DEPENDANTS’ BENEFIT
Rule (ESI GENERAL RULES) 77. Report of death of employee by
employment injury.— In case of death of an employee
as a result of an employment injury, —
(a)
if the death occurs at the place of
employment the employer shall, and
(b)
if the death occurs at any other place,
a dependant intending to claim dependants’ benefit shall, or
(c)
any other person present at the time of
death may,
immediately report the death to the nearest Branch
Office and to the nearest dispensary, hospital, clinic or other institution
where medical benefit under the Act is available.
Rule (ESI GENERAL RULES) 78. Disposal of
body of an employee dying by employment injury. —
Where an employee dies as a result of an employment injury
sustained as an employee under the Act, the body of the employee shall not be
disposed of until the body has been examined by an Insurance Medical Officer,
who will also arrange a post mortem examination, if considered
necessary, in co-operation with any other existing agency :
Provided that if an Insurance Medical Officer is
unable to arrive for the examination within 12 hours of such death, the body
may be disposed of after obtaining a certificate from such medical officer or
practitioner as may be available :
Provided further that nothing contained in this
regulation shall be in derogation of any power conferred on a Coroner under any
law for the time being in force or on the officer-in-charge of a police station
or some other police officer under section 174 of the Code of Criminal
Procedure, 1973 (2 of 1974).
Rule (ESI GENERAL RULES) 79. Issue
of death certificate. — An Insurance Medical Officer
attending the disabled person at the time of his death or the
Insurance Medical Officer who examines the body after the death or the Medical
Officer who attended the insured person in a hospital or other institution
where such disabled person died, shall issue free of charge a death certificate
in Form 13 to the dependants of the deceased and shall send a report to the
appropriate Regional Office.
Rule (ESI GENERAL RULES) 80. Submission
of claim for dependants’ benefit. — (1) A claim for
dependants’ benefit shall be submitted to the appropriate Branch
Office by post otherwise in Form 15 by the dependant or dependants concerned or
by their legal representative or, in case of a minor, by his guardian, and such
claim shall be supported by documents proving —
(i)
that the death is due to an employment
injury ;
(ii)
that the person claiming is a dependent
entitled to claim as provided in rule 58 of the Employees’ State Insurance
(Central) Rules, 1950 ;
(iii)
the age of the claimant ;
(iv)
the infirmity of the dependant claiming
to be infirm within the purview of rule 58 of the Employees’ State Insurance
(Central) Rules, 1950, by a certificate of such medical or other authority as
the Director-General may, by a general or special order specify in this behalf
:
Provided that where the appropriate Regional Office
is satisfied about the bona fides of the applicant or about the truth of
the facts relating to any of the matters mentioned above, one or more of the
documents may be dispensed with.
(2)
The following may be accepted as proof
of age : —
(a)
Certified extract from an official
record of births showing the date and place of birth and father’s name ;
(b)
Original horoscope prepared soon after
birth ;
(c)
Certified extract from baptismal
register ;
(d)
Certified extract from school record
showing the date of birth and father’s name ;
(e)
such other evidence as may be acceptable
to the appropriate Regional Office in the cir-cumstances of a particular case.
Rule (ESI GENERAL RULES) 81. Notice
for dependants’ benefit. — On receipt of a claim
or claims for dependants’ benefit in respect of the death of an
employee and, after making such enquiries as may be necessary about the
circumstances and cause of death and about all persons, who may be entitled to
dependants’ benefit, the appropriate Regional Office shall issue by registered
post to such other persons if any, as appear on enquiry, to be entitled to
dependants’ benefit, and who have not yet submitted a claim for such benefit a
notice for submission of claims for dependants’ benefit within a period of
thirty days from the date of such notice. The notice shall indicate inter
alia the relevant provisions of the Act and regulations and the procedure
for submission of a claim for dependants’ benefit.
Rule (ESI GENERAL RULES) 82. Intimation of
decision regarding dependants’ benefit. — As soon as
possible after the expiry of the period during which claims can
be submitted in terms of the notice issued under regulation 81, the appropriate
Regional Office shall intimate by registered post the decision of the
Corporation in regard to the claim of each of the dependants in writing to the
dependant concerned or to his legal representative, or, in the case of a minor,
to his guardian.
Rule (ESI GENERAL RULES) 83. Date of accrual of dependants’
benefit. — The dependants’ benefit shall accrue
from the date of the death in respect of which the benefit is
payable or, where disablement benefit was payable or where wages were payable
for that date from the date following the date of death.
Rule (ESI GENERAL RULES) 83-A. Submission of claims for
periodical payments of dependants’ benefit. —
Each dependant whose claim for dependants’ benefit is admitted
under regulation 82, shall submit to the appropriate Branch Office, by post or
otherwise, a claim covering, except in the case of first or a final payment, a
period of one or more complete calendar months in Form 16. Such claim may be
made by the legal representative of a beneficiary or in the case of a minor, by
his guardian.
Rule (ESI GENERAL RULES) 86. Appointment
of another guardian. — If at any time the appropriate
Regional Office is satisfied that a child who is in receipt of
dependants’ benefit is being neglected by his guardian, not being a guardian
appointed under the Guardian and Wards Act, 1890, and the child’s share of the
dependants’ benefit is not being properly spent on his or her maintenance, the
appropriate Regional Office may direct that such share may be paid subject to
such conditions as it may specify to such other person as it deems fit and as
in its opinion would utilise it for the care and maintenance of child.
MATERNITY BENEFIT
Rule (ESI GENERAL RULES) 87. Notice
of pregnancy. — An insured woman, who decides to give
notice of pregnancy before confinement, shall give such notice in
Form 17 to the appropriate Branch Office, by post or otherwise and shall
submit, together with such notice, a certificate of pregnancy in Form 17 given
in accordance with these regulations on a date not earlier than seven days
before the date on which such notice is given.
Rule (ESI GENERAL RULES) 88. Claim
for maternity benefit commencing before confinement. —
Every insured woman claiming maternity benefit before confinement
shall submit to the appropriate Branch Office by post or otherwise —
(i)
a certificate of expected confinement in
Form 18 given in accordance with these regulations, not earlier than fifty days
before the expected date of confinement ;
(ii)
a claim for maternity benefit in Form 19
stating therein the date on which she ceased or will cease to work for
remuneration ; and
(iii)
within thirty days of the date on which
her confinement takes place, a certificate of con-finement in Form 18 given in
accordance with these regulations.
Rule (ESI GENERAL RULES) 89.
Claim for maternity
benefit only after confinement or for miscarriage. —
Every insured woman claiming maternity benefit for miscarriage
shall within 30 days of the date of the miscarriage, and every insured woman
claiming maternity benefit after confinement, shall submit to the appropriate
office by post or otherwise a claim for maternity benefit in Form 19 together
with a certificate of confinement or miscarriage in Form 18 given in accordance
with these regulations.
Rule (ESI GENERAL RULES) 89-A. Claim for
maternity benefit after the death of an insured woman leaving behind the child.
—
For
the purposes of the proviso to sub -section (2) of section 50 of the Act, the
person nominated by the deceased insured woman on Form 1 or on such other form
as may be specified by the Director General in this behalf and if there is no
such nominee, the legal representative, shall submit to the appropriate office
by post or otherwise a claim for maternity benefit, as may be due, in Form 20
within 30 days of the death of the insured woman together with a death
certificate in Form 21 given in accordance with those regulations.
Rule (ESI GENERAL RULES) 89-B. Claim for maternity benefit in
case of sickness arising out of pregnancy, confinement, premature birth of
child or miscarriage. — (1) Every insured woman claiming
maternity benefit in case of sickness arising out of pregnancy, confinement,
premature birth of child or miscarriage, shall submit to the appropriate office
by post or otherwise a claim for benefit in Form 9 appropriate to the
circumstances of
the case together with the appropriate medical
certificate in Form 7 or 8 as the case may be, given in accordance with these
regulations.
(2) The provision of Regulations 55 to 61 and 64
shall, so far as may be, apply in relation to a claim submitted and a
certificate given in accordance with this Regulation as they apply to
certification and claims under these regulations.
Rule (ESI GENERAL RULES) 90. Other evidence in lieu of a
certificate. — The Corporation may accept any other
evidence in lieu of a certificate of pregnancy, expected
confinement, confinement death during maternity, miscarriage or sickness
arising out of pregnancy, confinement, premature birth of child or miscarriage
by an Insurance Medical Officer, if in its opinion, the circumstances of any
particular case so justify.
Rule (ESI GENERAL RULES) 91. Notice
of work for remuneration. — Except as provided in
Regulation 89-B every insured woman who has claimed maternity
benefit shall give notice in Form 19 if she does work for remuneration on any
day during the period for which maternity benefit would be payable to her but
for her working for remuneration.
Rule (ESI GENERAL RULES) 92. Date
of payment of maternity benefit. — Maternity benefit
shall be payable from the date from which it is claimed provided
that such date does not precede the expected date of confinement by more than
forty-two days, and that no work is undertaken by the insured woman for
remuneration.
Rule (ESI GENERAL RULES) 93. Disqualification
for maternity benefit. — An insured woman may be
disqualified from receiving maternity benefit if she fails
without good cause to attend for or to submit herself to medical examination
when so required ; and such disqualification shall be for such number of days
as may be decided by the authority authorised by the Corporation in this behalf
:
Provided that a woman
may refuse to be examined by other than a female doctor or midwife.
Rule (ESI GENERAL RULES) 94. Authority which may issue
certificate. — No certificate required under any of
the Regulations 87 to 89-B shall be issued except by the
Insurance Medical Officer to whom the insured woman has or had been allotted or
by an Insurance Medical Officer attached to a dispensary, hospital, clinic or
other institution to which the insured woman is or was allotted, and such
Insurance Medical Officer shall examine and if in his opinion the condition of
the woman so justifies or in case of death of the insured woman or the death of
the child, if satisfied about such death issue to such insured woman or in case
of her death to her nominee or legal representative as the case may be, free of
charge any such certificate when reasonably required by such insured woman or
her nominee or legal representative, as the case may be, under or for the
purposes of the Act or any other enactment or these regulations :
Provided that such officer may issue a certificate,
as aforesaid, under these regulations, to or in respect of an insured woman who
is or was not allotted to him or to the dispensary, hospital, clinic or other
institution to which such officer is attached, if such officer is attending the
woman for pre-natal care, for confinement, for miscarriage or for sickness
arising out of pregnancy, confinement, premature birth of child or miscarriage
or in case of death, was attending the deceased insured woman or the child at
the time of the death of the insured woman or the child :
Provided further that a certificate of pregnancy, of
expected confinement, of confinement or miscarriage required under these
regulations may be issued by a registered mid-wife which shall be accepted by
the Corporation on countersignature by the Insurance Medical Officer.
Rule (ESI GENERAL RULES) 95. Obligations of Insurance Medical
Officer. — Nothing in these regulations shall
relieve an Insurance Medical Officer to whom an insured woman has
been allotted, or an Insurance Medical Officer attached to the dispensary,
hospital, clinic or other institution to which an insured woman is allotted of
the obligation to examine and if in his opinion, the condition of the woman so
justifies, issue free of charge a certificate of pregnancy, of expected
confinement, of confinement or miscarriage or of a sickness arising out of
pregnancy, confinement, premature birth of a child or miscarriage during any
period in which such insured woman is obtaining treatment or attendance from
any other person or from any other hospital or institution.
MEDICAL BENEFIT TO FAMILIES
Rule (ESI GENERAL RULES) 95-A. Medical benefit to families of
insured persons. — (1) Medical benefit may be extended to
the families of insured persons from such date as the Corporation
may in consultation with State Government, notify.
(2)
The family of an insured person shall
become entitled to medical benefit from the day the insured person himself
becomes entitled to medical benefit and shall continue to be so entitled so
long as the insured person is entitled to receive medical benefit for himself,
or in the case of death of the insured person till such date upto which the
insured person would have remained entitled to medical care, had he survived.
(3)
The nature and scale of medical benefit
to which the family of an insured person shall be entitled shall be such as may
be specified by the State Government in consultation with the Corporation from
time to time.
(4)
The appropriate office shall arrange to
add in Form 4, Form 4-A, the particulars of the family entitled to medical
benefits.
FUNERAL EXPENSES
Rule (ESI GENERAL RULES) 95-B. Report of
death of insured person. —
In case of death of an insured person, —
(a)
if the death occurs at the place of
employment, the employer shall, and
(b)
if the death occurs at any other place,
the person entitled and intending to claim funeral expenses shall, or
(c)
any other person present at the time of
death (sic.) may, immediately, report the death to the Branch Office of
the deceased insured person.
Rule (ESI GENERAL RULES) 95- C. Issue of
death certificate. — An Insurance Medical Officer
attending the insured person at the time of death or the
Insurance Medical Officer who examines the body after the death or the Medical
Officer who attended the insured person in a hospital or other institution
where such insured person died, shall issue free of charge a death certificate
in Form 13 to the person entitled and intending to claim funeral expenses.
Rule (ESI GENERAL RULES) 95 -D. Other
evidence in lieu of a certificate. —
The Corporation may accept any other evidence in lieu of a death
certificate by Insurance Medical Officer if in its opinion, the circumstances
of any particular case so justify.
Rule (ESI GENERAL RULES) 95-E. Submission
of claim for Funeral Expenses. —
(1) A claim to funeral expenses shall be submitted to the
appropriate Branch Office by post or otherwise in Form 22 by the claimant
entitled under the Act and in case of a minor, by his guardian, and such claim
shall be supported by documents proving :
—
(i)
the death of the deceased person.
(ii)
that the person claiming is the eldest
surviving member of the family of the deceased insured person and incurred the
expenditure necessary for the funeral of the deceased, or
(iii)
in case the claimant is other than the
eldest surviving member of the family : —
(a)
that the deceased insured person did not
have a family or that the deceased insured person was not living with his
family at the time of his death ; and
(b)
that the claimant actually incurred the
expenditure claimed on the funeral of the deceased insured person:
Provided that where the
appropriate office is satisfied about the bona fides of the applicant or
about the truth of the facts relating to any of the matters mentioned above,
one or more of the documents may be dispensed with.
(2)
The following may be accepted as proof
for purposes of clauses (ii) and (iii) of sub-regulation
(1)
of this Regulation : —
A declaration of the
claimant duly countersigned by —
(i)
An Officer of the Revenue, Judicial or
Magisterial Departments of Government ; or
(ii)
A Municipal Commissioner ; or
(iii)
A Workmen’s Compensation Commissioner ;
or
(iv)
The Head of Gram Panchayat under the
official seal of the Panchayat ; or
(v)
The employer of the deceased insured
person ; or
(vi)
9 member of the Regional Board ; or
(vii)
A member of Local Committee ; or
(viii)
An official of the Trade Union ; or
(ix)
An Insurance Medical Officer or
Insurance Medical Practitioner.
(b)
Any other evidence or declaration
acceptable to the appropriate office in the circumstances of a particular
case.
