The Employees' State Insurance Act,1948

•This Act may be called the Employees' State

Insurance Act,1948.
• (2) It extends to the whole of India
•It shall apply, in the first instance, to all
factories
•Appropriate Government may extend the
provisions of this Act to any other
establishment
 Definitions
•"dependant" means any of the following relatives of a deceased insured
person, namely,-
• (i) a widow, a minor legitimate or adopted son, an unmarried legitimate or
adopted daughter
•(ia) a widowed mother
•(ii) 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 eighteen years and is infirm;
• (iii) if wholly or in part dependent on the earnings of the insured person at
the time of his death,-
• (a) a parent other than a widowed mother,
• (b) a minor illegitimate son,
•an unmarried illegitimate daughter or
•a daughter legitimate or adopted or illegitimate if married and a minor or
•if widowed and a minor
 Definitions

• (c) a minor brother or an unmarried sister or a widowed

sister if a minor,
• (d) a widowed daughter-in-law,
•(e) a minor child of a pre-deceased son,
• (f) a minor child of a pre-deceased daughter where no parent
of the child is alive, or
•(g) a paternal grand-parent if no parent of the insured person
is alive
 Definitions

•"employment injury" means

•a 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
 Definitions

•"employee" means any person employed for wages in

or in connection with the work of a factory or
establishment to which this Act applies
•Persons employed through contractors also included
but does not include
• (a) any member of the Indian naval, military or air
forces; or
• (b) any person so employed whose wages
(excluding remuneration for overtime work) exceed
Rs.7500/-
 Definitions

•"family" means all or any of the following relatives of an insured person,

namely,-
• (i) a spouse;
• (ii) a minor legitimate or adopted child dependent upon the insured
person;
• (iii) a child who is wholly dependent on the earnings of the insured person
and who is-
• (a) receiving education, till he or she attains the age of twenty-one years,
• (b) an unmarried daughter;
•(iv) a child who is infirm by reason of any physical or mental abnormality
or injury and is wholly dependent on the earnings of the insured person, so
long as the infirmity continues;
•(v) dependent parents;
 Definition

• "permanent partial disablement" means

•such disablement of a permanent nature,
•which reduces the earning capacity of an employee in every
employment
•which he was capable of undertaking at the time of the
accident resulting in the disablement:
•Every injury specified in Part II of the Second Schedule shall
be deemed to result in permanent partial disablement
 Definition

•"permanent total disablement" means such disablement of a

permanent nature which incapacitates an employee for all
work which he was capable of performing at the time of the
accident resulting in such disablement:
• permanent total disablement shall be deemed to result from
every injury specified in Part I of the Second Schedule or from
any combination of injuries specified in Part II thereof where
the aggregate percentage of the loss of earning capacity, as
specified in the said Part II against those injuries, amounts to
one hundred per cent or more
 Definition

•"temporary disablement" means a

condition resulting from an employment
injury
•which requires medical treatment and
renders an employee, as a result of such
injury, temporarily incapable of doing the
work which he was doing prior to or at
the time of the injury
 Definition

•"wages" 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 authorised 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
• (a) any contribution paid by the employer to any pension fund or
provident fund, or under this Act;
• (b) any travelling allowance or the value of any travelling concession;
• (c) any sum paid to the person employed to defray special expenses
entailed on him by the nature of his employment; or
• (d) any gratuity payable on discharge
2A. Registration of factories and establishments

•Every factory or establishment to

which this Act applies shall be
registered within such time and in
such manner as may be specified in
the regulations made in this behalf
 38. All employees to be insured

•Subject to the provisions of this Act,

all employees in factories or
establishments to which this Act
applies shall be insured in the manner
provided by this Act
 Employer to pay contribution

•The principal employer shall pay in respect of every

employee, whether directly employed by him or by or through
an immediate employer,
•both the employer's contribution and
•the employee's contribution
•Delayed payment will attract interest
•Employer is entitled to recover the employees contribution by
deduction from wages
•Any contribution payable under this Act may be recovered as
an arrear of land revenue from the employer(45B )
 Contribution period and Benefit period

Contribution period Corresponding benefit

period
1 April to 30 September 1 January to 30 June

1 October to 31 March 1 July to 31 December

 45. Inspectors, their functions and duties

•ESI Corporation may appoint such persons as Inspectors, as it

thinks fit
•(a) require any principal or immediate employer to furnish to
him such information as he may consider necessary
•at any reasonable time enter any office, establishment, factory
examine such accounts, books and other documents relating to
the employment of persons
•examine the principal or immediate employer, his agent or
servant
•make copies of, or take extracts from, any register, account
book or other document
•exercise such other powers as may be prescribed
 46. Benefits

•the insured persons, their dependants or the persons

hereinafter mentioned, as the case may be, shall be
entitled to the following benefits
•(a) periodical payments to any insured person in case
of his sickness certified by a duly appointed medical
practitioner
•(b) periodical payments to an insured woman in case
of confinement or miscarriage or sickness arising out
of pregnancy, confinement, premature birth of child
or miscarriage
 46. Benefits

•(c) 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
•(d) periodical payments to such dependants of an
insured person who dies as a result of an employment
injury
•(e.) medical treatment for insured persons (medical
benefit)
 46. Benefits

•(f)payment to the eldest surviving member of

the family of an insured person who has died,
towards the expenditure on the funeral of the
deceased insured person or, where the insured
person did not have a family or was not living
with his family at the time of his death, to the
person who actually incurs the expenditure on
the funeral of the deceased insured person
(funeral expenses)
 56. Medical benefit

(1) An insured person or (where such medical benefit is extended to his

family) members of his family whose condition requires medical treatment
and attendance shall be entitled to receive medical benefit.
(2) Such medical benefit may be given either in the form of out-patient
treatment and attendance in a hospital or dispensary, clinic or other
institution or by visits to the home of the insured person or treatment as in-
patient in a hospital or other institution.
(3) A person shall be entitled to medical benefit during any period for
which contributions are payable in respect of him or in which he is qualified
to claim sickness benefit or maternity benefit or is in receipt of such
disablement benefit as does not disentitle him to medical benefit under the
regulations
 56. Medical benefit

an insured person who ceases to be in insurable employment on account of

permanent disablement shall continue, subject to payment of contribution
and such other conditions as may be prescribed by the Central Government,
to receive medical benefit till the date on which he would have vacated the
employment on attaining the age of superannuation had he not sustained
such permanent disablement:
that an insured person, who has attained the age of superannuation, and his
spouse shall be eligible to receive medical benefit subject to payment of
contribution and such other conditions as may be prescribed by the Central
Government
 Extent of Sickness benefit

If an employee falls sick necessitating his absence from

work he will be entitled to cash payment from ESIC
At daily standard rate which is equivalent to 50 % of normal
wages
Upto 91 days (except initial 2 days of waiting period)
Upto 309 days(extended sickness benefit) for serious
diseases provided the employee is in continuous employment
for at least 2 years
 Extent of maternity benefit

Cash Payments for

Confinement upto 12 weeks
Miscarriage upto 6 weeks
Sickness arising out of pregnancy upto one
month
In case of death 12 weeks if child survives
or till the child survives
Rate: twice the daily standard benefit rate
which is roughly amounts to normal wages.
 Disablement benefit
Available for employment injury
For total (permanent or temporary) disablement
the benefit is at full rate which is 25 percent more than the daily
standard benefit rate
For permanent partial disablement the payment is at such percentage of
the full rate proportionate to the loss of earning capacity
Duration
In case of temporary disablement the benefit is payable as long as the
disablement exists
In case of permanent disablement the benefit is payable till the death of
the insured person
There is no waiting period
There is no limit on the number of days payable
There is no contributory condition
 Extent of Dependent’s benefit

If an insured person dies as a result of

employment injury
Dependents’ benefit is payable to the
dependents
Rate : at full rate which is 25 percent more
than the standard rate
There is no contributory condition for
dependents benefit
Funeral benefit Rs. 100/-
 Medical Benefit

Medical treatment and attendance for illness

for insured person and his family members
Out patient and in patient treatments
In case of employment injury
Free supply of artificial limb and cost towards fitting such limbs
Supply of hand driven tricycles in case of loss of lower limbs
Free supply of spectacles, dentures and hearing aids
Available immediately on commencement of the insurance
Family is defined to include only the spouse, minor legitimate/adopted
children and dependent parents for this benefit
 59. Establishment and maintenance of
hospitals, etc. by Corporation
(1) The Corporation may, with the approval of the State
Government, establish and maintain in a State such
hospitals, dispensaries and other medical and surgical
services as it may think fit for the benefit of insured
persons and their families.
(2) The Corporation may enter into agreement with
any local authority, private body or individual in
regard to the provision of medical treatment and
attendance for insured persons and their families, in
any area and sharing the cost thereof.
 58. Provision of medical treatment by
State Government
The State Government may provide for insured persons and their families in
the State reasonable medical, surgical and obstetric treatment:
State Government may, with the approval of the Corporation, arrange for
medical treatment at clinics of medical practitioners on such scale and
subject to such terms and conditions as may be agreed upon.
Where the incidence of sickness benefit payment to insured persons in any
State is found to exceed the all-India average, the amount of such excess
shall be shared between the Corporation and the State Government in such
proportion as may be fixed by agreement between them:
 60. Benefit not assignable or attachable

(1) The right to receive any payment of any benefit under this Act shall not
be transferable or assignable.
(2) No cash benefit payable under this Act shall be liable to attachment or
sale in execution of any decree or order of any Court.
61. Bar of benefits under other enactments
When a person is entitled to any of the benefits provided by this Act, he shall
not be entitled to receive any similar benefit admissible under the provisions
of any other enactment.
62. Persons not to commute cash benefits
Save as may be provided in the regulations, no person shall be entitled to
commute for a lump sum any disablement benefit admissible under this Act
51A. Presumption as to accident arising in
course of employment

•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
51B. Accidents happening while acting in breach
of regulations, etc.
•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
• (a) 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
• (b) the act is done for the purpose of and in connection with
the employer's trade or business
 5IC. Accidents happening while traveling in
employer's transport
• (1) 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
• (a) the accident would have been deemed so to have arisen had he been under
such obligation; and
• (b) at the time of the accident, the vehicle
• (i) 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
• (ii) is not being operated in the ordinary course of public transport service.
• (2) In this section "vehicle" includes a vessel and an aircraft
 51D. Accidents happening while meeting
emergency
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
 52A. Occupational disease

•(1) If an employee employed in any employment

•specified in Part A of the Third Schedule contracts any disease specified
therein as an occupational disease peculiar to that employment or
•if an employee employed in the employment specified in Part B of that
Schedule for a continuous period of not less than six months contracts any
disease specified therein as an occupational disease peculiar to that
employment or
•if an employee employed in any employment specified in Part C of that
Schedule for such continuous period as the Corporation may specify in
respect of each such employment, contracts any disease specified therein as
an occupational disease peculiar to that employment,
•the contracting of the disease shall, unless the contrary is proved, be
deemed to be an 'employment injury' arising out of and in the course of
employment
 53. Bar against receiving or recovery of
compensation or damages under any other law
•An insured person or his dependants
shall not be entitled to receive or recover,
whether from the employer of the insured
person or from any other person, any
compensation or damages under the
Workmen's Compensation Act, 1923 or
any other law
63. Persons not entitled to receive benefit in
certain cases
•No person shall be entitled to
•sickness benefit or disablement benefit for
temporary disablement
•on any day on which he works or remains on
leave or on a holiday in respect of which he
receives wages or
•on any day on which he remains on strike
 64. Recipients of sickness or disablement
benefit to observe conditions

•A person who is in receipt of sickness benefit or disablement benefit

(other than benefit granted on permanent disablement)
• (a) shall remain under medical treatment at a dispensary, hospital, clinic
or other institution provided under this Act and shall carry out the
instructions given by the medical officer or medical attendant in charge
thereof;
•(b) shall not while under treatment do anything which might retard or
prejudice his chances of recovery;
•(c) shall not leave the area in which medical treatment provided by this
Act is being given, without the permission of the medical officer, medical
attendant or such other authority as may be specified in this behalf by the
regulations; and
• (d) shall allow himself to be examined by any duly appointed medical
officer or other person authorised by the Corporation in this behalf
 65. Benefits not to be combined

•(1) An insured person shall not be entitled to receive for the

same period-
• (a) both sickness benefit and maternity benefit; or
• (b) both sickness benefit and disablement benefit for
temporary disablement; or
• (c) both maternity benefit and disablement benefit for
temporary disablement.
• (2) Where a person is entitled to more than one of the
benefits mentioned in sub-section (1), he shall be entitled to
choose which benefit he shall receive.
69. Liability of owner or occupier of factories,
etc. for excessive sickness benefit
•(1) Where the Corporation considers that the incidence of sickness among
insured persons is excessive by reason of-
• (i) in sanitary working conditions in a factory or establishment or the
neglect of the owner or occupier of the factory or establishment to observe
any health regulations enjoined on him or under any enactment; or
• (ii) in sanitary conditions of any tenements or lodgings occupied by
insured persons and such in sanitary conditions are attributable to the
neglect of the owner of the tenements or lodgings to observe any health
regulations enjoined on him by or under any enactment,
•the Corporation may send to the owner or occupier of the factory or
establishment or to the owner of the tenements or lodgings, as the case may
be, a claim for the payment of the amount of the extra expenditure incurred
by the Corporation as sickness benefit; and if the claim is not settled by
agreement, the Corporation may refer the matter with a statement in support
of its claim, to the appropriate government.
 72. Employer not to reduce wages, etc.

•No employer by reason only of his liability

for any contributions payable under this Act
• shall, directly or indirectly, reduce the wages
of any employee, or except as provided by the
regulations,
•discontinue or reduce benefits payable to him
under the conditions of his service which are
similar to the benefits conferred by this Act
73. Employer not to dismiss or punish employee
during period of sickness, etc
•(1) No employer shall dismiss, discharge, or reduce or
otherwise punish an employee during the period the employee
is in receipt of sickness benefit or maternity benefit, nor shall
he, except as provided under the regulations, dismiss,
discharge or reduce or otherwise punish an employee during
the period he is in receipt of disablement benefit for temporary
disablement or is under medical treatment for sickness or is
absent from work as a result of illness duly certified in
accordance with the regulations to arise out of the pregnancy
or confinement rendering the employee unfit for work.
• (2) No notice of dismissal or discharge or reduction given
to an employee during the period specified in sub-section (1)
shall be valid or operative.
74. Constitution of Employees' Insurance Court

•(1) The State Government shall, by notification in the Official Gazette,

constitute an Employees' Insurance Court for such local area as may be
specified in the notification
• If any question or dispute arises as to-
• (a) whether any person is an employee within the meaning of this Act or
whether he is liable to pay the employee's contribution, or
• (b) the rate of wages or average daily wages of an employee for the
purposes of this Act, or
• (c) the rate of contribution payable by a principal employer in respect of
any employee, or
• (d) the person who is or was the principal employer in respect of any
employee, or
• (e) the right of any person to any benefit and as to the amount and
duration thereof, or
74. Constitution of Employees' Insurance Court

•(ee) any direction issued by the Corporation under section 55A on a review of any
payment of dependants benefits, or
•(g) any other matter which is in dispute between a principal employer and the
Corporation, or between a principal employer and an immediate employer or
between a person and the Corporation or between an employee and a principal or
immediate employer, in respect of any contribution or benefit or other dues payable
or recoverable under this Act, or any other matter required to be or which may be
decided by the Employees' Insurance Court under this Act,
•such question or dispute subject to the provision of sub-section (2A) shall be
decided by the Employees' Insurance Court in accordance with the provisions of
this Act.
• (2) Subject to the provisions of sub-section (2A), the following claims shall be
decided by the Employees' Insurance Court, namely:-
• (a) claim for the recovery of contributions from the principal employer;
• (b) claim by a principal employer to recover contributions from any immediate
employer;
74. Constitution of Employees' Insurance Court

•(d) claim against a principal employer under section 68;

• (e) claim under section 70 for the recovery of the value or amount of the benefits
received by a person when he is not lawfully entitled thereto; and
• (f) any claim for the recovery of any benefit admissible under this Act.
•2A) If in any proceedings before the Employees' Insurance Court a disablement
question arises and the decision of a medical board or a medical appeal tribunal has
not been obtained on the same and the decision of such question is necessary for the
determination of the claim or question before the Employees' Insurance Court, that
Court shall direct the Corporation to have the question decided by this Act and shall
thereafter proceed with the determination of the claim or question before it in
accordance with the decision of the medical board or the medical appeal tribunal, as
the case may be, except where an appeal has been filed before the Employees'
Insurance Court under sub-section (2) of section 54A in which case the Employees'
Insurance Court may itself determine all the issues arising before it.
74. Constitution of Employees' Insurance Court

•(2B) No matter which is in dispute between a principal employer and the

Corporation in respect of any contribution or any other dues shall be raised
by the principal employer in the Employees' Insurance Court unless he has
deposited with the Court fifty per cent of the amount due from him as
claimed by the Corporation:
• Court may, for reasons to be recorded in writing, waive or reduce the
amount to be deposited under this sub-section.
• (3) No Civil Court shall have jurisdiction to decide or deal with any
question or dispute as aforesaid or to adjudicate on any liability which by
or under this Act is to be decided by a medical board, or by a medical
appeal tribunal or by the Employees' Insurance Court.
 82. Appeal

•1) Save as expressly provided in this section, no appeal shall

lie from an order of an Employees' Insurance Court.
• (2) An appeal shall lie to the High Court from an order of
an Employees' Insurance Court if it involves substantial
question of law.
• (3) The period of limitation for an appeal under this section
shall be sixty days.
• (4) The provisions of sections 5 and 12 of the Limitation
Act, 1963 shall apply to appeals under this section.