46. Benefits. -
(l)Subject to the provisions of this Act, the insured
persons, 1[their dependents or the persons hereinafter mentioned,
as the case may be,] shall be entitled to the following benefits,
namely:
(a)Periodical payments to any insured person in case
of his sickness certified by a duly appointed medical practitioner
2[or by any other person possessing such qualifications and
experience as the Corporation may, by regulations, specify in this
behalf] (hereinafter referred to as sickness benefit);
3[(b) Periodical payments to an insured woman
in case of confinement or miscarriage or sickness arising out of pregnancy,
confinement, premature birth of child or miscarriage, such woman being
certified to be eligible for such payments by an authority specified
in this behalf by the regulations (hereinafter referred to as maternity
benefit);]
(c)Periodical payments to an insured person suffering
from disablement as a result of an employment injury sustained as
an employee under this Act and certified to be eligible for such payments
by an authority specified in this behalf by the regulations (hereinafter
referred to as disablement benefit);
(d)Periodical payments to such dependents of an insured
person who dies as a result of an employment injury sustained as an
employee under this Act, as are entitled to compensation under this
Act (hereinafter referred to as dependents' benefit); 4****
(e)Medical treatment for and attendance on insured persons
(hereinafter referred to as medical benefit); 5[and]
6[(f) Payment to the eldest surviving member
of the family of an insured person who has died, towards the expenditure
on the funeral of the deceased insured person, or, where the insured
person did not have a family or was not living with his family at
the time of his death, to the person who actually incurs the expenditure
on the funeral of the deceased insured person (to be known as 7[funeral
expenses]);
Provided that the amount of such payment shall not exceed
8[such amount as may be prescribed by the Central Government]
and the claim for such payment shall be made within three months of
the death of the insured person or within such extended period as
the Corporation or any officer or authority authorised by it in this
behalf may allow.]
(2)The Corporation may, at the request of the appropriate
Government, and subject to such conditions as may be laid down in
the regulations, extend the medical benefits to the family of an insured
person.
1.Subs. by Act No. 44 of 1966, s. 18, for “or, as
the case may be, their dependents” (w.e.f. 28-1-1968).
2.Ins. by Act No. 44 of 1966, s. 18, (w.e.f. 28-1-1968).
3.Subs. by Act No. 44 of 1966, s. 18, for original
cl. (b) (w.e.f. 28-1-1968).
4.The word “and” omitted by Act No. 44 of 1966, s.
18, (w.e.f. 28-1-1968).
5.Ins. by Act No. 44 of 1966, s.18, (w.e.f. 28.1.1968).
6.Subs. for “funeral benefit” by Act No. 29 of 1989,
s. 17 (i), (w.e.f. 20-10-1989).
7.Subs. for “one hundred rupees” by Act No. 29 of
1989, s. 17 (ii), (w.e.f. 1-2- 1991).
47.[When person eligible for sickness
benefit] Rep. by the Employee's State Insurance [Amendment] Act,
1989 (29 of 1989) s. 18 (1-2-1991).
48.[When person deemed available
for employment.] Rep. by the Employees' State Insurance (Amendment)
Act, 1966 (44 of 1966), s. 20.
1[49.Sickness benefit.
-The qualification of a person to claim sickness benefit, the conditions
subject to which such benefit may be given, the rates and period thereof
shall be such as may be prescribed by the Central Government.
1. Subs. for sections 49 and 50 by Act. No. 29 of
1989, s. 19, (w.e.f. 1-2-1991).
50.Maternity benefit.
-The qualification of an insured woman to claim maternity benefit,
the conditions subject to which such benefit may be given, the rates
and period thereof shall be such as may be prescribed by the Central
Government].
1[51. Disablement benefit.
-Subject to the provisions of this Act 2* * *, -
(a)A person who sustains temporary disablement for not
less than three days (excluding the day of accident) shall be entitled
to periodical payment 3[at such rates and for such periods
and subject to such conditions as may be prescribed by the Central
Government]
(b)A person who sustains permanent disablement, whether
total or partial, shall be entitled to periodical payment 4[at
such rates and for such periods and subject to such conditions as
may be prescribed by the Central Government]:
5* * *
1.Subs. by Act No. 44 of 1966, s. 23, for the original
s. 51 (w.e.f. 28-1-1968).
2.Words “and the regulations, if any” omitted by
Act No. 29 of 1989, s. 20 (i), (w.e.f. 1-2-1991).
3.Subs. for “for the period of such disablement in
accordance with the provisions of the First Schedule” by Act No. 29
of 1989, s. 20 (ii), (w.e.f. 1-2-1991).
4.Subs. for “for such disablement in accordance with
the provisions of the first Schedule” by Act No. 29 of 1991, s. 20
(iii), (w.e.f. 1-2-1991).
5.Proviso omitted by Act No. 29 of 1991, s. 20 (iv)
(w.e.f. 1-2-1991).
51A.Presumption as to accident
arising in course of employment. -For the purposes of this Act,
an accident arising in the course of an insured person's employment
shall be presumed, in the absence of evidence to the contrary, also
to have arisen out of that employment.
51B. Accidents happening while
acting in breach of regulations, etc.-An accident shall be deemed
to arise out of and in the course of an t with standing that he is
at the time Of insured person's employment no the accident acting
in contravention of the provisions of any law applicable to him, or
of any orders given by or on behalf of his employer or that he is
acting without instructions from his employer, if-
(a)The accident would have been deemed so to have arisen
had the act not been done in contravention as aforesaid or on without
instructions from his employer, as the case may be; and
(b)The act is done for the purpose of and in connection
with the employer's trade or business.
51C. Accidents happening while
travelling in employer’s transport. –
(l)An accident happening while an insured person is,
with the express or implied permission of his employer, travelling
as a passenger by any vehicle to or from his place of work shall,
notwithstanding that he is under no obligation to his employer to
travel by that vehicle, be deemed to arise out of and in the course
of his employment, if-
(a)The accident would have been deemed so to have arise
been under such obligation; and
(b)At the time of the accident, the vehicle-
(i)Is being operated by or on behalf of his employer
or some other person by whom it is provided in pursuance of arrangements
made with his employer, and
(ii)Is not being operated in the ordinary course of
public transport service.
(2)In this section “Vehicle” includes vessel and an
aircraft-
51D. Accidents happening while meeting
emergency. -An accident happening to an insured person in
or about any premises at which he is for the time being employed for
the purpose of his employer's trade or business shall be deemed to
arise out of and in the course of his employment, if it happens while
he is taking steps, on an actual of supposed emergency at those premises,
to rescue, succour or protect persons who are, or are thought to be
or possibly to be, injured or imperilled, or to avert or minimise
serious damage to property.]
1[52. Dependent's benefit. –
(l)If an insured person dies as a result of an employment
injury sustained as an employee under this Act (whether or not he
was in receipt of any periodical payment for temporary disablement
in respect of the injury) dependents' benefit shall be payable 2[at
such rates and for such period and subject to such conditions as may
be prescribed by the Central Government] to this dependents specified
in 3[sub-clause (i), sub-clause (ia) and] sub-clause (ii) of
clause (6A) of section 2.
(2)In case the insured person dies without leaving behind
him the dependents as aforesaid, the dependents' benefit shall be
paid to the other dependents of the deceased 4[at such rates
and for such period and subject to such conditions as may be prescribed
by the Central Government].
1.Subs. by Act No. 44 of 1966, s. 24, for the original
s. 52 (w.e.f. 28-1-1968).
2.Subs. for “in accordance with the provisions of
the First Schedule” by Act No. 29 of 1989, s. 21(a)(i), (w.e.f. 1-2-1991).
3.Subs. for “sub-clause (i) and” by Act No. 29 of
1989, s. 21 (a) (ii), (w.e.f. 1-2-1991).
4.Subs. for “in accordance with the provision of
the First Schedule” by Act No. 29 of 1989, s. 21 (b), (w.e.f. 1-2-1991).
52A. Occupational disease. –
(1)If an employee employed in any employment specified
in Part A of the Third Schedule contracts any disease specified therein
as an occupational disease peculiar to that employment or if an employee
employed in the employment specified in Part B of that Schedule for
a continuous period of not less than six months contracts any disease
specified therein as an occupational disease peculiar to that employment
or if an employee employed in any employment specified in Part C of
that Schedule for such continuous period as the Corporation may specify
in respect of each such employment, contracts any disease specified
therein as an occupational disease peculiar to that employment, the
contracting of the disease shall, unless the contrary is proved, be
deemed to be an “employment injury” arising out of and in the course
of employment.
(2)(i)Where the Central Government or a State Government,
as the case may be, adds any description of employment to the employments
specified in Schedule III to the Workmen's Compensation Act, 1923
(8 of 1923), by virtue of the powers vested in it under sub-section
(3) of section 3 of the said Act, the said description of employment
and the occupational diseases specified under that sub-section as
peculiar to that description of employment shall be deemed to form
part of the Third Schedule.
(ii)Without prejudice to the provisions of clause (i),
the Corporation after giving, by notification in the Official Gazette,
not less than three months' notice of its intention so to do, may,
by a like notification, add any description of employment to the employments
specified in the Third Schedule and shall specify in the case of employments
so added the diseases which shall be deemed for the purposes of this
section to be occupational diseases peculiar to those employments
respectively and thereupon the provisions of this Act shall apply,
as if such diseases had been declared by this Act to be occupational
diseases peculiar to those employments.
(3)Save as provided by sub-sections (1) and (2), no
benefit shall be payable to an employee in respect of any disease
unless the disease is directly attributable to a specific injury by
accident arising out of and in the course of his employment.
(4)The provisions of section 51A shall not apply to
the cases to which this section applies.]
1[53. Bar against receiving or recovery of compensation
or damagesunder any other
law. -An insured person or his dependents shall not be entitled
to receive or recover, whether from the employer of the insured person
or from any other person, any compensation or damages under the Workmen's
Compensation Act, 1923 (8 of 1923), or any other law for the time
being in force or otherwise, in respect of an employment injury sustained
by the insured person as an employee under this Act.]
1. Subs. by Act No. 44 of 1966, s. 25, for the original
s. 53 (w.e.f. 28-1-1968).
1[54. Determination of question of disablement.
-Any question-
(a)Whether the relevant accident has resulted in permanent
disablement; or
(b) Whether the extent of loss of earning capacity
can be assessed provisionally or finally; or
(c) Whether the assessment of the proportion of the
loss of earning capacity is provisional or final; or
(d) In the case of provisional assessment, as to the
period for which such assessment shall hold good,
Shall be determined by a medical board constituted in
accordance with the provisions of the regulations and any such question
shall hereafter be referred to as the “disablement questions”.
1.Subs. by Act No. 44 of 1966, s. 26, for the original
s. 54 (w.e.f. 28-1-1968).
54A. References to medical boards and
appeals to medical appeal tribunals and Employees' Insurance Courts.
–
(l)The case of any insured person for permanent disablement
benefit shall be referred by the Corporation to a medical board for
determination of the disablement question and if, on that or any subsequent
reference, the extent of loss of earning capacity of the insured person
is provisionally assessed, it shall again be so referred to the medical
board not later than the end of the period taken into account by the
provisional assessment.
(2)If the insured person or the Corporation is not satisfied
with the decision of the medical board, the insured person or the
Corporation may appeal in the prescribed manner and within the prescribed
time to-
(i)The medical appeal tribunal constituted in accordance
with the provisions of the regulations with a further right of appeal
in the prescribed manner and within the prescribed time to the Employees'
Insurance Court, or
(ii) The Employees' insurance Court directly]:
1[Provided that no appeal by an insured person
shall lie under this sub-section if such person has applied for commutation
of disablement benefit on the basis of the decision of the medical
board and received the commuted value of such benefit:
Provided further that no appeal by the Corporation shall
lie under this sub-section if the Corporation paid the commuted value
of the disablement benefit based on the decision of the medical board.].
1.Ins. by Act No. 29 of 1989. s. 79, (w.e.f. 20-10-1989).
1[55. Review of decisions by
medical board or medical appeal tribunal. –
(1)Any decision under this Act of a medical board or
a medical appeal tribunal may be reviewed at any time by the medical
board or the medical appeal tribunal, as the case may be, if it is
satisfied by fresh evidence that the decision was given in consequence
of the nondisclosure or mis-representation by the employee or any
other person of a material fact (whether the non-disclosure or misrepresentation
was or was not fraudulent).
(2)Any assessment of the extent of the disablement resulting
from the relevant employment injury may also be reviewed by a medical
board, if it is satisfied that since the making of the assessment
there has been a substantial and unforeseen aggravation of the results
of the relevant injury:
Provided that an assessment shall not be reviewed under
this subsection unless the medical board is of opinion that having
regard to the period taken into account by the assessment and the
probable duration of the aggravation aforesaid, substantial injustice
will be done by not reviewing it.
(3)Except with the leave of a medical appeal tribunal,
an assessment shall not be reviewed under sub-section (2) on any application
made less than five years, or in the case of a provisional assessment,
six months, from the date thereof and on such a review the period
to be taken into account by any revised assessment shall not include
any period before the date of the application.
(4)Subject to the foregoing provisions of this section,
a medical board may deal with a case of review in any manner in which
it could deal with it on an original reference to it, and in particular
may make a provisional assessment notwithstanding that the assessment
under review was final; and the provisions of section 54A shall apply
to an application for review under this section and to a decision
of a medical board in connection with such application as they apply
to a case for disablement benefit under that section and to a decision
of the medical board in connection with such case.
1.Subs. by Act No. 44 of 1966, s. 27, for the original
s. 55 (w.e.f. 28-1-1968).
55A. Review of dependents' benefit. –
(1)Any decision awarding dependents' benefit under this
Act may be reviewed at any time by the Corporation if it is satisfied
by fresh evidence that the decision was given in consequence of non-disclosure
or misrepresentation by the claimant or any other person of a material
fact (whether the non-disclosure or misrepresentation was or was not
fraudulent) or that the decision is no longer in accordance with this
Act due to any birth or death or due to the marriage, re-marriage
or cesser of infirmity of, or attainment of the age of eighteen years
by, a claimant.
(2)Subject to the provisions of this Act, the Corporation
may, on such review as aforesaid, direct that the dependents' benefit
be continued, increased, reduced or discontinued.]
56. Medical benefit. -
(1)An insured person or (where such medical benefit
is extended to his family) a member of his family whose condition
requires medical treatment and attendance shall be entitled to receive
medical benefit.
(2)Such medical benefit may be given either in the form
of out patient treatment and attendance in a hospital or dispensary,
clinic or other institution or by visits to the home of the insured
person or treatment as in-patient in a hospital or other institution.
(3)A person shall be entitled to medical benefit during
any 1[period] for which contributions are payable in respect
of him or in which he is qualified to claim sickness benefit or maternity
benefit 2[or is in receipt of such disablement benefit as does
not disentitle him to medical benefit under the regulations]:
Provided that a person in respect of whom contribution
ceases to be payable under this Act may be allowed medical benefit
for such period and of such nature as may be provided under the regulations.
3[Provided further that an insured person who
ceases to be in insurable employment on account of permanent disablement
shall continue, subject to payment of contribution and such other
conditions as may be prescribed by the Central Government, to receive
medical benefit till the date on which he would have vacated the employment
on attaining the age of superannuation had he not sustained such permanent
disablement:
Provided also that an insured person, who has attained
the age of superannuation, and his spouse shall be eligible to receive
medical benefit subject to payment of contribution and such other
conditions as may be prescribed by the Central Government.
Explanation. -In this section, “superannuation”,
in relation to an insured person, means the attainment by that person
of such age as is fixed in the contract or conditions of service as
the age on the attainment of which he shall vacate the insurable employment
or the age of sixty years where no such age is fixed and the person
is no more in the insurable employment.]
1.Subs. by Act No. 45 of 1984, s. 8, for “week” (w.e.f.
27-1-1985).
2.Subs. by Act No. 53 of 1951, s. 17, for “or, as
provided under the regulations, is in receipt of disablement benefit”.
3.Ins. by Act No. 29 of 1989, s. 23, (w.e.f. 1-2-1991).
57. Scale of medical benefit.
-
(l)An insured person and (where such medical benefit
is extended to his family) his family shall be entitled to receive
medical benefit only of such kind and on such scale as may be provided
by the State Government or by the Corporation, and an insured person
or, where such medical benefit is extended to his family, his family
shall not have a right to claim any medical treatment except such
as is provided by the dispensary, hospital, clinic or other institution
to which he or his family is allotted, or as may be provided by the
regulations.
(2)Nothing in this Act shall entitle an insured person
and (where such medical benefit is extended to his family) his family
to claim reimbursement from the Corporation of any expenses incurred
in respect of any medical treatment, except as may be provided by
the regulations.
58. Provision of medical treatment
by State Government-
(1)The State Government shall provide for insured persons
and (where such benefit is extended to their families) their families
in the State reasonable medical, surgical and obstetric treatment:
Provided that the State Government may, with the approval
of the Corporation, arrange for medical treatment at clinics of medical
practitioners on such scale and subject to such terms and conditions
as may be agreed upon.
(2)Where the incidence of sickness benefit payment to
insured persons in any State is found to exceed the all-India average,
the amount of such excess shall be shared between the Corporation
and the State Government in such proportion as may fixed by agreement
between them:
Provided that the Corporation may in any case waive
the recovery of the whole or any part of the share, which is to be
borne by the State Government.
(3)The Corporation may enter into an agreement with
a State Government in regard to the nature and scale of the medical
treatment that should be provided to insured persons and (where such
medical benefit is extended to the families) their families (including
provision of buildings, equipment, medicines and staff) and for the
sharing of the cost thereof and of any excess in the incidence of
sickness benefit to insured persons between the Corporation and the
State Government.
(4)In default of agreement between the Corporation and
any State Government as aforesaid the nature and extent of the medical
treatment to be provided by the State Government and the proportion
in which the cost thereof and of the excess in the incidence of sickness
benefit shall be shared between the Corporation and that Government,
shall be determined by an arbitrator (who shall be or shall have been
a Judge of the 1[High Court]2[of a State]) appointed
by the Chief justice of India and the award of the arbitrator shall
be binding on the Corporation and the State Government.
1.Subs. by the A.0. 1950, for “High Court of a Province”.
2.Subs. by Act No. 53 of 1951, s. 18, for “for a
Part A State”.
59. Establishment and maintenance
of hospitals, etc., by Corporation. -
(1)The Corporation may, with the approval of the State
Government establish and maintain in a State such hospitals, dispensaries
and other medical and surgical services as it may think fit for the
benefit of insured persons and (where such medical benefit is extended
to their families) their families.
(2)The Corporation may enter into agreement with any
1* * * local authority, private body or individual in regard
to the provision of medical treatment and attendance for insured persons
and (where such medical benefit extended to their families) their
families, in any area and sharing the cost thereof.
1.The words “Part B State”, omitted by the A.0. (No.
4) 1957.
1[59A. Provision of medical benefit
by the Corporation in lieu of State Government. -
(l)Notwithstanding anything contained in any other provision
of his Act, the Corporation may, in consultation with the State Government,
undertake the responsibility for providing medical benefit to insured
persons and where such medical benefit is extended to their families,
to the families of such insured persons in the State subject to the
condition that the State Government shall share the cost of such medical
benefit in such proportion as may be agreed upon between the State
Government and the Corporation.
(2)In the event of the Corporation exercising its power
under subsection (1), the provisions relating to medical benefit under
this Act shall apply, so far as may be, as if a reference therein
to the State Government were a reference to the Corporation.]
1.Ins. by Act No. 44 of 1966, s. 28 (w.e.f. 17-6-1967).