ESIC – An Overview of the Death Benefit Scheme

ESIC – History

Employees’ State Insurance Corporation (ESIC) as a scheme was inaugurated on the 24^th February 1952 in Kanpur by our then Prime Minister Pandit Jawahar Lal Nehru. The Scheme was simultaneously launched in Delhi, and the initial coverage for both the centres was 1,20,000 employees. It is the first Social Security scheme enacted to protect the employees and their dependents in 1944.

The ESI Act, 1948 covers contingencies such as sickness, maternity, temporary or permanent disablement, occupational disease, or death due to employment injury that results in loss of earning capacity. Thus, the Act is made to annul the financial distress in such contingencies.

Benefits Under the ESI Act

Section 46 of the ESI Act covers six social security benefits: medical benefits, sickness benefits (extended sickness benefit, enhanced sickness benefit), maternity benefit, disablement benefit (temporary disablement benefit, permanent disablement benefit), dependent’s benefit and funeral expenses.

Implementation of ESIC COVID-19 Relief Scheme

The ongoing pandemic has created havoc in everybody’s life. People across the world are losing out on their jobs, health, their and their family’s life. These are uncertain times for everybody and a lot of people are suffering as they no longer have any source of income.

ESIC has recently implemented the ‘ESIC COVID-19 Relief Scheme’. The scheme is a welfare measure for all insured persons under section 2(9) of the ESI Act. This scheme has come into force to provide relief to the dependents of the insured persons in case of their death due to COVID-19. The insured person’s dependent will be paid periodically in case of his death. This scheme shall be valid for 2 years w.e.f. 24^th March 2020.

Eligibility Conditions for ESIC COVID-19 Relief Scheme

For a person to be eligible for the ESIC death benefit scheme, he/she must fulfil the two conditions; (i) the insured person must have been registered on the ESIC portal at least three months before being diagnosed with Covid-19 resulting in death; (ii) the deceased insured person must have been employed on the date of diagnosis of COVID-19 and contributions for at least 70 days should have been paid in respect of him/her during a period of maximum one year preceding to the diagnosis of COVID-19 disease resulting in death.

This scheme is eligible to the relatives of the insured person, and that would be his/her spouse, legitimate or adopted son (who has not attained twenty-five years of age), legitimate or adopted unmarried daughter or widowed mother.

Distribution of Relief

In case the insured person died of COVID-19, the spouse of the deceased will get an amount equivalent to two-fifths of the full rate during their lifetime; the son (legitimate or adopted) will get two-fifths of the rate till he attains the age of twenty-five years; unmarried daughters, legitimate or adopted shall get two-fifth of the rate and widowed mother, two-fifth of the full rate for life.

Implementation of the ESIC Death Benefit Scheme

In case of death of the insured person, the claimant is required to submit the claim for relief CRS-I form along with the Covid positive report and death certificate in the ESIC branch office. If the branch office is not designated to the Insured Person, the branch manager shall forward his claim and all the documents to the designated branch office. The verification certificate of the claimant shall be issued by the branch manager enclosed with all the required documents. Proof of dependent’s age and identity shall be provided via Aadhar Card or a valid birth certificate.

For the insured persons who were availing maternity benefit, extended sickness benefit or temporary disablement benefit and died due to COVID-19 and who fall short of the required 70 days of contribution due to these benefits, the number of days they were on the mentioned benefits during one year prior to the diagnosis of COVID-19 will be eligible for relief under this scheme.

In cases, where the insured person dies after recovery within 30 days of discharge from the hospital, such cases shall be decided by the Regional Director/Sub-Regional Office in charge on the recommendation of a medical board in the nearest ESIC Hospital.

The dependents other than the once authorized shall provide the certificate of dependency attested by the authorities mentioned therein. The claims of dependents shall then be examined by the branch manager of the designated branch office of the deceased insured person.

Once the claims made by claimants are satisfied by the Regional Director, the first payment shall be made in the bank account of the claimant within 15 days of receipt of the claim. Subsequently, periodic payments of the relief shall be made by the designated branch office of the deceased person. The claimant must submit a life certificate to the authority once every year.

Thus, the local audit team will audit all the payments made under this scheme. All the records of the cases that have been approved under the scheme shall be maintained at the regional office or sub-regional office. The grievances received under the scheme shall be addressed by the branch officer along with monitoring the progress on the schemes made.

Along with the above, a helpdesk will be created at every branch office, regional office, and sub-regional office to help the claimants know better about the scheme and clarify their doubts. There should also be a wide publication about this scheme through banners and pamphlets in local languages.

All the actions on the claims received shall be acted on promptly by the branch officer and the claims have to be settled within 15 days of receipt of the complete claim. This is a grand addition towards recognizing and providing for the welfare of all the insured persons and their dependents.

Disclaimer: This blog is meant for informational purposes and discussion only. It contains only general information about legal matters. The information provided is not legal advice and should not be acted upon without seeking proper legal advice from a practicing attorney.Simpliance makes no representations or warranties in relation to the information on this article.