Claim for benefits. —
Every claim for a benefit payable under the Act shall be made in writing,
in accordance with these regulations, to the appropriate Branch Office
on the form appropriate for the purpose of the benefit for which the claim is
made, or in such other manner as the appropriate office may, subject to its
being in writing, accept as sufficient in the circumstances of any particular
case or class of cases. Assistance for filling in the form of claim in case of
insured persons who cannot do so themselves shall be provided at the Branch
Offices of the Corporation. When claim becomes due. —
A claim for any benefit under the Act shall for the purposes of section
77 of the Act, becomes due on the following days : — (a) for sickness benefit or for disablement
benefit for temporary disablement for any period, on the date of issue of the
medical certificate in respect of such periods ; provided that in cases where a
person is not entitled to sickness benefit for the first two days of sickness,
the due date shall be deferred by such days ;
(b) for
maternity benefit : —
(i) in case of confinement, on the date of
issue, in accordance with these regulations, of the certificate of expected
confinement or on the day six weeks preceding the expected date of confinement
so certified whichever is later or, if no such certificate is issued, on the
date of confinement ; and
(ii) in case of miscarriage and in case of
sickness arising out of pregnancy, confinement, premature birth of child or
miscarriage, on the date of issue of the medical certificate of such
miscarriage or sickness, as the case may be ;
(c) for first payment of disablement benefit
for permanent disablement, on the date on which an insured person is declared
as permanently disabled in accordance with the Act and these regulations ;
(d) for first payment of dependants’
benefit, on the date of the death of the insured person in respect of whose
death the claim for such benefit arises or, where disablement benefit was
payable for that date, on the date following the date of death or, where the
beneficiary becomes entitled to a claim on any subsequent date, on the date on
which he becomes so entitled ;
(e) for subsequent payments of disablement
benefit for permanent disablement and for subsequent payments of dependants’
benefit, on the last day of the month to which the claim relates ; and
(f) for funeral expenses, on the date of the
death of the insured person in respect of whose death the claim for such
benefit arises.
Availability
of claims forms. —
Claim forms shall be available to intending claimants from such persons
and such offices of the Corporation as it may appoint or authorise for that
purpose, and shall be supplied free of charge.
Claims
on wrong form. — Where a claim for any benefit has been
made on an approved form other than the form appropriate to the
benefit claimed, the Corporation may treat the claim as if it was made on the
appropriate form :
Provided that the Corporation may
in any such case require the claimant to complete the appropriateform. Evidence
in support of claim. — Every person who makes a claim
for any benefit shall, in addition to the medical certificate and
other forms specifically required under these regulations, furnish such other
information and evidence for the purpose of determining the claim as may be
required by the appropriate office, and, if reasonably so required, shall for
that purpose attend at such office or place as the appropriate office may
direct.
Defective
claim. — If, in the absence of due signature or
of due certification, a claim is defective on the date of its
receipt by an office of the Corporation, the office of the Corporation may in
its discretion, refer the claim to the claimant and if the form is returned
duly signed and/or certified within three months from the date on which it was
so referred, the office may treat the claim as if it had been duly made in the
first instance.
Claim
for inappropriate benefit. — Where it appears that
a person who has made a claim for any benefit payable under the
Act, may be entitled to a benefit other than that which he has claimed, any
such claim may be treated as a claim in the alternative for that other benefit.
Authority
for certifying eligibility of claimants. — The authority
which is to certify eligibility of claimants shall be the
appropriate Branch Office in respect of sickness, maternity, temporary
disablement benefits and funeral expenses and the appropriate Regional Office,
in respect of permanent disablement and dependants’ benefits.
Benefits when payable. — (1) Any
benefit payable under the Act shall be paid —
(a)
in
the case of sickness benefit, not later than 7 days ;
(b)
in
the case of funeral expenses not later than 15 days ;
(c) in
the case of the first payment in respect of maternity benefit not later than 14
days ;
(d) in the case of the first payment in
respect of temporary disablement benefit not later than one month ;
(e) in
the case of first payment of permanent disablement benefit not later than one
month ;
(f) in
the case of first payment of dependant’s benefit not later than three months ;
After the claim therefor together with the relevant
medical or other certificates and any other documentary evidence which may be
called for under these regulations has been furnished complete in all
particulars to the appropriate office. (2) Second and subsequent payments in
respect of any maternity, temporary disablement, permanent disablement or
dependants’ benefit shall be paid along with the first payment in respect
thereof, or within the calendar month following the month to the whole or part
of which they relate, whichever is later subject to production of any
documentary evidence which may be required under these regulations.
(3) Where a benefit payment is not made
within the time limits specified in sub-regulations (1) and (2) above, it shall
be reported to the appropriate Regional Office and shall be paid as soon as possible.
(4) Benefits under the Act shall be paid in
cash at a Branch Office on such days and working hours as may be fixed by the
Director-General or such other officer of the Corporation, as may be authorised
by him from time to time in this behalf or at the option of the claimant and
subject to deduction of the cost of remittance by means of postal money orders
or other orders payable through a post office, or by any other means which the
appropriate office may in the circumstances of any particular case consider appropriate
:
Provided that the
Corporation may waive the deduction of the cost of remittance in such cases as
the Director-General may, from time to time, specify. Provided further that the Director-General may
decide that in respect of certain areas/pay offices as may be specified by him
from time to time, the payments shall be remitted through money order also at
the cost of the Corporation subject to such restrictions as may be imposed by
the Director-General from time to time. (5) Where the payment of a benefit is to be made at
a Branch Office, such office may insist upon the production of the Identity
Card or other document issued in lieu thereof in respect of the insured person. Abstention verification.
—
(1) Every employer shall furnish to the appropriate office such information
and particulars in respect of the abstention of an insured person from work for
which sickness benefit or disablement benefit for temporary disablement, as
provided under the Act has been claimed or paid, in Form 10 and within such
time as the said office may in writing require in the said form. (2) Every employer shall furnish to the appropriate
office such information and particulars in respect of the abstention of an
insured woman from work for which maternity benefit as provided under the Act
has been claimed or paid, in Form 10 and within such time as the said office
may in writing require in the said form.
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