ESIC BRANCH OFFICE MANUAL

1 ESIC BRANCH OFFICE MANUAL FOURTH EDITION (UPDATED TILL JULY, 2010) FOR OFFICIAL USE ONLY PUBLISHED BY DIRECTOR GENERAL deZpkjh jkT; chek fuxe EMPLOYEES' STATE INSURANCE CORPORATION ROAD, NEW DELHI- 110002 UPREFACE TO THE FOURTH EDITION Employees State Insurance Corporation is implementing country s Social Security Scheme. It has now more than 4 crore workers and their family members under it's umbrella. In order to render the best possible services to its beneficiaries, the Corporation believes in creating an atmosphere of co-operation and mutual trust amongst the stakeholders the Employers, the Beneficiaries and the ESI Corporation. The BRANCH OFFICE MANUAL , a corporate publication of the ESIC, is an essential reference and guide book for effective delivery of social security services, to the vast clientele of ESI beneficiaries.

2 The fact, that the Corporation on average, makes 30 lakh cash benefit payments annually, through its broad base network of over 611 BRANCH Offices and 197 Pay Offices, underlines the importance of publication, for day to day operations. The last edition of the BRANCH OFFICE MANUAL was brought out in 2000, almost a decade back, and hence the need for a revised edition. This edition of the MANUAL , has been updated carefully and incorporates all important amendments made in Act, Rules and Regulations relating to provisions on Benefits. A new Chapter has been added in the revised edition- Chapter XIV on Finance & Accounts of BRANCH OFFICE . Further, Chapter IV on Temporary Disablement Law has been bifurcated and provisions relating to Occupational Diseases have been incorporated in Chapter IV-A.

3 Similarly, provisions relating to Unemployment Allowance under RGSKY have been incorporated in chapter XII and Super Speciality Treatment in Chapter XIII. These additions will make understanding of issues on important subjects easier for all concerned. I am hopeful, that, this updated edition of the MANUAL shall prove very useful at the operative level in ESIC Establishments and thereby, help in increasing the overall efficiency towards speedy and smooth flow of benefits to the insured population. Here, I find it opportune, to express my deep gratitude and thanks to Officers & Staff of the Benefit Division and Shri (Retd. ) whose relentless efforts have enabled the ESIC Headquarters to come out with this revised edition.

4 Each section of the book has been compiled with utmost care. Constructive suggestions for improvement of the book will be highly appreciated. ( ) UINSURANCE COMMISSIONER, ESIC New Delhi Dated UFOREWORD TO FOURTH EDITION From humble beginning in 1952 at Delhi and Kanpur ESI Corporation has acquired a Pan-India presence and it now serves its beneficiaries in all corners of the country. Today, we provide insurance and health care to more than 40 million population. This not only makes us one of the largest health service providers in the world but also a unique one as we are insurer as well as service provider. As a result of improved educational and living standards, the expectations of our beneficiaries have also risen.

5 To meet the aspirations of our stakeholders, a large number of new initiatives have been taken by the Corporation including up gradation of our existing Hospitals, Dispensaries, BRANCH Offices, construction of new corporate standard Hospitals, IT Roll Out, payment of PDB/DB through ECS and streamlining procedure involving delivery of medical & cash benefits for ultimate goal of 'Kahin bhi, Kabhi bhi' services. In order to provide quality service with speed it is essential that every stake holder should be fully conversant with the latest rules and regulations of the ESI Scheme. In this backdrop, it is gratifying to dedicate this revised, knowledge-based and updated version of the BRANCH OFFICE MANUAL to ESIC establishments across the country.

6 I am sure that availability of this exhaustive compilation of laws and procedures, concerning delivery of benefits and other related areas of activity, shall further enhance the efficacy of our field offices. I look forward to its extensive use by our officers and staff. (Dr. , ) UDIRECTOR GENERAL, ESIC New Delhi Dated EMPLOYEES STATE INSURANCE CORPORATION BRANCH OFFICE MANUAL (Fourth Edition) CONTENTS Chapter No. Name of Chapter Page No. I. registration - Law & Procedure 1 to 66 II. Certification- Law & Procedure 67 to 92 III. General Claims Law Procedure 93 to 104 105 to 142 IV. Temporary Disablement Benefit Law Procedure 143 to 164 165 to 188 IVA. Temporary Disablement Benefit (Occupational Diseases) Law Procedure 189 to 198 199 to 224 V.

7 Permanent Disablement Benefit Law Procedure 225 to 242 243 to 274 VI. Dependants Benefit Law Procedure 275 to 288 289 to 322 VII. Sickness Benefit Law Procedure 323 to 336 337 to 352 VIII. Extended Sickness Benefit Law Procedure 353 to 374 375 to 402 IX. Maternity Benefit Law Procedure 403 to 416 417 to 428 X. Funeral Expenses- Law & Procedure 429 to 438 XI. Miscellaneous Matters connected with Claims & Payments 439 to 498 XII. Other Important Matters concerning IPs and their Families 499 to 550 XIII. Entitlement to Medical Benefit 551 to 574 XIV. Finance & Accounts of BRANCH OFFICE 575 to 630 Alphabetical Subject Index to IV Edition 1 to 18 Annexure Finance & Accounts of BRANCH OFFICE a to c UABBREVIATIONS USED IN THIS MANUAL A Day Appointed Day or AE Alternative evidence or ALC Artificial Limb Centre or AMO Administrative Medical Officer or BO BRANCH OFFICE or BM BRANCH Manager or BP Benefit Period or CP Contribution Period or DB Dependants benefit or DIC Duplicate identity card DF Declaration form or DO Divisional OFFICE ESB Extended sickness benefit ESIC Employees State Insurance Corporation HC Head

8 Clerk or IMO Insurance Medical Officer or imp Insurance Medical Practitioner or IP Insured Person or IW Insured Woman or LTI Left Thumb Impression or MAT Medical Appeal Tribunal or MC Medical Commissioner or MR Medical Referee or MCR Medical Record Card or MRE Medical Record envelop or OD Occupational disease or PDB Permanent Disablement Benefit or PEPA Per employee per annum or PIC Permanent Identity Card or RC Return of contributions or RD Regional Director or RDF Return of declaration forms or RDMC Regional Dy. Medical Commissioner or RO Regional OFFICE or RTI Right Thumb Impression or SB Sickness Benefit or SMC State Medical Commissioner or SRO Sub Regional OFFICE or SSMC Sr.

9 State Medical Commissioner or TI Thumb impression or TIC Temporary identification certificate or UDC Upper Division Clerk or VRC Vocational Rehabilitation Centre or VRS Vocational Rehabilitation Scheme CHAPTER I registration (a) LAW & PROCEDURE - GENERAL CONTENTS Subject Para No. What is registration ? .. registration of employers .. to Coverage of employees of new factory/estt. BM s role .. registration of employees .. to OFFICE of registration .. registration forms etc.. to Rubber stamps for use by employer .. Declaration form of a new entrant .. to Late submission of declaration forms.

10 To Filling up of declaration forms .. Return of declaration form .. to Declaration forms in regional language .. Entry in register under Reg. 32 .. Declaration forms of indirect employees .. Receipt of declaration forms .. Checking of declaration forms .. Defective declaration forms .. to Allotment of insurance numbers .. to ESIC-86 by employer .. Revalidation of temporary identification certificate .. to Maintenance of declaration forms .. Writing of documents .. to Dispatch of documents .. Ledger sheet .. to Mass registration on Appointed Day.