EMPLOYEES STATE INSURANCE ACT, 1948workmen’s compensation actkalaignar kapitu thittam

DR. M. GEETHAPOST GRADUATE,ICM, MMC

EMPLOYEES STATE INSURANCE ACT, 1948

EMPLOYEES STATE INSURANCE ACT, 1948 first implemented at Kanpur & Delhi on 24th Feb., 1952 only health insurance scheme that offers full medical

care to workers & their dependants without any ceiling on individual expenditure.

Coverage of factories: -all non-seasonal factories using power & employing

10/more persons -non-power using factories employing 20/more persons

for wages

EMPLOYEES STATE INSURANCE ACT, 1948 Coverage of employees: - an ‘employee’ means any person employed for wages in or in

connection with the work of a factory or establishment to which this act applies

- employees with the monthly wage ceiling of Rs.15000

Administration: Administered by a corporate body called Employees State

Insurance Corporation Main function is to frame policies. Medical Benefit Council: advisory body Standing Committee: executive body

EMPLOYEES STATE INSURANCE ACT, 1948 Finance: ESI Fund * State Government share 1/8th of expenditure on

medical treatment & attendance * 7/8th of the expenditure borne by ESIC -Employers: 4.75% of the wages payable to the

employees -Employees: 1.75% of the wages payable to the

employee Employees with a daily average wage upto Rs. 50 are

exempted from payment of contribution. Employers will however contribute their share

EMPLOYEES STATE INSURANCE ACT, 1948 Benefits: Section 46 of the Act envisages

following 6 social security benefits

Medical BenefitSickness BenefitMaternity BenefitDisablement BenefitDependant BenefitFuneral Expenses

Medical Benefits

For insured persons: Full medical care For families of IP’s: 2 types of care provided Restricted medical care i.e. only out-patient care Expanded medical care i.e. full medical care short of hospitalisation DIRECT PATTERN: (1)In areas with a concentration of 1000 or more

employees’ family units-service dispensaries with fulltime medical & paramedical personnel

(2) In areas where employees’ are less than 750 – part time ESI dispensaries

(3) If residential concentration of employees’ scattered over a long distance - Mobile dispensaries

INDIRECT PATTERN: “Panel system” – Registered medical practitioners designated as

Insurance Medical Practitioners are appointed to provide medical care.

Sickness Benefits

50% of the average daily wages is payable for a maximum period of 91 days, in any continuous period of 365 days.

Extended sickness benefit:

- should have been in continuous employment for more than 2 years

-Provision for paying SB for an extended period upto 2 years in an ESB period of 3 years. 34 diseases have been recognised for provision of ESB as on 1.1.2000

Enhanced sickness benefit:

providing sickness cash benefit equal to full wages for a period of 7 days for vasectomy & 14 days for tubectomy from the date of surgery or admission

Maternity Benefits

Confinement- payable for a period of 12 weeks (84 days) (form21 & 23)

Miscarriage or Medical Termination of Pregnancy- payable for 6 weeks (42 days) from the date following miscarriage (form 20 & 23)

Sickness arising out of pregnancy, confinement, premature birth- payable for a period not more than 1 month (forms 8, 10 & 9)

Death of the insured mother during confinement leaving behind a child- maternity benefit is payable to her nominee (form 24[B])

Double the Standard Benefit Rate, or roughly equal to the average daily wage.

Disablement Benefits

Cash payment, besides free medical treatment, in the event of temporary or permanent disablement as a result of employment injury as well as occupational diseases.

Temporary Disablement Benefit(TDB):

-TDB rate is 40% over & above the normal SB rate, i.e. nearly 85% of the average daily wages

Permanent Disablement Benefit(PDB):

-in case of total permanent disablement, the IP is given life pension worked out on the basis of loss of earning capacity

-in case of partial permanent disablement, a portion of it is granted as life pension

Dependant Benefits

in case an IP dies d/t employment injuryno contributory conditionswidow/ legitimate or adopted child/ widowed

motherage of dependants has to be determinedminimum rate was Rs.14/day w.e.f. 1.1.90 latest enhancement w.e.f 1.8.2002 – 40%

more than the standard daily benefit rate

Funeral Expenses An amount of Rs. 2500 paid to the eldest surviving

member for the funeral purpose. Other benefits:

Rehabilitation allowance: On monthly payment of Rs.10, the insured person &

his family members continue to get medical treatment after permanent disablement or retirement.

Unemployment allowance: Rajiv Gandhi Shramik Kalyan Yojana w.e.f. from

1.4.2005. the daily benefit rate is the standard benefit rate

corresponding to the average daily wage of an IP

Benefits to Employers Exemption from applicability of Workmen’s

compensation act,1923 Exemption from Maternity Benefit Act,1961 Exemption from payment of medical allowance to

employees & their dependants or arranging for their medical care

Rebate under the Income Tax Act on contribution deposited in the ESI account

Healthy work force

Latest Amendments of ESI Act:

Wage ceiling for coverage enhanced from Rs.10000 to Rs.15000 w.e.f. 1st May,2010

 Funeral expenses increased to Rs.3000 to Rs.5000 w.e.f 1.9.2009

Eligibility condition for availing Unemployment allowance relaxed to 3 years w.e.f 11.9.2009

the daily rate of SB shall be 20% more than the standard benefit rate

Disablement benefit- instead of 40% more than the standard benefit rate for a day, it shall be 50%

Dependant benefit- - instead of 40% more than the standard benefit rate for a day, it shall be 50%

Section 2, clause 6A- instead of a widow or legitimate or adopted son aged 18 years, it shall be 25 years.

WORKMEN COMPENSATION ACT, 1923

WORKMEN COMPENSATION ACT, 1923 Act no. 8 of 1923, it is the first piece of legislation

towards social security. It was enacted on 5th March of 1923 & came into force on July 1,1924.

Objective:

The objective of this Act is that in the case of an employment injury compensation be provided to the injured workman and in case of his death to his dependants.

To which establishments does the Act apply?

It is only those establishments, which employ a lesser number of workers (<20), and therefore to do not come within the purview of the ESI Act that the Workmen’s Compensation Act applies to.

WORKMEN COMPENSATION ACT, 1923 Who are eligible?

-should be engaged in the employer’s trade or business

-with the Amendment of 2000 now even casual workers are covered

-a driver, a mechanic, cleaner, or person employed in any other capacity in connection with a motor vehicles

The only requirement is:

The worker should be employed in an activity, which has to be either listed in schedule II of the Act OR any duty having connection with the specified activity mentioned in the schedule.

WORKMEN COMPENSATION ACT, 1923 When is an employer liable to pay compensation? As per Section 3 of the Act, the employer is liable to pay

compensation if the worker is injured by accident that:

- arises out of (i.e. while engaged in work), and;

- in the course of his employment (i.e. during work hours) and

- such an injury results in disablement of the worker Employer is not liable,

-Where the disablement does not last for more than three days.

-Where the disablement has arisen out of the following:

(a) Drugs or drink;

(b) Disobedience;

(c) Disregard for the safety measures prescribed

WORKMEN COMPENSATION ACT, 1923 Definition of ‘Disablement’: Under the Act, there are 4 types of eventualities, which can be

compensated, 1. Death 2. Permanent Total Disablement: disablement that incapacitates a

worker from all kinds of work. 3. Permanent partial disablement: disablement that reduces the

capacity to work in any employment similar to that the worker was performing at the time of the accident.

4. Temporary disablement: This may be total or partial disablement, which is of temporary nature, which reduces the earning capacity of the worker in any similar employment for the period of disablement.

WORKMEN COMPENSATION ACT, 1923 Compensation for an occupational disease: An “occupational disease” while in service, is a disease that inflicts

workers in that particular occupation in which s/he was employed in and resulting from exposure to a hazardous working atmosphere, particular to that employment. If a worker contracts such a disease then the employer is liable to pay compensation, provided that the worker was employed by him for a continuous period of 6 months

WORKMEN COMPENSATION ACT, 1923 Deciding compensation: Compensation calculated on the basis of monthly wages received

by the worker. In case of death: (to the dependants) 50% of the monthly wage of

the deceased workman, multiplied by the relevant factor, or Rs. 80000, whichever is more.

(Where the monthly wages of a worker is more than Rs. 4000/- , it is taken to be only Rs. 4000/- for calculating either compensation in case of death, or permanent disablement)

In case of total permanent disablement: 60% of the monthly wage, multiplied by the relevant factor or Rs. 90000, whichever is more.

WORKMEN COMPENSATION ACT, 1923 Deciding compensation: In case of partial permanent disablement: the

compensation is a percentage of that payable in the case of total permanent disablement. The earning capacity is determined by a qualified medical practitioner.

In case of (total or partial disablement): a sum equal to 25% of the monthly wages of the workman shall be paid half-monthly.

KALAIGNAR KAPEETTU THITTAM

KALAIGNAR KAPEETTU THITTAM

The Chief Minister Kalaignar’s Insurance Scheme for Life Saving Treatments was launched on July, 23, 2009 for provision of medical care to underprivileged in tie-up with Star Health Insurance.

Beneficiaries:

About 1 crore people below poverty line will be benefitted.

-all members of welfare boards in the state will automatically become beneficiaries, with their dependants being covered too

-any family whose annual income is Rs.72000 or less Procedures covered:

51 notified medical interventions covered

KALAIGNAR KAPEETTU THITTAM

What is not covered?

-Expenses for investigation that results in the diagnosis of an ailment not covered in the scheme

-Cost of medicine/ conveyance etc. Before/after treatment

-Any other treatment cost not included in the list Sum insured: Rs. 100000(1 lakh) per family for a period of 4 years The Government will pay the premium of Rs. 500 per

annum A total of Rs. 517.3 crores is the allotment for the

current financial year

KALAIGNAR KAPEETTU THITTAM Network hospitals:

-The insurance company will identify hospitals & enrol under this scheme

-Minimum of 6 hospitals in each district & 15 hospitals in major cities

-The payment will be based on package rates finalised with the hospital

-The beneficiary is not required to pay for treatment until the limit of 1 lakh is exhausted

Liaison officer:

-A liaison officer of Star Health will be stationed in all hospitals under the network

-Will help the beneficiaries in registration to the hospital

-A dedicated kiosk will be provided by the hospital to facilitate service

KALAIGNAR KAPEETTU THITTAM

Admission process:

-For elective surgeries Biometric Smart Card along with referral form

-For emergencies Biometric Smart Card alone may be enough

-If smart cards have not been issued yet

* for head of the family

* for family members

* those not members of any welfare board Enrolment process: Administrative pattern:

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