Introduction - 

        The Employees State Insurance Act, 1948 is enacted to protect the Industrial workers and their families, who are exposed to the risk of sickness, employment injury, occupational diseases and Maternity in case of female employees. There are general rules relating to benefit under the said Act.

General rules relating to benefit under the Employees State Insurance Act, 1948  -

     Following are the general rules relating to benefits under the Employees State Insurance Act 1948

1) Benefit not assignable or attachable - 

According to Section 60(1), The right to receive any payment of any benefit under this Act (The Employees State Insurance Act, 1948) 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.


2) Bar of benefits under other Acts - 

     Section 61 of the said Act says that 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.

3) Cash benefit not commutable - 

    No person shall be entitled to commute for a lump sum any periodical payment admissible under this Act. But he may do so if the regulations specifically provide for commutation (Section 62) 

4) Benefit not receivable in certain cases - 

      According to Section 63, 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.

5) Observance of certain conditions (Section 64) - 

 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 authorized by the Corporation in this behalf.

6) Benefits not to be combined (Section 65) - 

        (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.
       

7) Default by the employees in paying the contribution - 

          Section 68(1), If any principal employer fails to neglect to pay any contributions, employees insurance act corporation is entitled to recover twice the amount of the contribution in arrears or the difference between the amount benefit paid and the amount which he would have received on the basis of contribution paid whichever is Greater The amount of arrears can be recovered as arrears of land revenue.

See also... Employees State Insurance Corporation (E.S.I.C) : Constitution, Powers of the Employees State Insurance

8) Repayment of benefit improperly received (Section 70) -

      (1) Where any person has received any benefit or payment under this Act when he is not lawfully entitled thereto, he shall be liable to repay to the Corporation the value of the benefit or the amount of such payment, or in the case of his death his representative shall be liable to repay the same from the assets of the deceased, if any, in his hands.

     (2) The value of any benefits received other than cash payments shall be determined by such authority as may be specified in the regulations made in this behalf and the decision of such authority shall be final.

    (3) The amount recoverable under this section may be recovered as if it were an arrear of land revenue or under Section, 45C to section 45I.

9) Benefits payable up to the day of death (Section 71) - 

      If a person dies, during any period for which he is entitled to a cash benefit under this Act, the amount of such benefit up to and including the day of his death shall be paid to any person nominated by the deceased person in writing in such form as may be specified in the regulations or, if there is no such nomination, to the heir or legal representative of the deceased person.

10) Employer not to reduce wages, etc.  (Section 72) - 

      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.

11) Employee not to dismiss or punish the employee during the benefit period (Section 73) -

      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.



See also 

Standing committee (Employees State Insurance Corporation 1948) | Labor Law

Conditions for payment of compensation under the Workmen's Compensation Act,1923

Medical Benefit Council (The Employees State Insurance Act, 1948) | Labor Law

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