Monday, 10 October 2016

Dependent's Benefit under ESI or Employee State Insurance


Under Section of ESI Act 46, Subject to the provisions of this Act, the insured persons, their dependants or the persons hereinafter mentioned, as the case may be, shall be entitled to the following benefits, namely,-

  1. Periodical payments to any insured person in case of his sickness certified by a duly appointed medical practitioner or by any other person possessing such qualifications and experience as the Corporation may, by regulations, specify in this behalf (hereinafter referred to as sickness benefit);
  2. Periodical payments to an insured woman in case of confinement or miscarriage or sickness arising out of pregnancy, confinement, premature birth of child or miscarriage, such woman being certified to be eligible for such payments by an authority specified in this behalf by the regulations (hereinafter referred to as maternity benefit);
  3. Periodical payments to an insured person suffering from disablement as a result of an employment injury sustained as an employee under this Act and certified to be eligible for such payments by an authority specified in this behalf by the regulations (hereinafter referred to as disablement benefit);
  4. Periodical payments to such dependants of an insured person who dies as a result of an employment injury sustained as an employee under this Act, as are entitled to compensation under this Act (hereinafter referred to as dependants' benefit);
  5. Medical treatment for and attendance on insured persons (hereinafter referred to as medical benefit);  and
  6. Payment to the eldest surviving member of the family of an insured person who has died, towards the expenditure on the funeral of the deceased insured person or, where the insured person did not have a family or was not living with his family at the time of his death, to the person who actually incurs the expenditure on the funeral of the deceased insured person (to be known as [funeral expenses]):
  7. PROVIDED that the amount of such payment shall not exceed such amount as may be prescribed by the Central Government] and the claim for such payment shall be made within three months of the death of the insured person or within such extended period as the Corporation or any officer or authority authorised by it in this behalf may allow.
  8. The Corporation may, at the request of the appropriate government, and subject to such conditions as may be laid down in the regulations, extend the medical benefit to the family of an insured person.

Under Section of ESI Act 49, The qualification of a person to claim sickness benefit, the conditions subject to which such benefit may be given, the rates and period thereof shall be such as may be prescribed by the Central Government.


Under Section of ESI Act 52, if an insured person
  1. Dies as a result of an employment injury sustained as an employee under this Act (whether or not he was in receipt of any periodical payment for temporary disablement in respect of the injury)
  2. Dependants' benefit shall be payable at such rates and for such period and subject to such conditions as may be prescribed by the Central Government to his dependants specified in sub-clause (i), and sub clause (ia) and sub-clause (ii) of clause (6A) of Section of ESI Act 2. In case the insured person dies without leaving behind him the dependants as aforesaid, the dependants' benefit shall be paid to the other dependants of the deceased at such rates and for such period and subject to such conditions as may be prescribed by the Central Government.
  3. Dependants specified in sub-clause (i), and sub clause (ia) and sub-clause (ii) of clause (6A) of Section of ESI Act 2 means 
    1. a widow, a legitimate or adopted son who has not attained the age of twenty-five years, an unmarried legitimate or adopted daughter ;
    2. a widowed mother ;
    3. If wholly dependent on the earnings of the insured person at the time of his death, a legitimate or adopted son or daughter who has attained the age of twenty-five and who is infirm ;
Under Rule 58, Dependant’s 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’ benefit 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 widow 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 twenty-five years :
Provided that in the case of a legitimate or adopted son] who is infirm and who is wholly dependant 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 or
the full rate :
Provided that in the case of legitimate or adopted daughter who is infirm and is wholly dependant on the earnings of the insured person at the time of his death, dependants’ benefit shall continue to be paid while the infirmity lasts :
Provided further that if the total of the dependants’ benefits 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-fifths of the full rate.
(B) In case the deceased person does not leave widow or legitimate or adopted child or widowed mother dependants’ benefits 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 re-marriage, 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) The daily rate of dependant’s benefit shall be ninety per cent. of the standard benefit rate in the contribution period corresponding to the benefit period in which the employment injury occurs :
Provided that where an employment injury occurs before the commencement of the first benefit period in respect of a person, the daily rate of dependants’ 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, ninety per cent. of his average daily wages during that wage period, rounded to the next higher rupee ;
(ii) where a person sustains employment injury before the expiry of the first wage period in the contribution period in which the injury occurs, ninety per cent. of wages actually earned or which would have been earned had he worked for a full day on the date of accident, rounded to the next higher rupee.


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