Last updated: November 14th, 2019 3:22 AM

Sickness Benefit under ESI

The ESI scheme was inaugurated in 1952 to help employees with financial assistance during times of sickness, maternity, temporary or permanent disablement, occupational disease or death due to employment injury. One of the major or most used benefits for employees registered with ESI is sickness benefits. In this article, we look at sickness benefit under ESI in detail.

Sickness Benefit

Sickness benefit in the form of periodic cash payments can be provided under the ESI scheme to a employee covered under ESI during period of certified sickness, requiring medical treatment and abstention from work on medical grounds. Sickness benefit at 70% of the average daily wages can be paid under the scheme for 91 days during 2 consecutive benefit periods. To be eligible to receive sickness benefit, the employee covered under ESI must meet the following conditions:

• The employee covered under ESI should have paid contribution for not less than 78 days during the corresponding contribution period.
• Employee covered under ESI who has entered into insurable employment for the first time has to wait for nearly 9 months before becoming eligible to sickness benefit, because his corresponding benefit period starts only after that interval.
• Sickness Benefit is not payable for the first two days of a spell of sickness except in case of a spell commencing within 15 days of closure of earlier spell for which sickness benefit was last paid. This period of 2 days is called "waiting period".

Extended Sickness Benefit

In case an employee covered under ESI is suffering from long term diseases and experiencing great hardship, then on expiry of 91 days of sickness benefit, extended sickness benefit of upto 2 years can b provided. Hence, extended sickness benefit is available only after exhausting sickness benefit to which an employee may be eligible. Further, to be entitled to the Extended Sickness Benefit the employee should have been in continuous employment for 2 years or more at the beginning of a spell of sickness in which the disease is diagnosed and should also satisfy other contributory conditions. Some of the diseases or conditions that are eligible for extended sickness benefit are:

1. Infectious Diseases
   • Tuberculosis
   • Leprosy
   • Chronic Empyema
   • AIDS
2. Neoplasms
   • Malignant Diseases
3. Endocrine, Nutritional and Metabolic Disorder
   • Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.
4. Disorders of Nervous System
   • Monoplegia
   • Hemiplegia
   • Paraplegia
   • Hemiparesis
   • Intracranial Space Occupying Lesion
   • Spinal Cord Compression
   • Parkinson's disease
   • Myasthenia Gravis/Neuromuscular Dystrophies
5. Disease of Eye
   • Immature Cataract with vision 6/60 or less
   • Detachment of Retina
   • Glaucoma
6. Diseases of Cardiovascular System
   • Coronary Artery Disease like unstable angina or myocardial infraction with ejection less than 45%
   • Congestive Heart Failure
   • Cardiac Valvular Diseases with failure/complications
   • Cardiomyopathies
   • Heart disease with surgical intervention alongwith complications
7. Chest Diseases
   • Bronchiectasis
   • Interstitial Lung Disease
   • Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale)
8. Diseases of the Digestive System
   • Cirrhosis of liver with ascities/chronic active hepatitis
9. Orthopaedic Diseases
   • Dislocation of vertebra/prolapse of intervertebral disc
   • Non union or delayed union of fracture
   • Post Traumatic Surgical amputation of lower extremity
   • Compound fracture with chronic osteomyelitis
10. Psychoses
    • Schizophrenia
    • Endogenous depression
    • Manic Depressive Psychosis (MDP)
    • Dementia
11. Others
    • More than 20% burns with infection/complication
    • Chronic Renal Failure
    • Reynaud's disease/Burger's disease.

Enhanced Sickness Benefit

Enhanced sickness benefit was introduced in 1976 to incentivice employees covered under ESI  who are undergoing vasectomy  or tubectomy. Employees covered under ESI are eligible for ordinary sickness benefit at enhanced sickness benefit of 100% of average daily wages for undergoing sterilisation operations for family welfare. Duration of enhanced sickness benefits is upto 7 days in the case of vasectomy and upto 14 days in the case of the tubectomy from the date of operation or from the date of admission in the hospital as the case may be. The period of enhanced sickness benefit is extendable in case of post operative complications