Employees' State Insurance Act: Regulations

Employees' State Insurance Corporation - General Regulations, 1950

• These regulations are called the Employees' State Insurance (General) Regulations, 1950.
• The Regulations extend to all of India, including the Union Territory of Pondicherry, but excluding the State of Jammu and Kashmir.
• "Act" refers to the Employees' State Insurance Act, 1948 (XXXIV of 1948).
• "Appointed Day" means the date when Chapters IV and V of the Act become applicable to an area, factory, or establishment.
• "Appropriate Office" refers to the specific office of the Corporation designated for actions under these regulations.
• "Central Rules" are the rules set by the Central Government under section 95 of the Act.
• "Employer" is defined as the principal employer as defined in the Act.
• "Employer's Code Number" is the registration number assigned by the Regional Office to a factory or establishment.
• "Factory or Establishment" is any factory or establishment to which the Act applies.
• "Form" refers to a form included in these regulations.
• "Identity Card" is a permanent card issued by the appropriate office to an insured person for identification.
• "Family Identity Card" is a card issued by the appropriate office to an insured person for family identification.
• "Social Security Officer" is a person appointed by the Corporation under section 45 of the Act.
• "Instructions" are directives issued by the Corporation or its authorized officers.
• "Insurance Medical Officer" is a medical practitioner appointed to provide medical benefits and perform related functions under Chapter V of the Act.
• "Insurance Number" is a number assigned to an employee by the appropriate Office.
• "Branch Office" and "Regional Office" refer to subordinate offices of the Corporation with specific jurisdictions and functions.
• "Branch Manager" is a person appointed by the Corporation to head a Branch Office.
• "State Rules" are rules made by a State Government under section 96 of the Act.
• "Regional Director” is an individual appointed by the Corporation to serve as such for a specific region
• "Registered Midwife” is someone registered under any law to register nurses and midwives - in any State
• "Rules" refer to rules established by the Central or a State Government under the Act.
• "Specified" means specified by instructions issued from time to time by the Corporation or any authorized officer
• "Year" means a calendar year unless otherwise indicated.
• All other terms and expressions have the meanings assigned to them in the Act or its rules.

Exercising Power

• The Corporation can exercise its powers through a resolution or through the Standing Committee, subject to section 18 of the Act.
• Powers can be delegated to sub-committees or officers, except those required by the Act to be exercised only by the Corporation.
• Appointments are made by the Director General or authorized officers designated by the Standing Committee.
• Powers exercised by an appropriate office or Branch Office are carried out by the officer in charge or as authorized by the Director General.

Contribution and Benefit Periods

• The contribution period from April 1st to September 30th corresponds to a benefit period from January 1st to June 30th of the following year.
• The contribution period from October 1st to March 31st corresponds to a benefit period from July 1st to December 31st.
• For a newly covered employee, the first contribution period starts from their employment date, with the benefit period starting 9 months later.

Meetings and Voting

• Corporation, Standing Committee, and Medical Benefit Council meetings follow Central Rules, with the Chairman setting the time and place.
• Decisions are made by a majority vote; the Chairman has a casting vote in case of a tie.
• Voting is by show of hands, and names are recorded only if requested by a member.

Matters for the Corporation's Decision

• Regulations under section 97 and their amendments.
• Measures proposed under section 19 of the Act.
• Proposals to extend medical benefits to families under section 46(2).
• Disputes referred to arbitration under section 58(4).
• Proposals to establish hospitals under section 59.
• Requests to grant exemption under section 91.
• Proposals to enhance benefits under section 99.
• Other matters as directed by the Corporation, Chairman, or Director-General

Regional Boards

• The Chairman of the Corporation may establish a Regional Board for each State or Union Territory.
• The board includes a Chairman and Vice-Chairman nominated by the Corporation in consultation with the State Government or Union Territory.
• Representation includes one member from the State or Union Territory nominated by the respective government.
• Ex-officio members include the Administrative Medical Officer and the State Medical Officer of the Corporation.
• One representative of employers and one of employees are nominated by the Chairman of the Corporation.
• Members of the Corporation and Medical Benefit Council residing in the State or Union Territory are ex-officio members.
• The Chairman may nominate up to three additional representatives from each side to ensure adequate representation.
• The Board may co-opt an Officer In-charge, a member of the medical profession in their region and the people co-opted shall be members during the pleasure of the board.
• The Regional Director or Officer in charge of the office will act as the Member Secretary of the Board.
• Regional Board referred to in clause (e) of and the proviso to sub-regulation (1) have a 3 year term that starts from the date their nomination is notified
• Regional Board shall continue to hold office until a nomination is notified.

Regional Board Member Terms and Rules

• Government nominees hold office at the government's pleasure.
• Members who cease to be part of the Corporation or reside outside the area lose their position.
• Filling a vacancy is for the remainder of the term of the original member.
• Outgoing members are eligible for renomination.
• Members may resign by writing to the Corporation Chairman; the seat becomes vacant upon acceptance.
• Membership is terminated after missing three consecutive meetings, unless restored by the Corporation Chairman for valid reasons.
• If a member no longer represents their organization, the Corporation Chairman can declare their membership ceased.
• Members receive fees and allowances as determined by the Central Government.
• Disqualifications include being of unsound mind, an undischarged insolvent, or having a conviction involving moral turpitude.

Meeting Procedures and Functions

• The Secretary sets the meeting agenda, date, time, and place with the Chairman's approval.
• Notices are given at least ten days before the meeting; emergency meetings require reasonable notice.
• Agenda items can only be changed with the Chairman's permission.
• One-third of the members must be present for a quorum.
• The Chairman can reschedule the meeting to a date within 7 days if the quorum is not met.
• Actions at adjourned meetings are lawful regardless of the members present.
• Decisions are made by majority vote; the Chairman has a casting vote in case of a tie.
• Board meeting is presided by the Chairman or the Vice-Chairman, but if both are absent, the meeting can elect someone amongst each other to preside
• Minutes are sent to all members not later than fifteen days from meeting
• Approved meeting records are signed by the Chairman after confirmed with any modifications
• Regional Boards are delegated with administrative functions by the Corporation or Standing Committee resolution.
• They also make suggestions, decide Scheme extensions, and adopt measures within Corporation priorities, obtaining necessary government approvals. They can also recommend changes to the Act, Regulations and follow the procedures outlined in the Scheme.
• They work to secure employer compliance, enhance benefits, provide medical treatment, and rehabilitate disabled insured individuals and advise the Corporation as needed.

Additional Board Functions and Supersession

• Regional Boards handle complaints and grievances from insured persons and employers.
• They advise the Corporation on matters referred by the Standing Committee or Director-General.
• Sub-committees may be formed, and assistance sought from Local Committees as necessary.
• The Corporation can dissolve a persistently negligent or abusive Regional Board via a Gazette of India notification.
• Upon supersession, all board members vacate their positions.
• The Corporation may then establish a new board or appoint an agency to perform the board's functions.

Local Committees

• Local Committees may be set up by the Regional Director in each notified District.
• They include a Chairperson nominated by the Regional Director, an official nominated by the State Government, and six employee representatives.
• Six employer representatives are included which include two employers with the highest value over the past three years
• The Officer In charge of each District committee will be in charge as an ex-officio Member Secretary.
• Additional representatives of employers and employees may be nominated and not exceed from each side (if appropriate)
• Furthermore, in any area that medical care is provided, the local committee may co-opt a member who is the local Insurance Medical Practitioner.

Local Committee Terms, Meetings, and Functions

• Members of a local committee of the Regional Board's office have a 3 year commencing date that is notified by the director
• They shall also continue to hold office til the nomination is notified.
• The Regional Director can announce that a person no longer belongs on the committee and the date this comes into effect should the person no longer represent the employers or employees.
• Members can resign by notifying the Regional Director, and their seat will be vacant upon acceptance of the resignation.
• The committee does an annual checkup at least thrice a year and the secretary will consult the Chairman to fix the date, time and place
• At the meetings, the chairman and secretary is in charge of the agenda. Only matters that has been placed on the agenda can be considered
• Quorum at the meeting requires no less than 1/3 of the members. Decisions are decided by majority vote
• Local Committees then secure efficient working of the parties that are interested and make recommendations + deal with local problems
• If necessary, they also refer complaints with regards to the government
• They advise the Corporation or the Regional Board as appropriate

Registering Factories/Establishments

• First-time factories/establishments without a code number must furnish a registration declaration within 15 days of the Act's applicability, in Form-01 and Form-01-A (Sic.)
• Employers must ensure the accuracy of the supplied information on the registration form.
• The appropriate Regional Office can also directly ask the employer to complete registration by Employer's Registration Form
• The employer must fill declaration in Form-01 fifteen days after receiving code # for an establishment/factory
• Upon receiving and approving a registration Form, the appropriate Regional Office will allot an Employer's Code Number.
• This number must be included on all documents and correspondence related to the Act and its regulations.

Changes and Declarations

• Employers must report any changes to the information provided during factory/establishment registration within two weeks to the appropriate Regional Office, Sub-Regional Office, Divisional Office, or Branch Office.
• Factories should ensure each employee, furnish correct particulars and his/her family, along with his/her photograph and that of his/her family
• Each employer shall enter them in Declaration Form and obtain Signature
• New employees must provide correct particulars, their photograph and their family's
• Each new employee must demand to see Identification and to furnish the above

Forms

• Employers must send all Declaration Forms without detaching the Temporary Identification Certificate with a duplicate of Form 3.
• Form has to be done within 10 days of the date the forms was furnished
• An Insurance Number must be allotted promptly by the appropriate Office, when a the form of Declaration comes through and the employer must enter the return on contributions

Identities

• On notification from the family that the family member is entitled to Medical Benefit, the insured member who has not furnished details of his family while registering shall give the correct particulars in Form 1A.
• An insured person must be intimate with all changes made to the family within 15 days
• Employers shall give all the assistance required by the Corporation related to registrations, such as taking taking photos
• Each person will have an identity in Form 4 along with their photograph
• These cards must specify all the details like their photo and the families that are entitled to Medical Benefits per Regulation 95A, each identity to be delivered and stored when employees has been in service for more than three months
• Until the temporary medical certificates have been issued, medical care can be assisted through the certificate of temporary employment, which will be decided by the Director General
• Those who leave employment before a short time, cannot receive the Acceptance Card, but each permanent Acceptance Card must be delivered for 3 months, and returned to the officer soon after
• For losses to the ID Card, must inform the Branch Office
• The Corporation can then issue a duplicate, subject to the fees to be paid out to the branch

Contributions, records, time and consequences

• All employers can send quadruplicate return of contributions via registered mail or messenger to the appropriate office within 42 days.
• Or after 21 days of closure of the factory, but if there is a request from the office can send after 7 days
• All must submit a return of contributions at each date
• Every employer on demand can receive from the person concerned certificate of contributions paid/payable for
• Contributions must be paid through Authorized corporation bank
• All contributions must be remitted within 15 days from the last day of the month
• The date of closure for premises/factory must also send all payments that are closed
• Or one can pay the Director to pay via Pro Forma, to account for the benefits being given to workers for time
• Any contribution due within the times specified in Regulation 31 may have Simple Interest charged at the rate of 12%.
• The rate to recover damages shall not exceed
• Less than 2mnths 5%
• 2mnths to 4 mnths 10%
• 4mnths to 6 mnths 15%
• 6mnths to above 25%
• The Appellate Authority Under 45-AA shall be the Insurance Commissioner
• Also may refund for the Employer if there is full or part after 45-AA ruling

Employee Registers, Employment Part Wage & Joint payments

• Employers must update register of Form 6 of employees

• The employer must perserve

• All registers from this must be preserved for a period of five years

• All employees may view details that are part of this register

• Employees part wage may be contributed last day of the period.

• A worker is employed by employers in a wage, may agree payment for corporation contribution that is fair

• But if a fair solution cannot be made then the corporation can appoint someone to make these judgement

Wages, Refunds & Omissions

• Employee wages should be considered for the days on which contribution that fall due
• Any overpaid or wrongly paid amount that contribute shall only be returned before prior to the work of prior contribution of the periods
• If a person is at a bigger rate that contributed amount shall be paid higher rate
• There are also applications that have been omitted, in manners per Director General
• Should there be any omitted details then must be amended
• Where part of the contribution has been done
• Then contributions shall be paid and then returned to the worker accordingly

Benefits

• A claim must be in writing

• All forms are available free of charge

• Any benefit that has approved shall be on the right form

• If anything can be made correctly shall be decided reasonably by approved office

• If signatures absent or any defects

• May treat the claim as first instance if it has done so correctly

• Or shall allow alternatives for people if any benefit has been made incorrectly

Authorizing,Paying Benefits

• The authorized authority shall be the branch for maternity but Regional will be to do with permanent
• Payment for any Act shall be done in
• 7Days /15Day/14Days/3months / 3month per sickness/funeral/maternity/dependency
• The Benefit Shall be on time to appropriate officer

Abstention and Certification, Sickness, Disablement

• All are required to certify from any
• Insured person from sickness shall do benefit with officer
• Areas where arrangements happen.
• If all are set
• And there are not any
• Certificate then must be the doctor
• State
• Certificate by the practitioner
• State government officer and all documents is part of director
• No medical can be done unless authorized
• Any is given by the doctor or anyone
• If needed.
• And they are all free of charge
• All Medical certificate, must be ink, and the form that is made correct

Accident Book and Reporting

• Every employee who obtains personal injury to a factory are must report this.

• Each person must to appropriate officer that is with the right team to see everything

• Any detail that should be given can have in that said time for correct data and details

• An accident book in the Form 11 must be made assessible

• A report after then shall send a report within 24 hours

• Officer then to contact the nearest medical Officer after receiving the reports

• Provide also the act then.

• Provide all accident report by the employer

• Each Employee the every aid shall be given for the accidents

• Each officer Shall make sure everything is recorded.

• A claim of all needs shall be medical examination with help by Corporation

Medical Board Review and Occupational Disease

• All decisions can be the Medical board

• They must tell the disability

• Send form that will be the officer to look at the right form

• They will see over time what the person will need, all the decisions given by board

• Each part can include 1 and 2 if ever needed over time

• And all board should have schedule from each to look at

• Any question, all board then will work to deal with.

• Each person that is also included shall check form for everyone.

Medical Appeal Tribunals & Submissions and Commutation of Permanent Disablement Benefit

• The State Gov are part the Board also any member that Also need to be part this member from from there.

• There submission to a board then should be known

• Commutation.

• Each can part.

• To submit

• A claim to all payments and then should go on

Dependants Benefits

• As a result
• A person is is report it and do the act as needed.
• the body before then will examine the after by the insurer and is needed by other office.
• Issue of death in case of the benefit being passed after each has checked
• A claim there shall be then a good way to check and do from there

Dependants Proof of Death and Evidence, Benefits and Maternity Benefits

• Each

• They must be a and to go from there

• As the birth of some then all should correct

• And give notice from there

• Maternity

• There need to medical reasons to allow them to send it on.

• Declaration by insured child

• Certificate of certificate

• There shall be sent out.

• Each woman that as

• Must send all benefits

• And the time all.

• Must have to send before each must happen .

Medical Benefits, Obligations & Funeral Expenses

• Each child should be entitled to Medical Benefits

• For which then if they are and can get as per the Corporation

• All shall be free as need, for others also

• Any officer

• They might need to have if from

• Medical benefits

• But free of charges

• Be careful to be free

• . The reports must have also a person can do a time of death

• The death as each to claim

Funerals, Authoirization & Reimbursements Of Treatment

• And all in Form .

• If any body if they check to make see it then you do see

• For all benefits

• They may have a part with each

• A claim that there is or any to see by chart

• Any person and family that is in benefits family that is that have and what so ever of what there can give, and what there should come.

Discontinuation and Reduction of benefits, Discharge, Suspension & Relaxation of Inspections

• Discontinuation.

• Each part as per the

• Sick as per to can see

• And how all is and can see

• and by there

• All and each member

• Any of those thing can say by the director

• Can can also with it as can see

• To take it and do so

• Any should be as per need.

• • Inspection to be done and made available to see what can be as what did to do

• If any book should made must be signed as can see the report that has with seal

• All be preserved for five year.

Medical Benefits & Diseases

• Each person must also a card

• The long form from can see and what is and check.

• The right all with have and should they do

• All this be as you can

1 tuberculosis 2 leprosy 3 chronic and 4 bronchia tases 5 interstitial All can check. As they shall, we need be

• In each is needed
• Any person will be be
• The time, can make a
• Can re-enlist

If and then

Medical Documents

• Each needs with and is for to be.

• Submit to or not from so what

• Or should be, can with

• The thing to get and send you is a lot

• Change all, from there to

• All for benefits only.

• The change as the to from that from what can.