Monday, 10 October 2016

Disability Benefits Under ESI or Employee State Insurance


Under Section 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 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);

Under Section of ESI Act 51, Subject to the provisions of this Act:-
  1. A person who sustains temporary disablement for not less than three days (excluding the day of accident) shall be entitled to periodical payment at such rates and for such period and subject to such conditions as may be prescribed by the Central Government;
  2. A person who sustains permanent disablement, whether total or partial, shall be entitled to periodical payment at such rates and for such period and subject to such conditions as may be prescribed by the Central Government :
Under Section of ESI Act 51 A, For the purposes of this Act, an accident arising in the course of an insured person's employment shall be presumed, in the absence of evidence to the contrary, also to have arisen out of that employment.
Under Section of ESI Act 51 B, An accident shall be deemed to arise out of and in the course of an insured person's employment notwithstanding that he is at the time of the accident acting in contravention of the provisions of any law applicable to him, or of any orders given by or on behalf of his employer or that he is acting without instructions from his employer, if
  1. the accident would have been deemed so to have arisen had the act not been done in contravention as aforesaid or on without instructions from his employer, as the case may be; and
  2. The act is done for the purpose of and in connection with the employer's trade or business.
Under Section of ESI Act 51 C, An accident happening while an insured person is, with the express or implied permission of his employer, travelling as a passenger by any vehicle to or from his place of work shall, notwithstanding that he is under no obligation to his employer to travel by that vehicle, be deemed to arise out of and in the course of his employment, if
  1. the accident would have been deemed so to have arisen had he been under such obligation; and
  2. at the time of the accident, the vehicle
    1. is being operated by or on behalf of his employer or some other person by whom it is provided in pursuance of arrangements made with his employer, and
    2. Is not being operated in the ordinary course of public transport service.
    3. In this Section of ESI Act "vehicle" includes a vessel and an aircraft.

Under Section of ESI Act 51 D, An accident happening to an insured person in or about any premises at which he is for the time-being employed for the purpose of his employer's trade or business shall be deemed to arise out of and in the course of his employment, if it happens while he is taking steps, on an actual or supposed emergency at those premises, to rescue, succour or protect persons who are, or are thought to be or possibly to be, injured or imperilled, or to avert or minimise serious damage to property.
Under Rule 57, A person shall be qualified to claim disablement benefits
  1. For temporary disablement for not less than three days (excluding the day of accident) for the period of such disablement sustained as an employee under the Act.
  2. 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
  3. 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.
  4. The daily rate of disablement 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, rounded to the next higher rupee.
  5. Provided that where an employment injury occurs before the commencement of the first benefit period in respect of a person, the daily rate of disablement benefit shall be
    1. 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 in that wage period, rounded to the next higher rupee ;
    2. 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 his 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.
    3. Explanation. — The disablement benefit calculated as aforesaid shall be called the “ full rate ”.
    4. The disablement benefits shall be payable to the insured person as follows : —
      1. for temporary disablement, at the full rate ;
      2. for permanent total disablement, at the full rate ;
      3. 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 ;
      4. 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.
      5. 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.
 

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