Instances have come to notice of ESI Headquarters that the insured person who had gone out of coverage due to crossing the earlier wage ceiling of Rs 15000/- and have subsequently re-entered into insurable employment due to enhancement of wage ceiling w.e.f 01-01-2017 have been facing difficulties in getting the benefits because of doubt over calculation of interruption period.

As per the Branch office manual, chapter VIII, para L.8.15.2.c containing the corporation’s resolution dated 05-12-1999 which read as, “A person in insurable employment may go out of coverage due to enhancement of wages and may be brought under coverage subsequently. The period of interruption should also be taken as insurable employment for the purpose of the Term “Continuous Service””. Therefore, such IP/IW will be eligible for getting benefits of extended sickness benefit and super speciality treatment, provided he or she fulfils the eligibility conditions as laid down under ESI Regulation and H.Q. instruction issued from time to time for the entitlement of these benefits.

Particulars of the case Extended Sickness Benefit Eligibility
The ESI Scheme is implemented for the first time in an area under Sec. 1(3) of the ESI Act and is later extended to establishments under Sec. 1(5) of the Act and an insured person’s spell of sickness commences in the first benefit period.

(This also includes cases where the said first spell commenced before the start of the first benefit period but continued into first benefit period.)

He will be eligible to ESB if :–

(a) before the date of start of this spell of sickness he had been in continuous service as defined in Sec. 25-B of the Industrial Disputes Act, 1947, for a period of 2 years or more either in a factory in terms of Sec. 2(12) or an establishment in terms of Sec. 1(5) of the ESI Act, and

(b) he has qualified to claim sickness benefit in the first benefit period.

The spell of sickness of an insured person covered as an employee under the ESI Act since the ‘A-Day’ for the area, starts before completion of four contribution periods by him. He will be eligible to ESB if :-

(a) he fulfils the condition (a) of item (1) above, and

(b) he fulfils the contributory condition for sickness benefit in at least one of the contribution periods expired after the appointed day.

A person joins insurable employment in a covered factory/establishment after the appointed day for the area and suffers from one of the long-term diseases and the date of start of spell of sickness falls before completion of four contribution periods by him. He will not normally be eligible to ESB during the spell unless he can produce evidence of having been in insurable employment in some other covered factory/establishment and having fulfilled the required contributory condition or unless the condition is relaxed by the Regional Director under powers delegated to his. [vide para 14/15 of old/new Resolution read with para 2(b) thereof]
A factory/establishment is covered under the Act after the appointed day for the area and insured person is in continuous service for 2 years as defined in Sec. 25-B of the I.D. Act, 1947 in the said establishment before the date of commencement of the spell of sickness for which ESB is admissible but has not completed four contribution periods from the date of coverage of the factory/establishment. “Appointed Day” for this factory/ establishment is the date of its coverage under the ESI Act. Hence, two years’ service condition may be applied to an employee of such a factory/establishment also even if it was covered from a date subsequent to the Appointed Day for this area. Eligibility to ESB in his case also will be determined in the same way as cases covered under item (1) and (2) above.

Order: Employee reentered to ESI will be eligible for Extended Sickness Benefit and Super Speciality Treatment

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