Eligibility:
should be an employee on the date of the
accident.
Benefit: Temporary
disablement benefit is payable till temporary
disablement lasts and is duly certified by authorized
insurance medical officer/practitioner.
In case of permanent disablement, the cash benefit
is payable for life. Amount payable is worked
out on the basis of loss of earning capacity determined
by a Medical Board.
Disablement benefit is payable within one month
of submission of the complete claim papers.
Rate: In case of Temporary
Disablement Benefit, above 88% of wages approx.
In case of Permanent Disablement Benefit, PDB
rate depending upon the percentage of loss of
earning capacity as assessed by the duly constituted
Medical Board, maximum 88% of wages, i.e. TDB
rate. … see rates
Claim procedure:
for Temporary Disablement Benefit:
- Procedure regarding submission
of Regulation Certificate and claiming the benefit
remains the same as shown above against Sickness
Benefit.
- In addition, an Insured Person
who sustains employment injury to give a notice
of such injury to the employer immediately either
in writing or orally and also ensure that the
employer has given the accident report to the
concerned Branch Office well in time in the
prescribed form-Form 16.
For Permanent Disablement Benefit:
- An Insured Person should submit
an application for reference to the Medical
Board on plain paper to the Branch Office Manager
after the termination of temporary disablement
benefit. This may be done at the time of submitting
the final certificate, or within twelve months
from the termination of temporary disablement.
- He should ensure that he also
gives his age proof to the Branch Office Manager
alongwith the application.
- Form B.l (a) indicating residual
incapacity will be issued by the I.M.O./I.M.l.at
the time of final certificate. It is required
to be submitted alongwith an application for
appearing before a Medical Board. If it has
not been obtained at the time of issue of final
certificate it should be obtained at the time
of applying for Medical Board.
- The Medical Board sends its decision
to the ESIC Regional Office directly or through
Branch Office as the case may be and the Regional
Office issues the sanction for periodical payments
of P.D.B. One copy of the sanction order is
endorsed to the Insured Person also. After receipt
of this sanction the Insured person should submit
the claims form in the Branch Office for payment
of P.D.B. This payment will be made to him every
month as long as he is alive.
- In case his rate of P.D.B. is
Rs. 5/- per day or less an
insured person can apply for lump sum commutation
of the payment provided that the total commuted
value does not exceed Rs. 30,000/-.
- n a period of six months from
the date of possible option. Then only the Branch
office Manager shall be able to send the request
to Regional Office immediately. Otherwise the
Insured Person will be referred to the Medical
Referee for certifying normal expectancy of
life, and only after such certificate is obtained,
the Insured Person's case will be processed
for sanction of commutation.
- The original sanction order of
commutation is sent to the Insured Person with
a copy to the Branch Office. The Insured person
should produce the original copy at the Branch
Office at the time of payment.
|