esi insurance

7/24/2019 Esi Insurance

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Employee State Insurance:

Introduction

The Employee State Insurance Act, [ESIC] 1948, is a piece of social welfare leislation enacte!

primarily with the o"#ect of pro$i!in certain "enefits to employees in case of sic%ness,maternity an! employment in#ury an! also to ma%e pro$ision for certain others matters inci!ental

thereto& The Act in fact tries to attain the oal of socio'economic #ustice enshrine! in the

(irecti$e principles of state policy un!er part 4 of our constitution, in particular articles 41, 4)

an! 4* which en#oin the state to ma%e effecti$e pro$ision for securin, the riht to wor%, to

e!ucation an! pu"lic assistance in cases of unemployment, ol! ae, sic%ness an! !isa"lement&

The act stri$es to materialise these a$owe! o"#ects throuh only to a limite! e+tent& This act

"ecomes a wi!er spectrum then factory act& In the sense that while the factory act concerns with

the health, safety, welfare, lea$e etc of the wor%ers employe! in the factory premises only& ut

the "enefits of this act e+ten! to employees whether wor%in insi!e the factory or esta"lishment

or else where or they are !irectly employe! "y the principal employee or throuh an interme!iate

aency, if the employment is inci!ental or in connection with the factory or esta"lishment&

Objective

The e$er e+pan!in in!ustrial hori-on an! reciprocal uprisin of la"our consciousness

necessitate the employee an! employer to "e con$ersant with the current la"or leislation that

o$ern their relationship, rihts an! o"liation&

The einnin The Employee State Insurance act was promulate! "y the .arliament of In!ia in

the year 1948&To "ein with the ESIC scheme was initially launche! on ) /e"ruary 190) at #ust

two in!ustrial centers in the country namely %anpur an! (elhi with a total co$erae of a"out 1&)

lac wor%ers&

There after the scheme was implemente! in a phase! manner across the country with the acti$e

in$ol$ement of the state o$ernment&


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Applicability

The ESIC Act applies to non'seasonal, power usin factories or manufacturin units employin

ten or

more persons an! non'power usin esta"lishments employin twenty or more persons& 2n!er the

ena"lin pro$isions of the act, a factory or esta"lishment, locate! in a eoraphical area, notifie!

for

implementation of the scheme, falls in the pur$iew of the act& Employees of the aforesai!

cateories of

factories or esta"lishments, "ut !rawin waes only up to 3s ,0 a month are entitle! to health

insurance co$er un!er the ESI act& The wae ceilin for purpose of co$erae is re$ise! from time

to

time5 to %eep pace with risin cost of li$in an! su"se6uent wae hi%es& The present ceilin of

3s

,0 has "een effecti$e from 1 7anuary 199 the appropriate o$ernment state or central is

empowere! to e+ten! the pro$ision of the ESI Act to $arious classes of esta"lishment, in!ustrial,

commercial, aricultural or otherwise in nature& 2n!er these ena"lin pro$isions most of the

state

o$ernments ha$e e+ten!e! the ESI act to certain specific classes of esta"lishments& i%e shops,

1ESI Act&1948& Sec&1

AC(s of :o$ernment

Centre for Ci$il Society 0

hotels, restaurants, cinemas, employin ) or more persons&) ut no in!ustry has the riht to opt

out

of the scheme&

;ae ceilin for co$erae

The monthly wae limit for co$erae un!er the ESI act woul! "e such as prescri"e! "y the

central

o$ernment in the ESI [central] rules, 190& The e+istin wae ceilin for co$erae [e+clu!in

remuneration for o$er'time wor%] is 3s&0 per month [rule 0 of ESI central rules, 190]& An

employee who is co$ere! at the "einnin of a contri"ution perio! shall continue to remain

co$ere!


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till the en! of that contri"ution perio! notwithstan!in the fact that his waes may e+cee! the

prescri"e! wae ceilin at any time after the commencement of that contri"ution perio!& Wage

ceiling for purpose of coverage is revised from time to time by the central government on

the

specific recommendation of the corporation, at present the corporation has recommended

for the

increase of the wage limit to s !",""" and its implementation is awaited#

ar aainst reco$ery of compensation or !amaes un!er any other law

An insure! person or his !epen!ants shall not "e entitle! to recei$e or reco$er, whether from the

employer or any other person, any compensation or !amaes un!er the ;or%men


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A!ministration

The comprehensi$e an! well'!esine! social security proramme is a!ministere! "y an ape+

corporate "o!y calle! the Employee State Insurance Corporation& It comprises mem"ers

representin

$ital interest roups that inclu!e, employee, employers, the central an! state o$ernment,

"esi!es,

representati$es of parliament an! me!ical profession& The corporation is hea!e! "y the union

minister of la"our, as its chairman, where as, the !irector eneral, appointe! "y the central

o$ernment functions as its chief e+ecuti$e officer& A stan!in committee constitute! from

amonst

the mem"ers of the corporation, acts as an e+ecuti$e "o!y& The me!ical "enefit council,

constitute! "y

the central o$ernment, is yet another statuary "o!y that a!$ises the corporation on matters

relate!

to effecti$e !eli$ery ser$ices to the "eneficiary population& The corporation with its central hea!

6uarters at >ew (elhi, operates throuh a networ% of ) reional an! su"' reional offices

locate! in

$arious state& The respecti$e state o$ernments ta%e care of the a!ministration of me!ical

"enefit&

E+cept in case of (elhi an! >oi!a, reater >oi!a areas of 2ttar pra!esh, where, the corporation

a!ministers me!ical facilities !irectly&0

) ESI Act&1948&Sec&1

* ESI Act&1948& Sec&0*?1

4 )1'))& ESI Annual 3eport

0 ESI Act 1948& Sec 8,9,1&

AC(s of :o$ernment

Centre for Ci$il Society

/inance

i%e most of the social security schemes, the worl! o$er, ESI scheme is a self'financin health

insurance scheme& Contri"utions are raise! from co$ere! employees an! their employers as a

fi+e!


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percentae of waes& As of now, co$ere! employees contri"ute 1&0@ of the waes, whereas as

the

employers contri"ute 4&0@ of the waes, paya"le to the insure! persons& Employers earning

less

than s $" a !ay as !aily wae are e+empte! from payment of their share of contri"ution& The

state

o$ernment as per the pro$ision of the act contri"utes 18 of the e+pen!iture on me!ical "enefit

within a per capita ceilin of 3s& per insure! person per annum& Any a!!itional e+pen!iture

incurre! "y the state o$ernment, o$er an! a"o$e the ceilin, an! not fallin within the sharea"le

pool, is "orne "y the state o$ernments concerne!& The contri"ution is !eposite! "y the

employer in

cash or "y chea6ue at the !esinate! "ranches of some nationalise! "an%s& The responsi"ility for

payment of all contri"utions is that if the employer with a riht to !e!uct the employees share of

contri"ution from employees waes relatin to the perio! in respect of which the contri"ution is

paya"le&

Contri"ution perio!s an! "enefit perio!

;or%ers, co$ere! un!er the ESI Act, are re6uire! to pay contri"ution towar!s the scheme on a

monthly "asis contri"ution perio! means a si+'month time span from 1 April to * Bcto"er an! 1

>o$em"er to *1 arch& Thus, in a financial year there are two contri"ution perio!s of si+

months

!uration& Cash "enefits un!er the scheme are enerally lin%e! with contri"ution pai!& The "enefit

perio! starts their months after the closure of a contri"ution perio!,

%ontribution period corresponding benefit period

! April to &" September ! 'anuary to &" 'une of the following year

! October to &! march !( 'uly to &! )ecember

3eistration

Simultaneously with his or her entry into employment in a co$ere! factory or esta"lishment, an

employee is re6uire! to fill in a !eclaration form& The employee is then allotte! a reistration

num"er,

which !istinuishes an! i!entifies the person for the purposes of the scheme& A person is

reistere!


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once an! only upon his entry in insura"le employment&8 ut recent S%*s judgement in

+alarishna v

ESI% has hel! that a wor%er co$ere! un!er the act woul! "e entitle! to "enefit from the !ate of

his

employment an! not from the !ate of reistration after contri"ution "y the employer&

I!entity car!

Bn reistration e$ery insure! person is pro$i!e! with a Dtemporary i!entification certificatea!a for early !etection an! treatment of occupational !iseases pre$alent

amon

wor%ers employe! in ha-ar!ous in!ustries& /or payment of cash "enefits, the corporation

operates

throuh a networ% of o$er 84 local offices an! cash offices, whose functionin is super$ise! "y

the

reional su"'reional offices& At the rass root le$el, ser$ices !eli$ery units, comprisin

!ispensaries,

clinics, hospitals an! local offices etc are the mainstay of the hue ser$ice intensi$e set'up&1

Social security "enefits

-uantum, scale and contributory conditions


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Employees co$ere! un!er the scheme are entitle! to me!ical facilities for self an! !epen!ants&

They

are also entitle! to cash "enefits in the e$ent of specifie! continencies resultin in loss of waes

or

earnin capacity& The insure! women are entitle! to maternity "enefit for confinement& ;here

!eath

of an insure! employee occurs !ue to employment in#ury or occupational !isease, the !epen!ants

are entitle! to family pension&

Farious "enefits that the insure! employees an! their !epen!ants are entitle! to, the !uration of

"enefits an! contri"utory con!itions therefor are as un!er

!# .edical benefit

/ull me!ical facilities for self an! !epen!ants are a!missi"le from !ay one of enterin insura"le

employment& ;hereas, the primary, out patient, in patient an! specialist ser$ices are pro$i!e!

throuh a networ% of panel clinics, ESI !ispensaries an! hospitals, super specialty ser$ices are

pro$i!e! throuh a lare num"er of a!$ance! empanelle! me!ical institutions on referral "asis&

Eligibility to medical benefit

G /rom !ay one of enterin insura"le employment for self an! !epen!ants such as spouse,

parents an! chil!ren own or a!opte!&

G /or self an! spouse on superannauation su"#ect to ha$in complete! fi$e years in insura"le

employment on superannuation or in case of ha$in suffere! permanent physical

!isa"lement !urin the course of insura"le employment&

G The rate of contri"ution for superannuate! !isa"le! is 3s 1,)) per annum paya"le in lump

sum at the local office for a$ailin full me!ical care for self an! spouse&11

1 An Intro!uction' ESIC Scheme of In!ia&

11 ESI Act 1948& Sec 0&

AC(s of :o$ernment


/# Sicness benefit 0cash1

Sic%ness "enefit is paya"le to an insure! person in cash, in the e$ent of sic%ness resultin in

a"sence

from wor% an! !uly certifie! "y an authorise! insura"le me!ical officer practitioner&


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G The "enefit "ecomes a!missi"le only after an insure! has pai! contri"ution for at least 8

!ays in a contri"ution perio! of months&

G Sic%ness "enefit is paya"le for a ma+imum of 91 !ays in two consecuti$e contri"ution perio!&[

one year]

G .ayment is to "e ma!e "y the local office within !ays of certificate of sic%ness at a stan!ar!

rate, which is not less than 0@ of the waes&1)

[The loic "ehin! fi+in of 8 ? 91 !ays of contri"ution is "ase! on certain statistics wor%e! "y

the

corporation to i$e cash "enefits& ut the officials in the corporation !on


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3# .aternity benefit 0cash1

aternity "enefit is paya"le to insure! women in case of confinement or miscarriae or sic%ness

relate! thereto&

G /or claimin this an insure! woman shoul! ha$e pai! for at least !ays in ) consecuti$e

contri"ution perio!s i&e& 1 year&

G The "enefit is normally paya"le for 1) wee%s, which can "e further e+ten!e! up to 1 wee%s

on me!ical roun!s&

G The rate of payment of the "enefit is e6ual to wae or !ou"le the stan!ar! sic%ness "enefit

rate&

G The "enefit is paya"le within 14 !ays of !uly authenticate! claim papers&14

4# )isablement benefit 0cash1

(isa"lement "enefit is paya"le to insure! employees sufferin from physical !isa"lement !ue to

employment in#ury or occupation !isease&

G An insure! person shoul! "e an employee on the !ate of the acci!ent&

1) ESI Act 1948& Sec 49&

1* ESIC Scheme of In!ia Citi-ens Charter

14 ESI Act 1948& Sec 0&

AC(s of :o$ernment


G Temporary !isa"lement "enefit at @ of the waes is paya"le till temporary !isa"lement

lasts an! is !uly certifie! "y authorise! insurance me!ical officer&

G In case of permanent !isa"lement, the cash "enefit is paya"le is paya"le for life& Amount

paya"le is wor%e! out on the "asis of earnin capacity !etermine! "y a me!ical "oar!&

G (isa"lement "enefit is paya"le within one month of su"mission of the complete claim

papers&10

5# )ependands benefits 0cash1

(epen!ants "enefit [family pension] is paya"le to !epen!ants of a !ecease! insure! person

where

!eath occurs !ue to employment or occupational !isease&

G A wi!ow can recei$e this "enefit on a monthly "asis for life or till remarriae&

G A son or !auhter can recei$e this "enefit till 18 years of ae&


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G Bther !epen!ants li%e parents inclu!in a wi!owe! mother can also recei$e the "enefit un

un!er certain con!ition&

G The rate of payment is a"out @ of the waes sharea"le amon !epen!ants in a fi+e! ratio&

G The first installment is paya"le within a ma+imum of * months followin the !eath of an

insure! person an! thereafter, on a reular monthly "asis&1

(# Other benefits

a# a# 6uneral e2penses

Bn the !eath of an insure! person su"#ect to a ma+imum of a 3s& ),0 paya"le at the local

office&

b# 7ocational rehabilitation

In case of !isa"le! insure! persons un!er 40 years of ae with 4@ or more !isa"lement&

c# 6ree supply of physical ai!s an! appliances such as crutches, wheelchairs, spectacles an!

other

such physical ai!s&

d# 8reventive health cares ser$ices such as immuni-ation, family welfare ser$ices, HIFAI(S

!etection, treatment etc&

e# .edical bonus 3s)0 is pai! to an insure! woman or in respect of the wife of an insure!

person in

case she !oes not a$ail hospital facilities of the scheme for chil! !eli$ery&1

Employee State Insurance Corporation, (elhi reion

The scheme was implemente! in (elhi on )4 /e"ruary 190)& As on *1 arch )) 4&94 lac

employees

an! 0&0 lac insure! persons are co$ere!& The num"ers of "eneficiaries inclu!in insure! in

(elhi are

)1&90 lac& The scheme is a!ministere! throuh the reional office locate! at (elhi (e$elopment

Authorityew (elhi&

The cash

"enefits are !is"urse! throuh a networ% of 1) local offices& The me!ical care is a!ministere! "y

the

corporation itself in the national capital territory of (elhi&

10 ESI Act 1948& Sec 01&


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1 ESI Act 1948& Sec 0)

1 ESIC Scheme of In!ia, Citi-ens Charter

AC(s of :o$ernment


Co$erae

The co$erae position of (elhi reion as on *1'*')) is as un!er

[/iures in lacs]

9EA

! /""" /""! /""/

>o of employees 0&4* 0&*) 0&) 4&94

>o of insure!

persons

0&8 0&8 0&) 0&0

>o of "eneficiaries ))&44 ))&4 )1&8) )1&90

>o of employers &)0 &)) &)) &)8

;e can clearly fin! in the a"o$e column, that year "y year, >um"er of Employees an! num"er of

eneficiaries co$ere! are !ecreasin, the reason i$en the Assistant !irector of ESIC, (elhi 8 ;

haul

is that, there has "een a chane in the pay scale yearly an! as an! when the pay scale increases

a"o$e

3s ,0 the >um"er of Employees who come un!er the act are re!uce!, "ut he has also faile! to

note

an important point that num"er of new employees comin un!er the act are also increasin

yearly&

Income an! e+pen!iture

It shoul! "e note! that the ESI Corporation controls the whole fun! of the ESIC !irectly an! the

reional office in particular state has no say with rear! to financial a!ministration& The

corporation

has one "u!et yearly an! it allocates the fun! to particular state on the "asis of total num"er of

"eneficiaries, e+pen!iture of the prece!in year an! re6uirement of the ne+t year&

The position of contri"ution income realise! an! e+pen!iture incurre! "y the (elhi corporation


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!urin the last * years is shown "elow[ fiures in lacs]

9EA %ontribution

income

EE

Cash ? other

"enefit

e+clu!in

me!ical "enefit

A!ministrat

i$e

e+pen!iture

Total e+pen!iture on

re$enue account

e+clu!in me!ical

"enefit

ESI

E(ICA

(EHI

1999') 9)9&89 09&84 99)&1) 101&9 8*80&19

)')1 91&1 9*&4* 9&)0 18*&9 918&9)

)1')1 94&0 9**&18 90)&90 188&1* 944&9)

Note: the above figures do not contain the capitalised value expenditure in medical care during

the years.

E+pen!iture inclu!es e+pen!iture on me!ical "enefit, cash an! other "enefits, a!ministrati$e

e+penses an! total e+pen!iture of !rus an! !ressin with pay an! allowances "ut e+clu!in rent

of

"uil!in&

AC(s of :o$ernment


a%e payment of arrears to assistant ca!re as per CAT or!er&


14/28

It should be noted that the findings from the above table are very clear, that the

e2penditure is

more than the revenue of the corporation# =he reason given for this by .rs =homas,

director, ESI%

)elhi is that, it is only in )elhi, which has $ major hospitals, including a super specialty

hospital

in ohini, which caters the needs of employees through out north India#

3eser$e fun!s an! in$estment of ESIC fun!s

The in$estments ma!e "y the corporation pertainin to !ifferent reser$e fun!s an! ESIC eneral

reser$e fun!s as on *1'*')) were as un!er

S?#;O ;A.E O6 =@E 6>;)S A.O>;= AS

O; &!&/""/0s

lacs1

1 ESIC .3BFI(E>T /2>( )*909&99

) ESIC :3B2. I>S23A>CE /2>( *1&84

* .E>SIB> 3ESE3FE /2>( 1,94&

4 (E.3ECIATIB> 3ESE3FE /2>( B/

B//ICE 2I(I>:S A>( STA//

J2A3TE3S

0*)&00

0 (E.3ECIATIB> 3ESE3FE /2>( B/

HBS.ITA 2I(I>:S

1)*&4)

STA// CA3S 3E.ACEE>T3ESE3FE

/2>(

)0&91

3E.AI3 A>( AI>TE>A>CE 3ESE3FE

/2>( /B3 B//ICE 2I(I>: A>( STA//

J2A3TE3S

449&8

8 3E.AI3 A>( AI>TE>A>CE 3ESE3FE


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/2>( /B3 HBS.ITA 2I(I>:S

40&8

9 .E3A>E>T (ISAEE>T E>E/IT

3ESE3FE /2>(

19*81&*1

1 (E.E>(A>T E>E/IT 3ESE3FE /2>( 0*11&88

11 CA.ITA CB>ST32CTIB> 3ESE3FE

/2>(

404&81

1) CB>TI>:E>C 3ESE3FE /2>( 0&

1* I>FESTE>T B/ ESI :E>E3A 3ESE3FE

/2>(

48*&9)

TBTA *18&

It shoul! "e note! from the a"o$e ta"le that ESIC has a hue amount of reser$e fun!& The reason

for

such e+cess amount in the corporation is that, it is less than 0@ of the employees potentially use

the

"enefit offere! to them& ost of the employees prefer to o to pri$ate hospitals rather than wait

for

the corporation to appro$e their "enefit& I ha$e foun! that ettin a sanction for the me!ical or

cash

"enefit is such a cum"ersome proce!ure that it ta%es months to et the appro$al& oreo$er most

of

the employees are illiterate who are not in the position to file an application in the office&

Infrastructure for !eli$ery of me!ical care

The me!ical scheme in (elhi is "ein a!ministere! "y the Corporation throuh a separate

!irectorate

hea!e! "y !irector [me!ical] (elhi& In national capital territory of (elhi full me!ical care

comprisin

of< Dout patient ser$ices< specialists ser$ices an! hospital ser$ices is pro$i!e! un!er ESI scheme


16/28

AC(s of :o$ernment

Centre for Ci$il Society )

throuh ser$ices !ispensaries !ianostic centres an! ESI hospitals& The e+pen!iture on me!ical

care

is share! "etween the ESI Corporation an! o$ernment of >CT of (elhi in ratio of 1& The

me!ical

infrastructure in the national capital territory of (elhi as un!er

!# ;o# of ESI hospitals with bed strength as on &!&/""/

S#;O ;A.E O6 =@E @OS8I=A? +E) S=E;B=@

1& ESI HBS.ITA, ASI(A3A.23, >E;

(EHI

00K0 E(S /B3 BCC2.ATIB>A

(ISEASE CE>TE3&

)& I>(I3A :A>(HI ESI HBS.ITA,

7HII, (EHI

)4K1 E(S /B3 I>(I:E>B2S

SSTE B/ E(ICI>ES

*& ESI HBS.ITA B=HA, >E; (EHI )) E(S [1 E(S

CBISSIB>E(]

4& ESI HBS.ITA, 3BHI>I, >E; (EHI ) E(S [1 E(S

CBISSIB>E(]

/# eserved beds in other hospitals as on &!&/"/

S#;O#

;A.E O6 =@E @OS8I=A?

;O#O6#+E)S

1& 3&&T&& HBS.ITA, =I>:S;A CA., >E;

(EHI

4[T E(S]

)& &3&S&T&& HB.ITA, EH3A2I, (EHI 0[T E(S]

>.+E O6 ESI )IS8E;SAIES

a& /ull time !ispensaries **


17/28

"& o"ile !ispensaries 1

c& Ayur$e!ic wins 9

e& (ianostic centres 4

$#8osition of type of medical care as on &!&/""/

;ame of the

state

estricted medical care E2panded medical care 6ull medical care

>nitC

(elhi L L 0,0,90

3# ;o# of I.O*sD specialistsD para medical and other categories staff in ESI hospitalD

dispensaries,

diagnostic centres, Ayurvedic wings, family welfare projects, central

AC(s of :o$ernment

Centre for Ci$il Society *

;O ;ame of the

posts

ESI hospital

+asaidarapur

ESI hospital,

'ilmil

ESI hospital,

ohla

ESI hospital,

ohini

SA>C

TIB>E

(

.BSIT

IB'>

SA>C

TIB>E


18/28

(

.BSIT

IB>

SA>C

TIB''

>E(

.BSITI

B>

SA>CTI

B>E'I(

.BSITI

B>

1 :E>E3A

(2T

B//ICE3S

1) 01 84 44 *0 *) 84 )

) S.ECIAIST

S

4 *K)

.T

)* 10 1 18 )* 1)

* (E>TA

S23:EB>

* ) 1 1 1 L ' '

4 SE>IB3

3ESI(E>TS

09 48 )* 10 1 ) 1

0 72>IB3

3ESI(E>TS

0 14 14 ' 1 ' '


19/28

.A3A

E(ICA?

>23SI>:

STA//

89 40 ** )1 )) 10 * 114

BTHE3

CATE:B3

STA//

*9 * 190 11 * 9 110 0*

4# O%%>8A;%9 O6 @O8I=A? +E)S A;) SE7I%ES >=I?ISA=IO; A==E;)A;%E

I;

@ospitals, specialists centre, investigations, ;umber of Admissions from ! A8I? /""! to

&!

.A%@ /""/#

a& Hospitals

S; ESI

hospital

+eds Occupancy Attendance Admissions Investigatio

n

1 asai!arap

ur

8@ 084 *044 9))

) 7hilmil )0 8*@ ))89 1)*)9 )109

* B%hla ))[1]

commissio

ne!

149@ ))44 980 1441

4 3ohini ))[1]

commissio

ne!

9@ 1*8*1 04 99


20/28

b# Attendance in dispensaries up to &!&/""/:

Atten!ance of I.o& Bf& Employees !eeme! e+pose! to ris% for sic%ness e+ten!e! sic%ness "enefit '0,),9

G =otal no of %ash benefit payments !,"/,&/

G A$erae no of Cash "enefits payments per employee per annum '&19

G A$erae !aily "enefit rate 3s& &)1

G aternity "enefit, a$erae amount pai! per confinement 3s11,4)9

;umber of worers who became permanently disabled and die at wor in /""/

.ermanent !isa"lement ' 094

>o of !eath cases M*8


21/28

8osition of on going construction projects

8lots acFuired for construction projects

1& ;a-ir .ur, )'0'99 M plans appro$e! "y C( on *''))&

)& Ar#un naar, 1'*'8' oun!ary wall constructe!& .lans with C(, >BC rante! "y ((A up

to )*'')*&

*& ayur $ihar, 1*''9) M plans with HJ3SC( for appro$al&

8osition of pending reimbursement cases, number and amount as on &!&/""/

*9 '3s&)4,4,)18

Bn papers, the ESI Corporation in (elhi appears iantic with 0,9,90 insure! persons

)1,90,9

"eneficiaries, four ma#or hospitals with 1,110 "e!s, ** !ispensaries, 0 !octors with annual

re$enue

of 94& crores& In reality, the Coporation is ri!!le! with pro"lems& ac% of proper ser$ice,

unfrien!ly

!octors, an! cum"ersome proce!ures restrict employees from usin their "enefits to full

potential&

18 ESIC Annual 3eport )1')

AC(s of :o$ernment


(octors !o not i$e proper treatment an! prefer to atten! to the payin patients& As a result,

employees are often force! to pay more than their monthly contri"utions& The !ispensaries !o not

ha$e enouh me!icines in stoc% an! persua!in a !octor to authorise the purchase of me!icines

elsewhere is a cum"ersome an! time'consumin process& (octors are $ery often a"sent an!

hospital

e6uipments are "ro%en for e+ten!e! perio!& .atients sufferin from occupational !isease ha$e

!ifficulty fin!in proper treatment& ;or%ers complain of "ein treate! as "ears at the ESIC

office&

/or instance, when I $isite! =A=A7I !ispensary I foun! a patient [7ual opee] who was

sufferin from some luns pro"lem "ein !enie! a!mission in the hospital, the reason i$en "y

the !octor was that he ha! no serious pro"lem to "e a!mitte! in the hospital& The !octors were

"usy ha$in snac%s for half an hour e$en thouh the patients were in a lon 6ueues& In


22/28

ayapur !ispensary out of 1 !octors on !uty only * !octors were present, con!ition of the

toilets were pathetic& The story of Sham al is precarious, he ha! a "asic pro"lem suffere! "y a

human "ein li%e fe$er an! hea!ache, the !octor ha! written for a .aracetamol an!

>eimusuli!e& ut to my surprise I foun! that Sham al !i! not et >eimusuli!e ta"lets "ecause

the ta"lets were out of stoc%& Bne shoul! imaine that if a !ispensary !oesn


23/28

clear itself of all leal o"liations& They stri%e off the name of e$ery wor%er from the roll list

once he

has wor%e! for a perio! of up to 89 !ays& E$en thouh, in many cases, the same employee is

ta%en

"ac% within a wee%, the roll'list now shows his name as a fresh employee& Therefore at any point

in

time, thouh hun!re!s of wor%ers are actually wor%in in the factory, the roll'list woul! not

contain

the names of the ma#ority of them since they are all !e #ure employe! for less than * months&

=his

what happened to .ahesh a machine operator, who gets no benefit from the ESI, even

though he

is contributing for the corporationC I had met a person by name ;arayana, whose fingers

was cut

off while operating a machine some !! years bac# =ill now he has neither got medical nor

the cash

benefit# @is case is pending from the past !! years# =he story of S#G#Bupta, am abir,

Burvindar

are allsimilar whose cases are pending from past many years# Bod nows the plight of all

these

employeesH

.oor cash manaement

(urin the course of au!it of (elhi reion of ESIC, au!it notice! that )90 employers !eposite! a

sum

3s **&)9 lacs into the State "an% of In!ia, Shah!ara, (elhi !urin 1988 to 199& ut the "an%

faile! to

cre!it this amount in the account of ESIC& To resol$e this, three meetins "etween officers of

SI an!

ESIC were hel! !urin may 1998 an! march )1, till now this amount has not "een cre!ite! in

the


24/28

account of ESIC& Thus failure to protect its financial interests resulte! not only in losin s

&/ lacs

"ut also loss of interest of s $3#! lacs& Apart from this ESIC in (elhi has faile! to reco$er s#

(5

AC(s of :o$ernment


crore from (elhi o$ernment on account of e+pen!iture incurre! on me!ical care "y ESIC

(elhi& In

(elhi, where the scheme is !irectly run "y the ESI Corporation, the entire e+pen!iture on

me!ical

care is incurre! initially "y the corporation an! is su"se6uently share! with o$ernment of (elhi&

E+pen!iture incurre! "eyon! the amount "eara"le "y ESIC is reco$era"le from the o$ernment

of

(elhi in !ue course& The o$ernment& of >CT of (elhi ha! "een sharin an! payin 18 share of

e+pen!iture on me!ical care plus e+penses incurre! o$er an! a"o$e the ceilin up to the year

1989'9&

Su"se6uently the o$ernment of >CT of (elhi !i! not pay their share from the year 199'91 on

the

plea that they are not lia"le to pay the e+pen!iture "eyon! the ceilin in the a"sence of

areement&

The issue has "een ta%en up with o$ernment of >CT of (elhi at the hihest le$el& The

o$ernment

of (elhi has not committe! to pay its so far&

E$en thouh there has "een chane in the metho!oloy of selectin units for inspection the

>um"er of Inspection, which was to "e hel! as on )), was 1*,*)1 "ut till now only )*

inspections

were con!ucte!& This is one of the main reasons for ESIC (elhi "ein in arrears of 3s )&*)

crore as on

*1'*'))& Apart from this the ESIC annual reports are spea%in the mantra of computerisation

of ESI


25/28

!ispensaries an! local offices, "ut to the "est of my %nowle!e I coul! not fin! a sinle computer

in

local office or the !ispensaries& >ow where !oes all this money oN =he e2penditure of the

corporation is more than its revenue from the past four years, if this state continues, what

is the

future of ESI% in )elhiC The ESIC in (elhi has set a HIFAI(S cell with the assistance of

>ATIB>A AI(S CB>T3B B3:A>ISATIB> in the year 1999, In or!er to pre$ent control

sprea!

of HIFAI(S amonst ESI "eneficiaries& ut e$en after three years it has not come up with any

official

!ata& Is the cell really functioningC )r aju in chare of the cell has no answer for this

6uestion& The

ESIC (elhi has set up a pu"lic rie$ances commission to loo% into the rie$ances an! !ifficulties

face! "y the employees, "ut has the commission "een successful in sol$in the pro"lems of the

employees is the 6uestion to "e answere! "y the commission& Thus the employees< state

insurance

corporation in (elhi has "ecome a legalised way of duping the employers and the employees

at

large* clearly, it nee!s a fun!amental chanes so it is more fruitful to the employees& E$en as

there

has "een a sea of chane in the in!ustrial sector, the ESI scheme is continue! with the same

pro$isions& The system cannot "e ma!e more $ia"le an! useful without the participation of the

employees& Bne of the reasons for the failure of the corporation is lac% of acti$e participation "y

the

employees& /or instance there is no sta"le employees union or oranisation to loo% into the

functionin of the corporation& Bne of the "est ways to impro$e the functionin of the

corporation is

to pri$atise the manaement of the newly constructe! hospitals, which the state o$ernment has

faile! to commission on time& If pro$e! successful, the scope of pri$atisation woul! "e e+ten!e!

to


26/28

other ESI hospitals whose performance is "elow stan!ar!& In fact the Sathyam committee which

was

forme! to loo% into the !iscrepancies in the functionin of ESI hospitals ha! recommen!e! that

surplus capacities coul! "e lease! or rente! to the pri$ate sector& Three T.A

e!icare .$t& T( has ma!e a "i! for the scheme& ut there has har!ly "een any hea!way on

this

front& Some of the recommen!ations i$en "y 7E.A %O..I==EE to ta%e steps to ma%e

the

system more $ia"le an! useful are li%e enhancement of wae ceilin for purpose of co$erae

from the

present 3s ,0 to a minimum of 3s 9,& /or up ra!ation of me!ical ser$ices un!er the

scheme,

the committee has recommen!e! enhancement on e+pen!iture of me!ical "enefit from the

present 3s

to 3s& 80, the new ESI hospitals shoul! not "e constructe! as lon as any a!!itional

ser$ices

re6uirements coul! "e out'source! throuh tie'up arranement with o$ernment of pri$ate

me!ical

institutions issuin of national i!entity car!, which coul! ena"le a "eneficiary to utilise the

treatment

facilities from the ESI hospitals or institution across the country, the employees shoul! "e

allowe! to

utilise pri$ate me!ical facilities, instea! of only oin to ESI hospitals an! !ispensaries, the

present

system which is tar!y nee!s to "e controlle! "y ESI employers an! employees& The role of

finance,

la"our an! health !epartments shoul! "e cut !own&19

19 Tri"une >ews Ser$ice, )) Bct&

AC(s of :o$ernment


27/28


The stratey

Thus the only way to achie$e this oal is "y participation of citi-ens roups an! other non'profit

aencies that a!$ocate for wor%ers< health care rihts& These roups can pressurise ESIC at the

local

le$el to impro$e me!ical ser$ices, the supply of me!icines, an! "enefits relate! to acci!ents an!

occupational !isease& any of the aencies are a!!ressin this aspect, "ut o$erall coor!ination

has

"een lac%in& These lo""yin roups shoul! #oin force with the wor%ers< watch!o committee

an!

start a "ier mo$ement to enerate pressure on the roun! for lealise! rihts of wor%ers in

helpin

them to form an! monitor the ESIC& Chane can only come a"out on the "asis of "uil!in up

consistent rassroots'"ase! pressure roups reionally an! nationally& The me!ia, which has

shown

fa$or towar!s the contri"utin employees rear!in the issue of the ESIC in the past, will also "e

le$erae! effecti$ely& Toether they can wor% to "roa!en the scope of the ESIC co$erae to the

informal sector throuh the * amen!ment of the constitution, which calls for local self'

o$ernance

from the $illae to the !istrict le$els&

Ac%nowle!ement

.&>& =aul, pu"lic relation officer, ESIC hea! office'>ew (elhi&

>alini Than!an, me!ical officer, ESIC hea! office' >ew (elhi&

anala, accounts !epartment, ESIC hea! office'>ew (elhi&

Thomas, !irector, ESIC 3eional office'>ew (elhi&

r& 7oon, !eputy !irector, ESIC reional office'>ew (elhi&

(r 3a#u, hea! of HIF cell !epartment, ESIC reional office'>ew (elhi&

(r artin athew, me!ical superinten!ent, ESIC hospital, asai!arapur'>ew (elhi&

(r 3e%ha Ararwal, ESIC !ispensary, %al%a#i&

.rala! ala$a!%ar, researcher an! trainer of wor%ers on ESIC'um"ai&

r >arayan, secretary, employee union'>ew (elhi&


28/28

eshwanth Shenoy, A!$ocate'um"ai&

3eference

ESIC Annual 3eport')1'))

/inancial Statement an! .erformance u!et'))')*

ESIC are Act 1948

Stan!ar! >ote on ESI Scheme of In!ia'))

Employers :ui!e arch')*

ESIC Citi-ens Charter

Employees :ui!e')*

rief proce!ure for claimin cash "enefits

>ewspaper article on Ferma Committee 3eport

>ewspaper articles on ESIC

Annual 3eport of ESIC Hospital asai!arapur

esi insurance

Documents