Chapter 5 - Employees State Insurance Act 1948
Chapter 5 - Employees State Insurance Act 1948
Chapter 5 - Employees State Insurance Act 1948
5.1 INTRODUCTION
ESI Act has been passed to provide for certain benefits to employees incase of sickness,
maternity and employment injury and to make provisions for matters related therto.It is
basically insurance scheme i.e., employees get benefits if they are sick or disabled. An
organization called ESI corporation has been formed under the Act to supervise the
scheme.
Employment injury means personal injury to an employee caused by accident or an
occupational disease arising out of and in the course of his employment, being an
insurable employment, whether the accident occurs or the occupational disease is
contracted within or outside the territorial limits of India.
The Employees State Insurance Act is a social welfare legislation aimed at bringing about
social and economic justice to workers employed in the factories and establishment to
which this Act applies.
5.2 AIMS
Securing maximum labor welfare through various welfare schemes like providing certain
benefits to employees in case of sickness, maternity, disablement and death due to employment
injury to workers and to make provisions for certain other matters in relation thereto.
5.3 NEED:
Legislation providing some social security in the form of Insurance against some contingencies
like sickness, maternity, employment injury and death etc was pleaded at various forms.
5.4 RECOMMENDATIONS
Proceed: The Central Government should proceed with the preparation of a scheme of
health insurance applicable to all perennial factories and covering employment injuries
and maternity benefits if possible.
Circulate: The scheme should be circulated to provincial Government and association of
State Insurance Bill providing for compulsory sickness, maternity and employment injury
benefits for workers in perennial factories was introduced in the Central Legislature on
6th November 1946 and passed in 1948.
5.5 COVERAGE OF THE ACT
It extends to the whole of India.
5.6 DATE OF ENFORCEMENT
It came into effect with effect from-19th April 1948, though Central Government may appoint
different dates for different provisions of the Act and for different States or for different part
thereof.
5.7 APPLICABILITY OF THE ACT:SECTION 1(4)
Include: All factories (including factories belonging to the government) other than
seasonal factories.
Extend: Enabling provision under which the appropriate Government is empowered to
extend the provision of the Act to other establishment-industrial, commercial, agricultural
or otherwise.
Establishment: Enabling provisions most of the State Governments have extended the
provision to new classes of establishments namely shops ,hotels, restaurants, Cinema
Halls including PVR, Road Motor Transport undertaking and Newspaper establishments
employing 20 or more coverable employees.
It is not sufficient that 20 persons are employed in the shop.They should be employee as
per section 2(9) of the Act,getting the wages prescribed therein.
Institution: The employees have been extended to Educational Institution employing
twenty or more employees in most of the States.
Exclude: Employees of factories/establishments mentioned above in the implemented
areas and drawing wages excluding overtime not exceeding ` 15,000 per month are
covered under the Act.
EMPLOYER
Owner of the factory
Head of the Department in case of Government Department
Person responsible for supervison and control in the case of any other establishment.
It may be noted that a factory or an establishment to which the act applies shall continue to be
governed by this act even if the number of persons employed therein at any time falls below the
limit specified by or under the act or the manufacturing process therein ceases to be carried on
with the aid of power. Section 1 (6).
SAVING PROVISION
This act is not applicable to a factory or establishment belonging to or under the control of the
government whose employees are otherwise in receipt of benefits substantially similar or
superior to the benefits provided under this Act
CONSTITUTIONAL PROVISION
The Subject Employees insurance is included in list III at entry no 23 Schedule 7 of Constitution
of India. Both State Government and State Governments have power to make legislative
enactment for this purpose.
5.8 DEFINITIONS
Appropriate government means, in respect of establishments under the control of the Central
Government or a railway administration] or a major port or a mine or oilfield, the Central
Government, and in all other cases, the State Government.
Confinement means labour resulting in the issue of a living child or labour after twenty-six
weeks of pregnancy resulting in the issue of a child whether alive or dead.
Contribution means the sum of money payable to the Corporation by the principal employer in
respect of an employee and includes any amount payable by or on behalf of the employee in
accordance with the provisions of this Act;
Dependant under Section [(6A)] dependant means any of the following relatives of a
deceased insured person, namely, A widow, a minor legitimate or adopted son, an unmarried legitimate or adopted daughter
[(ia) a widowed mother;]
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 years and is
infirm.
Wholly or in part dependent on the earnings of the insured person at the time of his death.
Wages Section 22 means all remuneration paid or payable, in cash to an employee, if the terms
of the contract of employment, express or implied, were fulfilled and includes any payment to an
employee in respect of any period of authorized leave, lock-out, strike which is not illegal or lay
-off and other additional remuneration, if any, paid at intervals not exceeding two months, but
does not include Contribution paid by the employer to any pension fund or provident fund, or under this
Act.
Travelling allowance
Reimbursement of the expense incurred by the employee
Gratuity
Occupational Disease
An employee employed in any employment specified in Part A of Schedule III
contracts any disease specified therein, as an occupational disease.
The employee employed in any employment specified in Part B of Schedule III, for a
continuous period of not less than six months under the same employer.
If an employee whilst in service of one or more employers (not necessarily the same
employer) in any employment specified in Part C of Schedule III for such continuous
period as the Central Government.
The Central Government or the State Government after giving, by notification in the
Official Gazette, not less than three months notice of its intention so to do, may, by a like
notification, add any description of
The period of employment and the place of work. In other words, the workman, at the time of
accident must have been employed in the performance of his duties and the accident took place
at or about the place where he was performing his duties.
Arising out of and in the course of employment:
The basic and undispensable ingredient is unexpectedness. The second ingredient is that the
injury must be traceable within reasonable limits, to a definite time, place or occasion or
cause. The Act should be broadly and liberally constructed in order to effectuate the real
intention and purpose of the Act.
Theory of notional extension of employment
Employer liable it is necessary that the injury caused by an accident must have arisen in the
course of employment. It means that the accident must take place at a time and place when he
was doing his masters job
Case Law : Naima Bibi v. Lodhne Colliery (1920) Ltd., 1977 Lab. I.C. NOC 14: .A
workman while returning home after duty was murdered within the premises of the employer. It
was held that there was casual and proximate connection between the accident and the
employment. Since the workman was on spot only for his employment and his wife is entitled
for compensation.
employees in the factory or establishment shall be insured. The initial and vital endeavour should
be to identify the beneficiaries or the employees for insurance.
5.12 CONTRIBUTION TO EMPLOYEES STATE INSURANCE FUND: SECTION 38
Apply: All employees in factories or establishments to which this Act applies are to be
Sickness Benefit.
Maternity Benefit.
Disablement Benefit.
Dependants Benefit.
Medical Benefit.
Funeral Expenses.
All these benefits except medical benefit are monetary benefits. The rules regarding benefits are
contained in Sections 46 to 58 and Rules 55 to 58.
Medical Benefit:
Full medical care is provided to an Insured person and his family members from the day
he enters insurable employment.
There is no ceiling on expenditure on the treatment of an Insured Person or his family
member. Medical care is also provided to retired and permanently disabled insured
persons and their spouses on payment of a token annual premium of ` 120/Sickness Benefit : Sickness Benefit in the form of cash compensation at the rate of 70 per cent
of wages is payable to insured workers during the periods of certified sickness for a maximum of
91 days in a year. In order to qualify for sickness benefit the insured worker is required to
contribute for 78 days in a contribution period of 6 months.
Extended Sickness Benefit: Sickness Benefit extendable upto two years in the case of 34
malignant and long term diseases at an enhanced rate of 80 per cent of wages.
Enhanced Sickness Benefit: Enhanced Sickness Benefit equal to full wage is payable to insured
persons undergoing sterilization for 7 days/14 days for male and female workers respectively.
Maternity Benefit : Maternity Benefit for confinement/pregnancy is payable for three months,
which is extendable by further one month on medical advice at the rate of full wage subject to
contribution for 70 days in the preceding year
5.13 DISABLEMENT BENEFIT
Temporary disablement benefit: From day one of entering insurable employment &
irrespective of having paid any contribution in case of employment injury. Temporary
Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.
Permanent disablement benefit: The benefit is paid at the rate of 90% of wage in the form of
monthly payment depending upon the extent of loss of earning capacity as certified by a Medical
Board
Dependants Benefit: Dependants Benefit paid at the rate of 90% of wage in the form of
monthly payment to the dependants of a deceased Insured person in cases where death occurs
due to employment injury or occupational hazards.
Other Benefits:
Funeral Expenses: An amount of ` 10, 000/- is payable to the dependents or to the person who
performs last rites from day one of entering insurable employment.
Confinement Expenses: An Insured Women or an Insured Person in respect of his wife in case
confinement occurs at a place where necessary medical facilities under ESI Scheme are not
available.
Vocational Rehabilitation: To permanently disabled Insured Person for undergoing VR Training
at VRS.
Physical Rehabilitation: In case of physical disablement due to employment injury.
Old Age Medical Care: For Insured Person retiring on attaining the age of superannuation or
under VRS/ERS and person having to leave service due to permanent disability insured person &
spouse on payment of ` 120/- per annum.
Rajiv Gandhi Shramik Kalyan Yojana - This scheme of Unemployment allowance was
introduced w.e.f. 01-04-2005. An Insured Person who become unemployed after being insured
maternity benefit. It further provides that no notice of dismissal or discharge or reduction given
to an employee during such period shall be valid or operative.
5.15 PURPOSE OF ESI FUND MAYBE EXPENDED UNDER ESI ACT
individual.
Include all expenses of auditing the accounts of the corporation and the valuation of
assets and liabilities.
Payment of sums under any decree, order or award of any court or tribunal against the
corporation or any of its officers or servants.
EMPLOYEES INSURANCE COURT-SECTION 74
Employees Insurance Court is constituted under the Section 74 of the employees State Insurance
Act, 1948.
the claims.
The State Government may appoint the same court for two or more local areas or two or
more courts for the same local area and may regulate the distribution of business between
them
5.16 MATTERS TO BE DECIDED BY EMPLOYEES STATE INSURANCE COURT
ADJUDICATION OF DISPUTES: The EIC has jurisdiction to adjudicate disputes, namely
whether any person is an employee under the Act, rate of wages/contribution, as to who is or was
the principal employer, right of a person to any benefit under the Act.
ADJUDICATION OF CLAIMS:
EI court also has jurisdiction to decide claims for recovery of contribution from principal
employer or immediate employer, action for failure or negligence to pay contribution ,
claim for recovery of any benefit admissible under the act.
Proceedings in both the above cases can be initiated by filing application in the
prescribed form by the employee or his dependent or employer or the corporation
depending who has cause of action.
No civil court has power to decide the matters falling within the purview /jurisdiction of
E.I.Court.
5.17 PENALTIES-SECTION 84
False Statement: Any person knowingly makes or cause to make a false statement or false
representation for the purpose of causing any increase in payment or benefit or causing any
payment or benefit not authorized under this Act.
Avoiding : For the purpose of avoiding any payment or benefits to be made under this Act shall
be punishable with imprisonment for a term which may extend to six months, or with fine not
exceeding two thousand rupees, or with both.
Contribution : Part of employers contribution from the salary or wages of the employee or
reducing salary or wages or any benefit of the employee on account of employer contribution
shall be punishable for a term which may extend to three years but
Shall not be less than one year, in case of failure to pay the employees contribution
which has been deducted by him from the employees wages and shall also be liable to
fine of ten thousand rupees
Shall not be less than six months, in any other case and shall also be liable to fine of five
thousand rupees for failure to deposit contribution. If the offence relates to recover of
employers contribution from salary and wages of the employee or reduction any benefit
or payment, with imprisonment for a term which may extend to one year or with fine
which may extend to four thousand rupees, or with both.
PENALTY FOR REPEATED VIOLATION-SECTION 85A
Commits the same offence shall, for every such subsequent offence, be punishable with
imprisonment for a term which may extend to two years and with fine of five thousand
rupees In case such subsequent offence is for failure by the employer to pay any
contribution which under this Act he is liable to pay, he shall, for every such subsequent
offence, be punishable with imprisonment for a term which may extend to five years but
which shall not be less than two years and shall also be liable to fine of twenty-five
thousand rupees.
Where an employer is convicted of an offence for failure to pay any contribution payable
under this Act, the Court may, in addition to awarding any punishment by order, in
writing require him within a period specified in the order to pay the amount of
contribution in respect of which the offence was committed, and to furnish the return
relating to such contributions.
In such a case the employer shall not be liable under this Act in respect of the
continuation of the offence during the period or extended period, if any, allowed by the
Court, but if, on the expiry of such period or extended period, as the case may be, the
order of the Court has not been fully complied with, the employer shall be deemed to
have committed a further offence and shall be punishable with imprisonment in respect
thereof under section 85 and shall also be liable to pay fine which may extend to one
thousand rupees for every day after such expiry on which the order has not been
complied with.
5.18 POWER TO DISENTITLE BENEFIT TO INSURED PERSON
Benefits: If the Central Government is satisfied that the benefits under this Act are being
beard is given to the concerned factory or establishment, insured persons and the trade
unions registered under the Trade Unions Act, 1926 having members in the factory or
establishment.
The E.S.I. Corporation, subject to certain conditions, can prescribe regulations and rules for the
administration of the affairs of the Corporation and for carrying into effect the provisions of this
Act.
CASE LAWS
Royal Talkies , Hyderabad vs ESI Corporation :
It was held that employee of the cycle stand and the canteen run in a cinema theatre by
contractors to whom the cycle stand and canteen have been leased are employees within the
meaning of ESI Act.
ESIC V.MM Suri and Associates Pvt Ltd :
It is not sufficient that 20 persons are employed in the shop. They should also be covered under
the meaning of employee as per the act.
Regional Director,ESI Vs Francis de Costa :
The Supreme Court held that mere road accident on a public road while employee was on his
way to place of employment cannot be said to have its origin in his employment in the
factory.Thus the injury cannot be said to be caused by an accident arising out of and in the course
of employment.
ESI Corpn Vs Babulal :
It was held that injury arose out of employment where a workmen attending duty in spite of
threats by persons giving call for strike and was assaulted by them while returning after his duty
was over.
Jayanthilal Dhanji Vs ESIC :
An injury caused to a worker while knocking the belt of the moving pulley was held to be
employment injury.
Hyderabad Asbestos Cement Products Vs ESIC :
The word employee would include not only persons employed in a factory but also persons
connected with the work of the factory
ESIC Vs Apex Engg Pvt Ltd
It was held that Managing Director could also be an employee of the company and hence
covered under the Act .
Regional Director , ESI Corpn Vs L.Rangarao
SUMMARY
The ESI Act applies to all power using factories employing 10 or more persons and to all nonpower using factories employing 20 or more persons. Persons whose remuneration [including
overtime] per month does not exceed Rs. 10,000/-are covered under the Act. The scheme
provides for sickness and extended sickness benefit, maternity benefit, disablement, dependents
benefit, medical benefit , funeral benefit and so on. The scheme is administered by a corporate
body called Employees State Insurance Corporation.
REVIEW QUESTIONS
Can an insured woman be entitled to sickness benefit and maternity benefit together for
the same period ? Difference between Principal and Immediate Employer?
Write short notes on Employment injury under the ESI Act,1948 ?
Write short notes on Purposes for Which ESI fund may be expended under the ESI
Act,1948 ?
Write short notes on Dependent under ESI Act,1948 ?
Write a short note on Benefits to which insured persons are entitled ?
Difference between Sickness Benefit and Medical Benefit under the ESI Act, 1948 ?
Write short notes on Employees Insurance Court under ESI Act, 1948 ?