injury or an occupational hazard.

This compensation is generally 90% of the dead employee’s wages in the form of monthly payments.

5. Disablement benefits

In case an employee suffers some disablement due to an employment injury, he can seek disablement benefits. Such disablement may be either temporary or permanent.

In the case of temporary disablement, the compensation is generally 90% of the wage amount until the disablement continues. The employee can claim this benefit irrespective of whether or not he paid his contribution.

As far as permanent disablement is concerned, the compensation amount depends on 0n the extent of the injury. The Medical Board first determines the extent of the employee’s loss of earning capacity and then decides it.

6. Other benefits

Apart from these five basic ESI benefits, an insurable employee can avail the following miscellaneous benefits also:

a) Funeral expenses: The dependents of a deceased employee receive Rs. 10,000 to perform his last rites.

b) Vocational/physical rehabilitation: This is generally payable to permanently disabled employees. They can avail of this benefit for undergoing vocational and physical rehabilitation.

c) Old age medical care: This is payable for employees retiring on superannuation or under VRS/ERS. Even persons who leave employment after suffering a permanent injury and their spouses can avail this benefit. The compensation amount here is generally Rs. 120 per month.

Solved Question on ESI benefits

Question: Specify the missing word in the following sentences.

(1) Section __________ of the Act contains ESI benefits.

(2) Medical benefits extend to workers as well as their __________.

(3) Disablement under the Act may be either __________ or __________.

(4) Depedents of a deceased employee can seek Rs. __________ for his funedal expenses.

Answers:          (1) 46          (2) family members          (3) temporary or permanent          (4) 10,000