ESIC – An Overview of the Death Benefit Scheme

 

The Employees' State Insurance Corporation (ESIC) plays a pivotal role in providing social security to workers in India. Established under the Employees' State Insurance Act, 1948, ESIC offers a variety of benefits to insured persons and their families, including medical care, sickness benefits, maternity benefits, and unemployment benefits. One of the most crucial benefits offered by ESIC is the Death Benefit Scheme, which provides financial support to the dependants of an insured person in the unfortunate event of their death. This article provides a comprehensive overview of the Death Benefit Scheme, explaining its features, eligibility criteria, benefits, and the process for claiming these benefits, along with a detailed FAQ section to address common queries.

Introduction to ESIC

Purpose and Applicability

ESIC was established to provide socio-economic protection to employees working in factories and other establishments. The scheme is funded through contributions from both employers and employees. It covers employees earning up to a certain limit, which is periodically revised by the government.

Key Features of ESIC

• Medical Benefits: Comprehensive medical care for insured persons and their families.
• Cash Benefits: Payments made during periods of illness, maternity, and employment injury.
• Rehabilitation Allowance: For insured persons undergoing physical rehabilitation due to employment injury.
• Unemployment Allowance: For insured persons who lose their jobs due to involuntary reasons.
• Death Benefit Scheme: Financial support to the dependants of an insured person in case of death.

Overview of the Death Benefit Scheme

Purpose of the Scheme

The Death Benefit Scheme under ESIC aims to provide financial assistance to the dependants of an insured person who dies as a result of employment injury or occupational disease. This benefit ensures that the family of the deceased is supported financially, mitigating the economic impact of the loss.

Eligibility Criteria

To be eligible for the Death Benefit Scheme, the following conditions must be met:

• The deceased must have been an insured person under the ESIC scheme.
• The death must have resulted from an employment injury or occupational disease.
• The dependants of the deceased, as defined under the ESIC Act, are eligible to claim the benefits.

Definition of Dependants

Dependants eligible for the Death Benefit Scheme include:

• A widow or widower.
• A minor legitimate or adopted son.
• An unmarried legitimate or adopted daughter.
• A widowed mother.
• If wholly or in part dependent on the earnings of the insured person at the time of his death, a parent other than a widowed mother, a minor illegitimate son, an unmarried illegitimate daughter, or a widowed daughter-in-law.
• A minor brother or an unmarried sister or a widowed sister if a minor.
• A widowed daughter if a minor.
• A paternal grandparent if no parent of the insured person is alive.

Benefits Provided under the Scheme

Dependants’ Benefit

The main benefit provided under the Death Benefit Scheme is the Dependants’ Benefit, which is a monthly payment to the dependants of the deceased insured person. The amount of the benefit is calculated as a percentage of the wage of the deceased insured person.

Funeral Expenses

In addition to the Dependants’ Benefit, a lump sum payment is provided towards the funeral expenses of the deceased insured person. This amount is subject to periodic revisions by ESIC.

Duration of Benefits

The duration for which the dependants can receive the Dependants’ Benefit varies:

• Widow/Widower: For life or until remarriage.
• Children: Until they reach 25 years of age.
• Others: As long as they meet the dependency criteria.

Calculation of Dependants’ Benefit

The Dependants’ Benefit is calculated as a percentage of the average daily wages of the deceased insured person. The benefit rates are as follows:

• Widow: 3/5th (60%) of the full rate.
• Children: 2/5th (40%) of the full rate each.
• Other Dependants: 2/5th (40%) of the full rate each, subject to a maximum limit.

Example Calculation

Suppose the average daily wage of the deceased insured person was INR 500. The Dependants’ Benefit would be calculated as:

• Widow: 60% of 500 = INR 300 per day.
• Each Child: 40% of 500 = INR 200 per day.
• Other Dependants: 40% of 500 = INR 200 per day, subject to the maximum limit.

Maximum Limits

The total amount of Dependants’ Benefit payable to all dependants combined cannot exceed the full rate of wages of the deceased insured person.

Claim Process for Death Benefit Scheme

Documentation Required

To claim the benefits under the Death Benefit Scheme, the following documents are typically required:

• Death certificate of the insured person.
• Proof of relationship with the deceased (e.g., marriage certificate, birth certificate).
• ESIC card or insurance number of the deceased.
• Medical report or accident report indicating the cause of death.
• Bank account details of the claimants.

Steps to File a Claim

1. Notification: Notify the ESIC office about the death of the insured person as soon as possible.
2. Form Submission: Submit the required claim forms and supporting documents to the nearest ESIC branch office. The relevant forms include Form 15 (Claim for Dependants’ Benefit) and Form 22 (Claim for Funeral Expenses).
3. Verification: ESIC will verify the documents and conduct any necessary investigations.
4. Approval and Payment: Upon approval, the Dependants’ Benefit and Funeral Expenses will be disbursed to the eligible dependants.

Timeframe for Claims

Claims should be submitted within a reasonable timeframe from the date of death. Delayed claims may still be considered, but they might require additional justification and documentation.

FAQs: Frequently Asked Questions

1. Who is eligible for the Death Benefit Scheme under ESIC?

The dependants of an insured person who dies as a result of an employment injury or occupational disease are eligible for the Death Benefit Scheme. Eligible dependants include the widow/widower, minor children, and other family members who were dependent on the deceased.

2. How is the Dependants’ Benefit calculated?

The Dependants’ Benefit is calculated as a percentage of the average daily wages of the deceased insured person. Widows receive 60%, children receive 40% each, and other dependants receive 40% each, subject to a maximum limit.

3. What documents are required to claim the Death Benefit?

The necessary documents include the death certificate of the insured person, proof of relationship with the deceased, ESIC card or insurance number, medical or accident report, and bank account details of the claimants.

4. What is the maximum amount payable under the Dependants’ Benefit?

The total amount payable to all dependants combined cannot exceed the full wage rate of the deceased insured person. There are specific percentages allocated to each category of dependant.

5. Can a widow continue to receive the benefit after remarriage?

No, the widow is eligible to receive the benefit only until she remarries. Once she remarries, the benefit is discontinued.

6. How long do children receive the Dependants’ Benefit?

Children are eligible to receive the Dependants’ Benefit until they reach the age of 25. Disabled children may receive the benefit for a longer period if they are unable to earn a livelihood due to their disability.

7. Are there any provisions for the funeral expenses of the deceased insured person?

Yes, ESIC provides a lump sum amount towards the funeral expenses of the deceased insured person. This amount is subject to periodic revisions and is paid to the eldest surviving member of the family or the person who performs the last rites.

8. What should be done if the ESIC claim is rejected?

If a claim is rejected, the dependants can appeal to the ESIC appellate authority. They may need to provide additional documentation or justification for their claim.

9. Can an employer assist in filing the ESIC claim?

Yes, employers can assist in the filing process by providing necessary documentation, facilitating communication with ESIC, and ensuring that all required forms are correctly filled out.

10. What happens if the death occurs outside the workplace?

If the death occurs outside the workplace but is still related to employment (such as during travel for work), it may still be considered an employment injury. The dependants can claim benefits if the death is proven to be work-related.

11. Is the Death Benefit Scheme applicable to contractual or temporary employees?

Yes, the Death Benefit Scheme applies to all insured persons under ESIC, including contractual and temporary employees, provided they meet the eligibility criteria and the death is due to an employment injury or occupational disease.

12. How long does it take to process a claim under the Death Benefit Scheme?

The processing time for a claim can vary, but ESIC aims to process claims promptly. Typically, it can take several weeks to a few months, depending on the complexity of the case and the completeness of the submitted documentation.

13. Can dependants receive benefits if the insured person had pre-existing health conditions?

Yes, dependants can receive benefits if the death resulted from an employment injury or occupational disease, regardless of any pre-existing health conditions of the insured person.

14. How are disputes regarding claims resolved?

Disputes regarding claims can be resolved by appealing to the ESIC appellate authority. If necessary, dependants can also seek legal recourse through the appropriate labour court or tribunal.

15. Are there any income restrictions for dependants to receive the benefit?

There are no specific income restrictions for dependants to receive the benefit. However, they must be able to prove their dependency on the deceased insured person.

Conclusion

The ESIC Death Benefit Scheme is a crucial support mechanism for the dependants of insured persons who tragically lose their lives due to employment-related injuries or occupational diseases. By understanding the eligibility criteria, benefits, and claim process, dependants can ensure they receive the financial assistance they are entitled to. This scheme not only provides economic support but also helps alleviate the burden on families during challenging times.