EMPLOYEES STATE INSURANCE ACT, 1948 workmens compensation act kalaignar kapitu thittam

DR. M. GEETHA POST 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 Benefit Sickness Benefit Maternity Benefit Disablement Benefit Dependant Benefit Funeral Expenses

Medical Benefits

For insured persons: Full medical care For families of IPs: 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 injury no contributory conditions widow/ legitimate or adopted child/ widowed mother age of dependants has to be determined minimum 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 Workmens 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 Workmens Compensation Act applies to.

WORKMEN COMPENSATION ACT, 1923

Who are eligible? -should be engaged in the employers 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 halfmonthly.

KALAIGNAR KAPEETTU THITTAM

KALAIGNAR KAPEETTU THITTAM

The Chief Minister Kalaignars 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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