Employee's State Insurance Corporation or ESIC is a government of India organisation that provides health services and insurance facilities to workers in the MSME sector. ESIC provides insurance and health care to more than 40 million people, making it the largest health service provider in the world.
Several benefits such as temporary disability, permanent disability benefits, sickness benefits, maternity benefits etc. come under the ESI schemes. Disability benefits are provided to employees suffering from an occupational injury or disease.
Here’s everything you need to know about the temporary and permanent disability insurance benefits available under the ESI.
What is a Temporary Disability Benefit?
The Temporary Disability benefits are there to help an employee who suffers an Employment Injury or Occupational Disease and has been officially diagnosed and is unable to work for the time being.
An "employment injury" is an injury that an employee suffers as a result of an "accident" or "occupational sickness." It can arise out of and in the course of his job.
For example, something as simple as an ankle sprain that makes it difficult for you to walk or take care of your company's routine job can be considered a temporary disability.
Documents Required for Claiming Temporary Disability Benefit
If you need to apply for TDB, you need to have the following document:
- Accident report form 16
- Forms 8, 9, 10, and 11
- The ESIC Med.13 certificate
Eligibility for Claiming Temporary Disability Benefit
The eligibility for an insured person begins on the first day of insurable work. 90% of the typical daily pay is the TDB rate. Whether the accident or disease happens inside or outside the country, an employee facing such an incident can claim temporary disability benefits.
The ESIC does not have any prescribed limit regarding the duration of TDB. Payments will be available as long as the temporary disability continues and substantial progress is treatable. Sickness compensation will be granted to the insured person if the duration of the Temporary Disablement is shorter than three days (not including the day of the accident).
Learn more about different types of disability insurance.
What is a Permanent Disability Benefit?
PDB is given to an insured person who loses their ability to work because of Employment Injury (including Occupational Diseases) and has a permanent residual disability.
For example, If there is an accident that causes absolute deafness or loss of any body parts to an employee, they can claim Permanent Disability Benefit.
The Medical Board and the Special Medical Board in the ESIC-affiliated medical institutions need to figure out the degree of disability because of an injury or illness.
PDB can last for the time given by the Medical Board if the assessment is temporary or for the rest of the person's life if the assessment is final.
The PDB rate is based on the percentage of loss of earning capacity that the Medical Board/MAT/EI Court assesses and confirms the TDB has caused.
In the 2nd Schedule to the ESIC Act of 1948, you can see a list of injuries that are thought to cause permanent total disability and a percentage loss of earning capacity. Thus, the highest rate of PDB can be the same as the highest rate of TDB.
The ESIC sometimes changes the PDB amount to account for inflation. The most recent change went into effect on September 13, 2019.
An insured person whose PDB has been judged to be final and who has been given it at a rate of not more than Rs.10 per day can ask for the periodical payments of PDB to be turned into a lump sum.
When a request for commutation is made within 6 months of the Medical Board's decision being made public, the periodic payments will be turned into a lump sum, as long as the total amount of commutations is at most Rs 60,000 at the time the final award starts.
But if this kind of request is made after 6 months, LO/RO will send the case to MR/PTMR to find out if the insured person has a normal life expectancy for his age. The Medical Referee puts this kind of certificate on the RO/LO letter.
In all cases, an insured person's age will have to be proven to the Corporation's satisfaction. Medical Board checks and confirms the anticipated age of the insured persons who can't show enough proof of their age. Also, the Medical Board's opinion is final in this case.
Know more about - Disability Insurance
Other Benefits Under ESI
Apart from the TDB and PDB, there are other benefits available for employees under the ESIC schemes.
Insured workers can avail of sickness benefits when sick and have a doctor's note. A cash amount equal to 70% of a worker's wages is paid as part of the benefit. This can be paid for up to 91 days per year. A person eligible for sickness benefits must have paid into the plan for 78 days over 6 months.
Extended Sickness Benefit (ESB)
S.B. can be extended up to two years at an increased rate of 80% of wages for 34 cancers and long-term diseases.
Enhanced Sickness Benefit
People insured and getting sterilised for family planning can get Enhanced Sickness Benefit equal to their full wage for up to 7 days for a vasectomy and 14 days for a tubectomy.
Maternity Benefit (M.B.)
Maternity Benefit for confinement/pregnancy is paid for twenty-six (26) weeks. It can be extended by one month on medical advice at the rate of full wage if the worker has contributed for seventy days in the two preceding contribution periods.
pays out 90% of a person's salary as a monthly payment to their dependents if they die because of an injury or hazard at work.
An Insured Woman or an I.P. for his wife if she gives birth in a place where the ESI Scheme doesn't have the right medical facilities.
A payment of Rs 15,000 is made to the person's dependents or to the person who does the last rites as soon as the person starts working and is eligible for insurance.
Rajiv Gandhi Shramik Kalyan Yojana
Since April 1, 2005, this plan for unemployment benefits has been in place. An insured person who loses their job after being covered for two or more years due to the closing of a factory or business, being laid off, or a permanent disability caused at least 40% by something other than work is entitled to:
- ESI hospitals and dispensaries will pay for medical care for the insured person and their family while the insured person is getting unemployment benefits
- Unemployment Allowance is equal to 50% of wage for up to two years
- ESIC pays for fees and travel allowances for vocational training to help people improve their skills
Atal Beemit Vyakti Kalyan Yojana (ABVKY)
This plan is a way to help employees who are covered by Section 2(9) of the ESI Act of 1948. It gives them relief payments for up to 90 days once in their lives. The scheme started on July 1, 2018, as a pilot project that would run for two years. The scheme has been made last until June 30, 2022.
It was also decided to raise the unemployment relief rate under the scheme from 25% to 50% of wages and to make it easier for people to qualify.
You can also send a physical claim containing the following to the designated ESIC Branch Office by mail or in person:
- An affidavit
- A copy of your Aadhaar card
An insured person must have worked in an insurable job for at least a year before becoming unemployed and must have paid into the scheme for at least 78 days in the 12 months before becoming unemployed.
In special cases, relief will be paid 30 days after the worker's last day of work, and the worker can go to the designated ESIC Branch Office to file a claim. You can claim the relief online at www.esic.in.Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised to exercise their caution and not to rely on the contents of the article as conclusive in nature. Readers should research further or consult an expert in this regard.