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THE EMPLOYEES’ STATE INSURANCE ACT,1948

A PRESENTATION BY
NARAYAN CHANDRA SARANGI, Ph.D.
ASSOCIATE PROFESSOR, XaHR
1
THE ESI ACT
The ESI Act passed in 1948
(amended in 1970, 1984 and 1989) is
an important measure of social
security and health insurance in this
country. It provides for certain cash
and medical benefits to industrial
employees in case of sickness,
maternity and employment injury.
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COVERAGE …
•The Act extends to the whole of India,
except Manipur, Sikkim, Arunachal
Pradesh and Mizoram.
•The Act of 1948 covered all power using
factories other than seasonal factories
wherein 20 or more persons were
employed (excluding mines, railways and
defense establishments).
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CONTINUED……
• The provisions of the ESI (Amendment ) Act
of 1975 were extended to the following new
classes of establishments:
– Small power-using factories employing 10 to 19
persons, and non-power-using factories employing
20 or more persons.
– Shops, Hotels and Restaurants.
– Cinemas and Theatres.
– Road-motor transport establishments
– Private Medical & Educational Establishments and
– Newspaper establishments.
4
COVERAGE
•With effect from 01.01.1997 the Act
covers all employees – manual, clerical,
supervisory and technical drawing upto
Rs.21000/- per month. [w.e.f.01/01/2017]
•The provisions of the Act can be extended
to any other agricultural or commercial
establishment by issuing a 30 days prior
notice by appropriate government in the
official gazette
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ADMINISTRATION OF THE ACT
The Act is a central Act having two wings:
I. Enforcement and providing non-medical
services of the Act – Central Government –
Department of Labour – Employees State
Insurance Corporation
II. Extending the Medical Services to insured
Persons and family members-
State Government – Department of Labour –
Employees State Insurance Scheme (Medical.)
Services. 6
ADMINISTRATION
• The comprehensive and multi-pronged social security
programme is administered by an apex corporate body
called the Employees' State Insurance Corporation.
• It comprises members representing vital interest
groups, including, employees, employers, the Central
and State Government, representatives of Parliament
and medical profession.
• The Corporation is headed by the Union Minister of
Labour, as its Chairman, whereas the Director
General, appointed by the Central Government
functions as its Chief Executive Officer.
ADMN…CONTD
• The broad based corporate body is, primarily,
responsible for coordinated policy planning and
decision making for growth, development and efficacy
of the scheme. A Standing Committee, constituted
from among the members of the Corporation, acts as
an Executive Body. The Medical Benefit Council,
constituted by the Central Government, is yet another
Statutory Body that advises the Corporation on
matters related to effective delivery of medical services
to the Beneficiary Population.
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ADMN…CONTINUED
• 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 administration of Medical
Benefit is taken care of by the respective State
Government except in case of Delhi and
Noida/Greater Noida area in Uttar Pradesh where the
Corporation administers medical facilities directly.
The Corporation has taken over the administration of
23 ESI Hospitals in various States for developing them
as ESIC Model Hospitals.
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WAGES Defined …
• Wages means all remuneration paid or payable in cash
to an employee, if the terms of the contract of
employment, express or implied, were fulfilled and
includes any payment to an employee in respect of any
period of authorized leave, lock out, strike which is not
illegal or layoff and other additional remuneration, if
any, paid at intervals not exceeding two months, but
does not include :-
a). Any contribution paid by the employer to any
pension fund or Provident fund, or under this act;
b). Any traveling allowance or the value of any
traveling concession;
c). Any sum paid to the person employed to defray
special expenses entailed on him by the nature of his
employment ; or
d). Any gratuity payable on discharge. 10
WAGES Defined …
The above definition has three parts
1. All remuneration paid or payable in cash to an
employee following from the term of employment
(including agreement) express or implied. The
periodicity of payment is not relevant in this case.
2. Any additional remuneration even if not flowing
from any agreement or settlement but paid at
intervals not exceeding two months.
3. The exceptions as provided in Clause (a) to (d) above. Any
remuneration paid or payable under Para 1 and 2 is wages
and chargeable to contribution whereas any amount paid
towards items mentioned in clause (a) to (d) are not wages
and therefore no contribution is chargeable on the amount.

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WAGES NOT WAGES

a) Suspension Allowance/Subsistence Allowance is a) Washing allowance – if the sum is paid to


wages defray special expenses entailed by the nature
of employment is not wages.

b) Overtime allowance is wages for payment of b) Annual Bonus is not wages if the
contribution only but not for determination of periodicity of the payments is more than 2
employee’ u/s 2(9) of the Act. months.

c) Inam is wages when it is paid for special skill or c) Incentive Bonus: Incentive Bonus is not
higher responsibilities or where the employer has no wages if the periodicity of the payments is
right to withdraw or revise it more than 2 months.

d) 'Lay Off' pay is wages. d) Production Bonus is not wages provided


periodicity of the payment is more than 2
months.

e) House Rent Allowance is wages. e) Inam is not wages where the employer has
right to withdraw at his discretion and where
there is scheme of ‘Inam’ in writing but still
employer might be making payment under the
head ‘Inam’ on the basis of some
understanding between the parties and the
periodicity of payment is beyond 2 months.12
f) Night Shift/Heat/Gas/Dust Allowance is f) ‘Annual Commission’ is not wages.
wages.

g) ‘Conveyance Allowance’ is wages which g) ‘Service Charges’ is not wages when it is


arises out of contract of employment from collected as tips.
1.4.02 as per Hqrs. letter dated 21.3.02

h) Medical Allowance is wages when it is h) Salary drawn by the proprietor/partners


not reimbursed. and contractor himself.

i) Newspaper Allowance is wages when it i) Ex-gratia payment in lieu of annual


is not re-imbursed. bonus

j) Education Allowance’ is wages when it is j) Payment made towards “Saving


not re-imbursed. Scheme” is not wage

k) ‘Drivers Allowance’ is wages. k) Hamalies or collies employed at a


particular time outside factory premises
are not employee.

l) Food, Meal, Tiffin and Lunch allowance L) Expenditure on annual servicing of


is wages when it arises out of contractual machines (contract for service), no
agreement. contribution payable. 13
m) ‘Gazetted Allowance’ is wages m) Commission to Dealers/Agents, no
contribution payable

n) ‘Wages’ and Dearness Allowance’ for n) Payment made to institutions having


un-substituted holidays is wages separate legal entity no contribution
payable

o) Interim Relief is wages. o) Service Contract with organization for


annual maintenance of machinery /
equipments as part of service contract will
not attract ESI contribution.

p) Attendance Bonus is wages provided p) Payment made to the Lawyers,


the periodicity is not more than 2 months Engineers, Counsellor and Chartered
Accountant is not wages.

q) Hamalies or collies at a particular time q) Payment made to Rickshaw-pullers,


in the premises of the employer is Hathairy pullers and truck operators
‘employee’ and contribution is payable. (including loading and unloading charges
when the loaders / unloaders are the
employee and truck operators are not
employee’ u/s 2(9) and no contribution is
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payable.
r) Short period contract for service – electrician, carpenters, r) The following items will not form part of wage either for the
plumbers, repair work if the work is done within the factory purposes of u/s. 2(9) or u/s 2(22) of the ESI Act.
premises, contribution is payable in respect of employees. 1) Payment made on account of unavailed leave at the time of
discharge (2) Commission on advertisement secured for
newspaper if not paid to the regular employees (3) Fuel
Allowance / Petrol Allowance (4) Entertainment Allowance (5)
Shoes Allowance (6) Payment made on account of gratuity /
discharge / retirement (7) Payment made on encashment of
leave.

s) The following items may be considered as ‘Wages’ :- (1)


Matinee allowance paid to the cinema employee (2) Shift
allowance (3) Location allowance paid in addition to D.A. to
meet the high house rent (4) Compensatory allowance (5) Cash
handling allowance paid to Cashier (6) Supervisory allowance
(7)Additional pay paid to training staff (8) Charge allowance (9)
Steno/typist allowance (10) Plant allowance (11) Computer
allowance (12) Gestetner/Photo copies/printers allowance (13)
Personal /special allowance (14) Machine allowance (15)
Canvassing allowance (16) First aid allowance (17) Personal
allowance for skill, efficiency or past good records (18) Area
allowance for high cost living (19) Ex-gratia payment if payment is
made within an interval of 2 months.
(20) Conveyance all w.e.f. 01.04.02 (21) Food/Tiffin/Meal all
w.e.f. 06.05.03
Coverage of workers engaged by the outside agencies / job
contractors in connection with the work of the principal
employer outside the premises. For the purpose of verification
and inspection, the details in respect of these employers/
employees should be furnished by the Principal Employer in
proforma prescribed in Annexure-I.

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IMPORTANT DEFINITIONS

Sec.2(3)-"confinement" means labour resulting in the issue of a


living child or labour after 26 weeks of pregnancy resulting in the
issue of a child whether alive or dead;

(4) "contribution" means the sum of money payable to the


Corporation by the principal employer in respect of an employee
and includes any amount payable by or on behalf of the employee
in accordance with the provisions of this Act;

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(6A) "dependant" means any of the following relatives of a
deceased insured person, namely,-

(i) a widow, a legitimate or adopted son who has not


attained the age of 25 years, an unmarried legitimate or
adopted daughter. (2010 amendment)
(ia) a widowed mother;

(ii) if wholly dependent on the earnings of the insured


person at the time of his death, a legitimate or adopted son
or daughter who has attained the age of 25 years and is
infirm; (2010 amendment)

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iii) if wholly or in part dependent on the earnings of the insured
person at the time of his death,-
(a) a parent other than a widowed mother,
(b) a minor illegitimate son, an unmarried illegitimate daughter
or a daughter legitimate or adopted or illegitimate if married
and a minor or if widowed and a minor,
(c) a minor brother or an unmarried sister or a widowed sister
if a minor,
(d) a widowed daughter-in-law,
(e) a minor child of a pre-deceased son,
(f) a minor child of a pre-deceased daughter where no parent of
the child is alive, or
(g) a paternal grand-parent if no parent of the insured person is
alive,

18
DEFINITIONS CONTINUED
8) "employment injury" means a personal injury to an employee
caused by accident or an occupational disease arising out of and in
the course of his employment, being an insurable employment,
whether the accident occurs or the occupational disease is
contracted within or outside the territorial limits of India;

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CONTRIBUTION
E.S.I. Scheme being contributory in nature, all the employees in
the factories or establishments to which the Act applies shall be
insured in a manner provided by the Act. The contribution
payable to the Corporation in respect of an employee shall
comprise of employer's contribution and employee's contribution
at a specified rate. The rates are revised from time to time.
Currently, the employee's contribution rate (w.e.f. 1.1.97) is
1.75% of the wages and that of employer's is 4.75% of the wages
paid/payable in respect of the employees in every wage period.
Employees in receipt of a daily average wage upto Rs.100/- are
exempted from payment of contribution. Employers will however
contribute their own share in respect of these employees.
20
CONTRIBUTION
Collection of Contribution:
An employer is liable to pay his contribution in
respect of every employee and deduct employees
contribution from wages bill and shall pay these
contributions at the above specified rates to the
Corporation within 21 days of the last day of the
Calendar month in which the contributions fall
due. The Corporation has authorized designated
branches of the State Bank of India and some
other banks to receive the payments on its behalf.
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Contribution & Benefit Period …
• Employees covered under the ESI Act, are
required to pay contribution towards the scheme
on a monthly basis. A contribution period means a
six month time span from 1st April to 30th
September and 1st October to 31st March.
• Cash benefits under the scheme are generally
liked with contributions paid. The benefit period
starts three months after the closure of a
contribution period. The two type of periods are
elucidated below.
Contribution Period Benefit Period
1st April to 30th September 1st January to 30th June
of the following year
1st October to 31st March 1st July to 31st Dec. 22
CALCULATION OF ESI
• Once contribution in respect of an employee begins, the
contribution should continue until the end of the contribution
period (Apr to Sep or Oct to Mar) even if the salary (for the
purpose of ESI calculation) increases beyond Rs 21,000 per
month during the contribution period.
• An employee whose wages crosses the prescribed ceiling limit
in any month at anytime after commencement of the
contribution period, continue to be an employee till the end of
that contribution period. Though there is a wage ceiling limit
for coverage of an employee, there is no ceiling limit in the
definition of wages for payment of contribution. Hence
contribution is payable on the total wages without any ceiling
limit.

23
ADVANTAGES OF EMPLOYERS …

Employers are absolved of their liabilities


of providing medical facilities to
employees and their dependents in kind
or in the form of fixed cash allowance,
reimbursement of actual expenses, lump
sum payment or opting for any other
medical insurance policy of limited scope
unless it is a contractual obligation of the
employer
24
ADVANTAGES OF EMPLOYERS …

2). Employers are exempted from the applicability


of the : -
(a). Maternity Benefit Act
(b). Employees’ Compensation Act
in respect of employee covered under the ESI
Scheme
3). Employers have their disposal, a productivity ,
well secured workforce, an essential ingredient
for better productivity
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ADVANTAGES OF EMPLOYERS …
4). Employers are absolved of any responsibility in
times of Physical distress of workers such as
sickness, employment injury or Physical
disablement resulting in loss of wages, as the
responsibility of Paying cash benefits shits to the
corporation in respect of insured employees

5). Any sum paid by way of contribution under


the ESI Act is deducted in computing ‘income’
under the Income Tax Act
26
BENEFITS FOR EMPLOYEES/IPS’
SIX TYPES OF BENEFITS UNDER THE ACT:
1. MEDICAL BENEFITS
2. SICKNESS BENEFITS
3. MATERNITY BENEFITS
4. DISABLEMENT BENEFITS
5. DEPENDENTS’ BENEFITS
6. OTHER BENEFITS-
• FUNERAL BENEFITS
• CONFINEMENT BENEFITS
[As per Section 46 of the Act]
27
MEDICAL BENEFITS
Full medical care is provided to an Insured
person and his family members from the day he
enters insurable employment. There is no
ceiling on expenditure on the treatment of an
Insured Person or his family member. Medical
care is also provided to retired and permanently
disabled insured persons and their spouses on
payment of a token annual premium of
Rs.120/- .
28
SYSTEM OF TREATMENT
• Generally, the allopathic system of medicine is used
for providing Medical Benefit. However, where a
substantial number of workers demand treatment by
Indian system of medicine and Homoeopathy (ISM &
H) other than Allopathy and where the State
Government has recognised the qualifications in such
system, treatment facilities may be provided under the
ISM & H as well. The various ISM &H systems of
treatment in vogue are:, Ayurvedic, Unani, Sidha,
Yoga therapy and Homeopathy.
29
SCALE OF MB
• The scale of Medical Benefit under section 57
of Act to be provided to the IPs and members
of their families is to be prescribed by State
Government in consultation with the
Corporation under Section 58(1 & 3) of Act
under State Medical Benefit Rules. An IP
and/or a member of his family does not have
the right to claim Medical Services over and
above those which have been so prescribed.
The beneficiaries are entitled to reasonable
medical, surgical and obstetric treatment.
30
SCALE OF MEDICAL BENEFIT
• To Insured Persons:- IPs are entitled to avail treatment in ESI
Dispensary/Hospital/Diagnostic Centre and recognised institutions, to which
he is attached such as:-Outpatient treatment
• Domiciliary treatment by visits at their residences.
• Specialists Consultation.
• In-patient treatment(Hospitalisation)
• Free supply of drugs dressings and artificial limbs, aids and appliances.
• Imaging and laboratory services.
• Integrated family welfare, immunisation and MCH Programme and other
national health programme etc.
• Ambulance service or re-imbursement of conveyance charges for going to
hospitals, diagnostic centres etc.
• Medical Certification and
• Special provisions.

31
SCALE OF MEDICAL BENEFIT
• To Family Members of Insured Persons:-
While in all implemented areas, IPs are entitled
to medical care as detailed above, members of a
family of an IP are entitled to one or other of
the following scales of Medical Benefits:-
"FULL" Medical Care i.e., all facilities as for IPs
including hospitalisation.
• "EXPANDED" Medical Care i.e., all facilities as for
IPs except hospitalisation. A small number of IPs in
the States of Gujarat and Bihar fall under this category.

32
SICKNESS BENEFITS
• Sickness Benefit in the form of cash
compensation at the rate of 70 per cent of
wages is payable to insured workers during the
periods of certified sickness for a maximum of
91 days in a year. In order to qualify for
sickness benefit the insured worker is required
to contribute for 78 days in a contribution
period of 6 months.

33
SICKNESS BENEFIT
• Extended Sickness Benefit(ESB) : SB
extendable upto two years in the case of
34 malignant and long-term diseases at an
enhanced rate of 80 per cent of wages.
• Enhanced Sickness Benefit : Enhanced
Sickness Benefit equal to full wage is
payable to insured persons undergoing
sterilization for 7 days/14 days for male
and female workers respectively.
34
Maternity Benefit

• Maternity Benefit is cash payable to an insured women


for the specified period of abstention from work for
confinement or mis-carriage or for sickness arising out
of pregnancy, “confinement” “premature birth of child
or miscarriage” “confinement” connotes labour after
26 weeks of pregnancy whether the result issue is alive
or dead,

• “Miscarriage” means expulsion of the contents of a


pregnant uterus at any period prior to or during 26th
week of pregnancy.

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Maternity Benefit…

• Criminal abortion or miscarriage does not,


however, entitle to benefit.
• The contribution condition is the same as for
Sickness Benefit.
• The daily benefit rate is double the sickness
Benefit rate and is thus roughly equivalent to
the full wages. Benefits is paid for Sundays also.

36
Maternity Benefit…

• The Benefit is paid as follows (Duration)


a). For Confinement
For a total period 12 Weeks beginning not more than
6 weeks before the expected date of child birth, if the
insured women dies during confinement or within 6
weeks thereafter, leaving behind the living child, the
benefit continues to be payable for the whole of the
period. But the child also die during that period, the
benefit will be paid upto and including the day of the
death of the child.

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Maternity Benefit…

b). For Miscarriage


For the period of 6 weeks following the
date of miscarriage
c). For sickness arising out of pregnancy,
confinement, Premature birth of child or
miscarriage :
For an additional period or upto four weeks.
In all the cases, the benefit is paid only if the insured
women does not work for remuneration during the
period for which benefit is claimed. There is no
waiting period.
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Maternity Benefit…

• Medical Bonus
Medical Bonus is lump sum payment
made to an insured woman or the wife of
an insures person in case she does not
avail medical facility from an ESI hospital
at the time of delivery of a child. This
bonus of Rs. 250/- has been increased to
Rs. 1000/- from 1st April 2003

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Disablement Benefit …
a). Temporary disablement benefit :

• In case of temporary disability arising out of an


employment injury or occupational disease.,
• Disablement benefit is admissible to insured
person for the entire period so certified by an
Insurance Medical officer / Practitioner for which
IP does not work for wages.
• The benefit is not subject to any contributory
condition and is payable at a rate which is not
less than 70% of daily average wages.
• However, not payable if the incapacity lasts for
less than 3 days excluding the date of accident.
40
Permanent disablement benefit …
• In case an employment injury or occupational
disease results in permanent, partial or total loss
of earning capacity,
• Periodical payments are made to the IP for life at
a rate depending on the actual loss of earning
capacity as may be determined and certified by
a duly-constituted Medical Board.
• The rates of Disablement Benefits are
determined in accordance with the provisions of
Rule 57 of ESI (Central) Rules, 1991.
• In order to product erosion in real value of the
periodical payments of Permanent Disablement
benefits, against rise in the cost of living index,
periodical increases are granted, based on
actuarial calculation 41
Permanent disablement benefit …

• Commutation of periodical payments into


lump sum (one time payment) is
permissible where the permanent
disablement stands assessed as final and
daily rate of benefit does not exceed Rs.
1.50. per day.
• Commutation of Permanent Disablement
Benefit into lump sum payment is also
allowed in case the total commuted value
does not exceed Rs.10000/- (The ceiling is
now being raised to Rs.30000/-).
42
Dependants’ Benefit …
• Dependents Benefit is a monthly pension payable to the
eligible dependents of an insured person who dies as a
result of an Employment Injury or occupational disease
• Beneficiaries and Duration of benefit
a). Widow / widows during life or until remarriage
b). Legitimate or adopted son until age 18 or if legitimate
son is infirm, till infirmity lasts.
c). Legitimate or adopted unmarried daughter until age
18 or until marriage, whichever is earlier, or if infirm, till
infirmity lasts and she continues to be unmarried.
In the absence of any widow or legitimate child, the
benefit is payable to a parent or grandparent for life, to
any other male dependent until age 18 or to an
unmarried or widowed female dependent until age 18.
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Dependants’ Benefit …
• How much …

• The total divisible benefit is equivalent to the temporary


disablement benefit rate (roughly 70% of the wage rate).
The widow / widows share 3/5th of the benefit and the
legitimate or adopted son and daughter 2/5th each of the
benefit. If the total benefit so divided exceeds the full rate,
there is a proportionate reduction in the respective shares
of the beneficiaries.
• The amount of pension paid to the dependents of a
deceased insured person is reviewed vis-à-vis the cost of
living index and increases are granted from time to time to
compensate for erosion in its real value.

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Other Benefit …
(i). Funeral Expenses

Funeral Expenses are in the nature of lump


sum payment up to a maximum of Rs.10000/-
made to defray the expenditure on the funeral
of deceased IP. The amount is paid either to
the eldest surviving member of the family or, in
his absence, to the person who actually incurs
the expenditure on the funeral.

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Other Benefit …

Rehabilitation Allowance
The corporation, vide its Resolution dated
22.12.1979, resolved to grant rehabilitation
Allowance to the IPs, for each day, on
which they remain admitted in an Artificial
Limb Centre. On the rates, which generally
confirm to double the Standard Sickness
Benefit rate. The above benefit was
introduced with effect from 1.1.1980

46
Levy of Interest & Damages …
• Under Section 39(5)(a) of the ESI act, read with Regulation 31(A) of
the ESI (General) Regulations 1950, the employer is liable to pay
simple interest at the rate of 15 percent per annum in respect of each
day of default or delay in payment contributions. In addition, under
the Provision of Regulation 31-C of ESI (General) Regulations, 1950,
read with sec.85(B)(i) of the ESI Act, the Corporation is empowered
to recover damage as under:
Period of delay in Rate of Damages
payment of Contribution on the amount due
i). Up to less than 2 months 5%
ii). 2 months and above but less than 4 months 10%
iii).4 months and above but less than 6 months 15%
iv). 6 months and above 25%
Interest and damages can also recovered as arrears of land
revenue Section 45(c) to Section 45(I) by the Recovery
Officer of ESI Corporation.

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Safeguard for Insured Employees:
• Right to receive payment of any benefit under the Act are not
transferable.
• Employer shall not dismiss, discharge or reduce the wages
or otherwise punish a covered employee during the period
he/she is in receipt of Sickness Benefit or Maternity Benefit etc.
• By reason of his liability to pay his share of contribution under
the ESI Act, no employer shall directly or indirectly reduce the
wages of a covered employee.
• Right to register their grievances / complaints at any level for
immediate redressal. Right to approach ESI Court against any
action/decision of the Medical Board etc
• Cash Benefits payable under the Act are not liable to
attachment or sale in execution of any decree or order of any
court
48
EMPLOYERS’ DUTIES UNDER THE ACT………………

• An employer shall apply in Form-01 for coverage under the


ESI Act, within 15 days after the Act becomes applicable to a
factory or establishment.
• The employer shall submit Declaration Form in respect of all
coverable employees in the unit.
• The employer shall deposit both employees’ and employers’
contribution as per specified rates within 21 days of the
following month.
• The Employer shall maintain all such records and registers as
are required under the Act and produce them for verification /
inspection before the authorised officers of the Corporation.
• The employer shall submit half-yearly Return of Contributions
(RC) by 12th May/11th November every year with all columns
properly filled.
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CONTD…..
• The employer will report any change in business activity,
address, ownership or the management to ESIC authorities
forthwith.
• An employer will also ascertain the liability towards ESI dues,
while taking over the ownership of a factory/establishment
through purchase, gift, lease, licence or otherwise as the new
owner is liable to discharge past liabilities.
• An employer will also ascertain the liability towards ESI dues,
while taking over the ownership of a factory / establishment
through purchase, gift, lease, licence or otherwise as the new
owner is liable to discharge past liabilities

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Obligation of the Employers …
Maintain the following records/ registers properly for the
purpose of inspection
1. Attendance Registers / Muster Rolls (in respect of all
employees including those employed through
contractors)
2. Wage Register
3. Cash Book / Bank Book
4. Account Books including Ledgers and Vouchers,
Balance Sheet.
5. Employees’ Register
6. Accident Book
7. Returns of Contribution
8. Return of Declaration Forms
9. Copies of Challans
10. Inspection Book
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52
Thank You

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