ESI Scheme: INSURANCE EXPLAINER - Know Temporary Disability Benefit, Permanent Disability Benefit, coverage, eligibility, durability, and more

Under what circumstances Temporary Disablement Benefit (TDB) and Permanent Disablement Benefit (PDB) can be availed in the Employees' State Insurance (ESI) scheme? ESI is a self-financing social security and health insurance scheme for Indian workers. The fund is managed by the Employees' State Insurance Corporation, according to rules and regulations stipulated in the ESI Act 1948. The TDB and PDB are two such schemes that provide huge relief to temporary and permanent disability workers. Let's understand both the scheme in detail how a worker, who is facing such a similar issue, can avail either of the ESI scheme benefits by following some simple procedure.   

Temporary Disablement Benefit (TDB) 

TDB is payable to an employee, who suffers employment injury (EI) or Occupational Disease. It is certified to be temporarily incapable to work. Employment injury has been defined as a personal injury to an employee caused by accident or occupational disease arising out of and in the course of his employment, being in insurable employment, whether the accident occurs or the occupational disease is contracted within or outside the territorial limits of India. The certificates required for TDB are accident report in form 16, Form 8,9,10, 11 and ESIC Med.13.

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For eligibility, the benefit is not subject to any contributory conditions. An insured person is eligible from the day he joins insurable employment. The TDB rate is 90 per cent of average daily wages. Also, if found that accident happened during the course and out of employment, the accident is accepted as employment injury. 

And for durability, there is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a temporary disablement spell lasts for less than 3 days, excluding the day of the accident, the insured person will be paid sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some insured persons may resist taking a final certificate, especially before 3 days for fear of loss of TDB. If needed, an investigation is done by ESIC/Branch office.

One may avail Temporary Disability Benefit (TDB) and Permanent Disability Benefit (PDB) under #ESIScheme by just following the procedure mentioned below. For more details visit – https://t.co/g1P81Q23p4#ESIC #ESI pic.twitter.com/0hjgXqeQHD

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Permanent Disablement Benefit (PDB) 

PDB is payable to an insured person, who suffers permanent residual disablement as a result of EI, including Occupational Diseases and results in loss of earning capacity. The proper authority for assessing loss of earning capacity for injuries is the Medical Board and for Occupational Diseases, Special Medical Board. 

The duration of PDB may be for the period given by Medical Board, if the assessment is provisional or for entire life. 

The PDB rate is calculated as a percentage of loss of earning capacity as assessed by the Medical Board/MAT/EI Court in relation to TDB. The list of injuries deemed to result in permanent total disablement and percentage loss of earning capacity has been previewed in the second schedule to ESIC Act, 1948. Hence, the maximum rate of PDB can be equal to the rate of TDB. 

PDB amount is revised by the ESIC from time to time to adjust for inflation. The latest enhancement is with effect from August 01, 2009. 

An insured person whose PDB has been assessed as final and who has been awarded the same at the rate not exceeding Rs 1.50 per day may apply for commutation of periodical payments of PDB into a lumpsum. When an application for commutation is made within 6 months of the date of communication of Medical Board decision periodical payments shall be commuted into a lumpsum provided the total commuted value does not exceed Rs 10,000 at the time of commencement of the final award.  

However, where such an application is made after the expiry of 6 months, LO/RO will refer the case to MR/PTMR to certify whether the IP has an average expectation of life for his age. Such a certificate is issued by Medical Referee in the relevant place on Regional Office/LO letter. 

Similarly, the age of an insured person will have to be proved to the satisfaction of the Corporation in all cases. Medical Boards assess the age of insured persons who are not able to produce satisfactory proof of age and the opinion of the Medical Board shall be final in this regard.