Apart from the explanation and procedural part of Disabilities benefits, that yu can find here http://esisimplified.blogspot.in/2016/10/disability-benefits-under-esi.html, There are some rules to be kept in mind.
DISABLEMENT BENEFIT
Under Rule (ESI General Rules) 65. Notice of
accident. — (i) Every employee who sustains
personal injury caused by accident arising out of and in the
course of his employment in a factory or establishment shall give notice of
such injury either in writing or orally, as soon as practicable after the
happening of the accident :
Provided that any such
notice required to be given by an employee person may be given by some other
person acting on his behalf.
Explanation. —
No such notice shall be required to be given by an employee if an employment
injury is caused by any Occupational Disease specified in the
Third Schedule to the Act.
(ii)
Every such notice shall be given to the
employer or to a foreman or to other official under whose supervision the
employee is employed at the time of the accident or any other person designated
for the purpose by the employer and shall contain the appropriate particulars.
(iii)
Any entry of the appropriate particulars
of the accident made in a book kept for that purpose in accordance with the
next following regulation shall, if made as soon as practicable after the
happening of the accident by the employee or by some other person acting on his
behalf, be sufficient notice of the accident for the purposes of these
regulations.
(iv)
In this regulation and the next
following regulation, the expression ‘ appropriate particulars ’ means the
particulars indicated below : —
(a) Full
name, Insurance Number, sex, age, address, occupation, department and shift of
the injured person ;
(b) Date
and time of accident ;
(c) Place
where accident happened ;
(d) Cause
and nature of injury ;
(e) Name,
address and occupation of the person giving the notice, if he is other than the
injured person ;
(f) A
statement of what exactly the injured person was doing at the time of injury ;
(g) Names,
addresses and occupation of two persons who were present at the spot when
acci-dent happened ; and
(h) Remarks,
if any.
Under Rule (ESI General Rules) 66. Maintenance
of accident book. — Every employer shall —
(i)
keep a book readily accessible
(hereinafter called ‘ the Accident Book ’) in Form 11, in which the appropriate
particulars of any accident causing personal injury to an employee may be
entered ;
(ii)
preserve every such book when it is
completed for a period of five years from the date of the last entry thereon :
Provided that it shall
not be necessary to enter in the said Accident Book particulars of any
employment injury caused by an Occupational Disease specified in the Third
Schedule to the Act.
Provided further that
the employer shall be deemed to have complied with this regulation sufficiently
if in any register maintained by him, the appropriate particulars are also
shown.
Under Rule (ESI General Rules) 67. Notice
otherwise than by an entry in accident book. —
If notice of an employment injury under regulation 65 is given
otherwise than by an entry in the Accident Book it shall be the duty of the
employer or any other person to whom such notice is given under that regulation
to make an appropriate entry in the book in respect of the accident to which
the notice relates immediately after such notice is received, and
where the notice is
received otherwise than in writing read over the particulars to the person who
gives the notice and obtain his signature or thumb impression on the Accident
Book.
Under Rule (ESI General Rules) 68. Report of accident
by an employer. — Every employer shall send a report in
Form 12 to the appropriate Branch Office and to the Insurance
Medical Officer of the insured person —
(i)
immediately, if the injury is serious, i.e.,
it is likely to cause death or permanent disablement or loss of a member, and
(ii)
in any other case within 48 hours after
the receipt of the notice under regulation 65 or of the time when the accident
came to the notice of the employer or of a foreman or other official under
whose supervision the employee was employed at the time of the accident or any
other person designated for the purpose by the employer :
Provided that in case
of a serious injury, and particularly when the injury results in death at the
place of employment, the report to the Insurance Medical Officer and the Branch
Office shall be sent through a special messenger, or otherwise as speedily as
may be practicable under the circumstances :
Provided further that
if the accident does not involve absence of the employee from work initially,
the employer may not send the report to the Branch Office and the Insurance
Medical Officer but shall do so within 48 hours after the absence from work
subsequently results from the injury.
Provided further that
where a report of the accident is made by the employer under the Factories Act,
1948, the report to the Branch Office and to the Insurance Medical Officer may
be made in the same form as is prescribed under the Factories Act, 1948,
provided that all the additional information required under Form 12 is added
thereto :
3[Provided
further that it shall not be necessary for the employer to send a report in
Form 12 if an employment injury is caused by an Occupational Disease specified
in the Third Schedule to the Act ; but the employer shall furnish on demand to
the appropriate Branch Office, within such reasonable period as may be
specified, such information and particulars as shall be required of the nature
of and other relevant circumstances relating to any employment specified in the
Third Schedule to the Act.
Under Rule (ESI General Rules) 69. Employer to
arrange for first-aid. — Every employer shall arrange for
such first-aid and medical care and transport for obtaining such
aid and care as the circumstances of the accident may require till the injured
person is seen by the Insurance Medical Officer and such employer shall be
entitled to reimbursement in respect of expenses thereby incurred by him but
not exceeding such scale of expenses as may be specified by the Corporation
from time to time :
Provided that if the
employer is required to provide such medical aid free of charge under any other
enactment, he shall not be entitled to any reimbursement of expenses.
Under Rule (ESI General Rules) 70.
Employer to furnish
further particulars of accident. — Every employer shall
furnish to the appropriate office such further information and
particulars of an accident and within such time as the said office may, in
writing, require.
Under Rule (ESI General Rules) 71.
Directions by the
Corporation. — Every claimant for and every
beneficiary in receipt of disablement benefit shall comply with
every direction given to him by the appropriate Regional Office which requires
him either —
(i)
to submit himself to a medical
examination by such medical authority as may be appointed by that office for the
purpose of determining the effect of the relevant employment injury or the
treatment appropriate to the relevant injury or loss of faculty, or
(ii)
to attend any vocational training
courses or industrial rehabilitation courses provided by any institution maintained
by any Government, local authority or any public or private body recognised for
the purpose by the Corporation and considered appropriate by it in his case.
Under Rule (ESI General Rules) 72. Reference
to a Medical Board. — A reference to the Medical Board
may be made —
(a)
at any time not later than twelve
months, in cases where claim for temporary disablement benefit is made for an
employment injury, from the date of the final certificate issued in respect of
the spell of temporary disablement commencing on or immediately after the date
of the occurrence of that injury, or from the date of the occurrence of an
employment injury in cases where temporary disablement benefit not
having
been claimed, claim for permanent disablement is made on the basis thereof, by
the appropriate Regional Office at the instance of the disabled person or the
employer or any recognised employees’ union
:
Provided that such
reference may be made by the appropriate Regional Office after the expiry of
the period prescribed as aforesaid if it is satisfied that the applicant was
prevented by sufficient cause from applying for the making of the reference in
time :
Provided further that
in the event of the claim for Temporary Disablement Benefit being rejected by
the Corporation but afterwards granted by the Employees’ Insurance Court in
respect of the injuries resulted in Permanent Disablement, the limit of 12
months will apply from the date of the order of the Employees’ Insurance Court
granting the claim of the insured person for Temporary Disablement Benefit,
or
(b)
by the Corporation, —
(i)
at any time, on the recommendation of an
Insurance Medical Officer, and
(ii)
on its own initiative, after the expiry
of the period of twenty-eight days from the first date on which the claimant was
rendered incapable of work by the relevant employment injury.
Under Rule (ESI General Rules) 73.
Report of Medical
Board. — The Medical Board shall after
examining the disabled person send its decision on such form as
may be specified by the Director-General, to the appropriate Regional Office.
The disabled person shall be informed in writing of the decision of the Medical
Board and the benefit, if any, to which the disabled person shall be entitled.
Under Rule (ESI General Rules) 74.
Occupational Disease. —
Any question whether an employment injury is caused by an Occupational
Disease specified in the Third Schedule to the Act shall be determined by a
Special Medical Board which shall examine the disabled person and send a report
in such form as may be prescribed by the Director-General in this behalf to the
appropriate Regional Office stating : —
(a)
whether the disabled person is suffering
from one or more of the diseases specified in the said Schedule ;
(b)
whether the relevant disease has
resulted in permanent disablement ;
(c)
whether the extent of loss of earning
capacity can be assessed provisionally or finally ;
(d)
the assessment of the proportion of loss
of earning capacity and in case of provisional assessment, the period for which
such assessment shall hold good.
All assessments which
are provisional may be referred to the Special Medical Board for review by the
appropriate Regional Office not later than the end of the period taken into
account by the provisional assessment. Any decision of the Special Medical
Board may be reviewed by it at any time. The disabled person shall be informed
in writing of the decision of the Special Medical Board by the appropriate
Regional Office and the benefit, if any, to which the insured person shall be
entitled.
Under Rule (ESI General Rules) 75.
Constitution of Medical
Boards/Special Medical Boards. — Medical Boards for
the purposes of the Act and the Special Medical Boards for the
purposes of Regulation 74 shall be constituted by the Corporation and where it
so desires it may approach the State Government for setting up the same and
shall consist of such persons, have such jurisdiction and follow such procedure
as the Director-General may from time to time decide.
Under Rule (ESI General Rules) 76.
Medical Appeal
Tribunals. — For the purposes of the Act, the State
Government shall constitute as many Medical Appeal Tribunals as
it thinks fit. Each such Medical Appeal Tribunal shall consist of such persons,
exercise such jurisdiction and follow such procedure (save for the manner in
which and the time within which the appeals may be filed as may be prescribed
by rules framed by the Central Government under the Act) as the State
Government in consultation with the Corporation may, from time to time, decide.
Notwithstanding the amendments hereby made, all appeals pending before the
Appeal Tribunals at the date of coming into force of the provisions of the Act
relating to Medical Appeal Tribunals shall be disposed of by the Appeal
Tribunals.
Under Rule (ESI General Rules) 76-A.
Submission of claims for permanent disablement. —
An insured person who has been declared to be permanently
disabled by a Medical Board or by a Medical Appeal Tribunal or an Employees’
Insurance Court shall submit, by post or otherwise, to the appropriate Branch
Office a claim, covering, except in the case of a first payment, a period of
one or more complete calendar months in Form 14 for claiming permanent
disablement benefit.
Under Rule (ESI General Rules) 76-B.
Commutation of permanent disablement benefit. —
(1) An insured person whose permanent disablement has been
assessed as final and who has been awarded permanent disablement benefit at a
rate not exceeding Rs. 5.00 per day may apply for commutation of permanent
disablement benefit into a lump sum :
Provided that the
insured person whose permanent disablement has been assessed as final and the
benefit rate exceeds Rs. 5.00 per day may also apply for commutation of
permanent disablement benefit into lump sum subject to the condition that the
total commuted value of the lump sum permanent disablement benefit does not
exceed Rs. 30,000 at the time of commencement of final award of his permanent
disability :
Provided further that
the cases falling under clause (3) of this regulation where commutation has
been refused because the insured person did not have average expectation of
life, shall not be reopened.
(2)
Where such an application is made within
6 months of the date on which he can opt for commutation hereafter called the
‘‘ date of possible option ’’, permanent disablement benefit shall be commuted
into a lump sum.
(3)
Where such an application is made after
the expiry of 6 months from the date of possible option, permanent disablement
benefit] may be commuted into a lump sum if the Corporation is satisfied that
the insured person has an average expectation of life for his age. For this
purpose, the insured person shall, if so required by the appropriate office,
present himself for examination by such medical authority as the
Director-General may, by general or special order, specify.
(4)
For the purpose of this regulation, the
date of possible option shall mean —
(i)
in the case of a person who, on the date
on which this regulation comes into force is in receipt of permanent
disablement benefit covered by sub-regulation (1), the date of coming into
force of this regulation ;
(ii)
in the case of any other insured person,
the date on which assessment of permanent dis-ablement covered by
sub-regulation (1), is communicated to him by the appropriate Re-gional Office.
(5)
The amount of lump sum admissible under
this regulation shall be determined by multiplying the daily rate of permanent
disablement benefit by the figure indicated in column 2 of Schedule III to
these regulations, corresponding to the age on last birthday of the insured
person on the date on which his application for commutation is received in the
appropriate office and on and from that date the permanent disablement benefit
shall cease to be payable to him :
Provided that where no
proof of age has been submitted as required by the appropriate office or if
submitted, has not been accepted as satisfactory by the appropriate office, the
corresponding age as aforesaid of the insured person shall be the age as
estimated by the Medical Board on the date of examination adjusted by the
period intervening between the date of examination by the Medical Board and the
date on which the application for commutation was received in the appropriate
office :
Provided further that
the age so estimated by the Medical Board shall also operate against any proof
of age that may be submitted after the time allowed for the purpose to the
insured person by the appropriate office before reference of his case to the
Medical Board.
