The document summarizes the key aspects of the Employees' State Insurance Act, 1948 in India. It was enacted to provide social insurance to workers against sickness, maternity, employment injury and death benefits. It is administered by the Employees' State Insurance Corporation through a network across states. The act provides for medical benefits, sickness benefits paid at 50% of wages, maternity benefits at double sickness rate and disablement benefits proportional to income loss for workers in establishments with 10 or more employees.

1. EMPLOYEES’ STATE INSURANCE
ACT, 1948
JAIPURIA INSTITUTE OF
MANAGEMENT,LUCKNOW

2. INTRODUCTION
 This Act came into being on 19th April, 1948.
 An Act to provide for certain benefits to employees in case
of sickness, maternity and employment injury and to make
provision for certain other matters in relation thereto.
 This Act covers a wider spectrum than the Factories Act.
 Extensive regulations have been framed under the Act to
identify the employees who would be entitled to the benefits.
 An elaborate machinery is provided for the effective
administration of the Act.

3. OBJECTIVES
 The basic objective is to offer social insurance to
workers.
 The ESI Act is a social welfare legislation enacted
with the object of providing certain benefits to
employees in case of sickness, maternity and
employment injury.
 The objective of the act is to secure sickness,
maternity and medical benefits to employees of
factories and establishments and dependents
benefits to the dependents of such employees.

4. OBJECTIVES CONTINUED….
 To attain the goal of socio-economic justice for securing, the right
to work, to education and public assistance in cases of
unemployment, old age, sickness and disablement.
 To make employee comfortable in the office by giving medical
relief, cash benefits, maternity benefits, pension to dependents of
deceased workers and compensation for fatal or other injuries
and diseases.
 CONTINGENSIES
 SICKNESS
 EMPLOYMENT INJURY
 CHILD BIRTH

5. COVERAGE
 This act was applicable to all non-seasonal factories using
power and employing 20 or more workers.
 But is now applicable to non-seasonal factories using power
and employing 10 or more workers and non power using
factories employing 20 or more workers.
 It covers all type of workers whose wage limit does not
exceed Rs. 15000 per month.

6. EXEMPTIONS
 The provisions of the ESI Act are not applicable to factories
or establishments, run by the State Governments / Central
Government, whose employees are, otherwise, in receipt of
social security benefits substantially similar or superior to
the benefits provided under the ESI Act.
 The "Appropriate Government", may grant or renew
exemption under Section 87 of the ESI Act in respect of a
Factory/Establishment or class of factories or
establishments in any specified area from the operation of
the Act for a period not exceeding one year at a time.

7. EXEMPTIONS CONTINUED….
 Exemption Under Section 88 of the Act is granted by the
"Appropriate Government" to employees, or class of employees,
who remain away from their Hqrs. for more than 7 months in a
year, and those employees who are posted in non-implemented
areas.
 No exemption, under Section 87, or Section 88 can be granted
unless a reasonable opportunity has been given to the
Corporation to make any representation and the same is
considered by the "appropriate Government".
 Exemption Under Section 90 can be granted to a factory /
establishment belonging to any local authority such as a
Municipality / Corporation, etc. if employees in any such
factory/establishment are otherwise in receipt of benefits
substantially similar or superior to the benefit. provided under the
Act.

8. ADMINISTRATION
 The Employees’ State Insurance Scheme is administered by
a Corporate body called the Employees’ State Insurance
Corporation (ESIC), which has members representing
employers, employees, the Central Government, State
Governments, medical profession and the Parliament.
 The Corporation, with its Central Headquarters at New
Delhi, operates through a network of 52 Regional, Sub-
Regional and Divisional Offices located in various States.
 The medical benefit is taken care of by the respective state
government.

10. PROVISIONS
INSURED PERSON IN CASE OF SICKNESS
INSURED WOMAN IN CASE OF MISCARRIAGE
OR CONFINEMENT
TO AN INSURED PERSON SUFFERING FROM
DISABLEMENT DUE TO EMPLOYMENT INJURY
TO DEPENDANTS OF AN INSURED PERSON
WHO DIES DUE TO EMPLOTMENT INJURY

11. PROVISIONS CONTINUED….
Sickness Benefit:
 The qualification of a person to claim sickness benefit, the
conditions subject to which such benefit may be given, the
rate and period thereof shall be such as may be prescribed
by the Central Government.
 ESI Scheme provides medical care via a network of ESI
dispensaries, hospitals, diagnostic centers, etc.

12. PROVISIONS CONTINUED….
Sickness Benefit (Eligibility):
 MINIMUM 78 DAYS CONTRIBUTION IN ONE
CONTRIBUTION PERIOD.
 DAILY RATE OF SICKNESS BENEFIT IS 50 % OF DAILY
WAGES.
 EXTENDED SICKNESS BENEFIT (ESB) IS A CASH
BENEFIT PAID FOR PROLONGED ILLNESS DUE TO ANY
OF THE 34 DISEASES SPECIFIED IN ANNEXURE-A.
 ESB REQUIRES CONTINUOUS EMPLOYMENT OF 2
YEARS AND CONTRIBUTION OF AT LEAST 156 DAYS IN
4 PRECEDING CONTRIBUTION PERIODS.

13. PROVISIONS CONTINUED….
Maternity Benefit:
 The qualification of an insured woman to claim maternity
benefit, the conditions subject to which such benefit may be
given, the rates and period thereof shall be such as may be
prescribed by the Central Government.
 The contribution condition is same as for sickness benefit.
 Daily benefit rate is double of sickness benefit. Benefit is
paid for Sundays also.

14. PROVISIONS CONTINUED….
Maternity Benefit (Eligibility):
 Delivery- A total period of 12 weeks beginning not more
than 6 weeks before the expected date of child birth.
 Miscarriage- 6 weeks following miscarriage.
 Sickness due to pregnancy, childbirth or miscarriage-
Additional period up to 4 weeks.
 Medical bonus of Rs. 2500/- if the woman does not
avail medical facility from an ESI hospital at the time of
delivery.
 Claim forms- 09 and 19.

15. PROVISIONS CONTINUED….
Disablement Benefit:
Subject to the provisions of this Act :
 a person who sustains temporary disablement for not less
than three days (excluding the day of accident) shall be
entitled to periodical payment [at such rates and for such
periods and subject to such conditions as may be
prescribed by the Central Government.
 a person who sustains permanent disablement, whether
total or partial, shall be entitled to periodical payment [at
such rates and for such periods and subject to such
conditions as may be prescribed by the Central
Government.

16. PROVISIONS CONTINUED….
Disablement Benefit:
 Daily benefit for both temporary and permanent illness is
roughly equivalent to 100% of the wage rate.
 The rate of benefit is proportional to the percentage of loss
of earning capacity. Benefit is paid for Sundays also.
 Forms: (a) Permanent disablement- Form 14
 (b) Temporary- Form 09.

17. ACCIDENTS- SEC 51
ACCIDENT
Arising in
course of
employment
Acting in
breach of
regulations
While
meeting
emergency
While
travelling in
employer’s
transport
While
commuting
to the place
of work and
vice versa

18. PROVISIONS CONTINUED….
Medical Benefit:
Government shall provide for insured persons and their
families in the , reasonable medical, surgical and obstetric
treatment.
Where the incidence of sickness benefit payment to insured
persons is found to exceed the all-India average, the amount
of such excess shall be shared between the Corporation and
the Government in such proportion as may be fixed by
agreement between them.
The Corporation may enter into an agreement with a
Government in regard to the nature and scale of the medical
treatment that should be provided to insured persons and their
families and for the sharing of the cost thereof and of any
excess in the incidence of sickness benefit to insured persons
between the Corporation and the Government.

19. PROVISIONS CONTINUED….
Medical Benefit:
In default of agreement between the Corporation and any
Government as aforesaid, the nature and extent of the medical
treatment to be provided by the Government and the
proportion in which the cost thereof and of the excess in the
incidence of sickness benefit shall be shared between the
Corporation and that Government.
The State Government may, in addition to the Corporation
under this Act, with the previous approval of the Central
Government, establish such organization (by whatever name
called) to provide for certain benefits to employees in case of
sickness, maternity and employment injury .

20. PROVISIONS CONTINUED….
Medical Benefit:
 An insured person or (where such medical benefit is
extended to his family) a member of his family whose
condition requires medical treatment and attendance shall
be entitled to receive medical benefit.
 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.

21. PROVISIONS CONTINUED….
Medical Benefit:
 A person shall be entitled to medical benefit during any
1[period] for which contributions are payable in respect of
him or in which he is qualified to claim sickness benefit or
maternity benefit 2 [or is in receipt of such disablement
benefit as does not disentitle him to medical benefit under
the regulations

22. PROVISIONS CONTINUED….
Dependant Benefit:
 A widow can receive this benefit on a monthly basis for life
or till her re-marriage.
 A son or daughter can receive this benefit till twenty five
years of age.
 Other dependants like parents including a widowed mother
etc. can also receive this benefit under certain conditions.
 The first instalment is payable within a maximum of three
months following the death of an insured person and
therefore, on a regular monthly basis.

23. PROVISIONS CONTINUED….
Other Benefit:
 Funeral expenses on death of an IP subject to a maximum
of Rs.5000/- payable at the Branch Office..
 Free supply of physical aids and appliances
 Preventive health care services such as immunization,
family welfare services, HIV/AIDS detection, treatment etc.
 Confinement expenses @ Rs. 2500/- is paid to an insured
woman or in respect of the wife of an insured person in case
the confinement occurs at a place where ESI medical
facilities are not available.
 Rajiv Gandhi Shramik Kalyan Yojana -

24. PENALTIES
Fails to pay contribution due:
 Not less than one year imprisonment in case of failure to
pay the employees’ contribution deducted from employees’
wages and/ or fine of Rs. 10000/-.
 Not less than six months imprisonment, in any other case
and/ or fine of Rs. 5000/-.

25. Enhanced punishment (in certain cases after previous
conviction by Court):
 Punishment with imprisonment for a term which may extend
to 2 years and with fine of Rs. 5,000/- .
 If subsequent offence is for failure to pay contribution which
under the Act is liable to pay for every such subsequent
offence, be punishable with imprisonment for a term which
may extend to 5 years but which shall not be less than 2
years and also liable to fine of Rs. 25,000/- .

26. EVALUATION
The ESI Scheme has been criticized on following
grounds:
 Even within the organized sector, the coverage is low.
 The Scheme has not been popular among the employees
and union. The State Governments , too, have not shown
much interest to implement the provisions.
 Employees complained about the inappropriateness of
facilities and benefits provided.
 Additional funds had to be spend by employees for
medicines which were not available in ESI dispensaries.
 Delay in transfer of benefits to insured workers.

27. Presented By:
Anjali Saxena (JL13PGDM068)
Krati Gupta (JL13PGDM087)
Riya Panjwani (JL13RM51)
Nasar Ashraf (JL13PGDM030)
Anita Sareen (JL13PGDM067)
Rashi Kevlani (JL13PGDM098)
Neelanshi Sachan (JL13PGDM031)
Netri Agarwal (JL13PGDM092)
Anvita Tiwari (JL13FS14)
Ankita Mishra (JL13FS12)
Kashish Khan (JL13PGDM024)
Vipul Sinha (JL13FS63)