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DISABLEMENT BENEFIT

What is Disablement?

Disablement is a condition resulting from employment injury which may ;be :

(a) temporary i.e. rendering an insured person incapable of work temporarily and necessitating medical treatment;
(b) permanent partial i.e. reducing the earning capacity of the ;insured person generally for every employment
(c) permanent total i.e. totally depriving the insured person of the power to do all work.

What constitutes an “Employment injury?”
Employment injury means a personal injury caused to an employee by an accident or occupational disease arising out of and in course of his employment in a factory or establishment covered under the Employees'’ State Insurance Act.
The law relating to Employment injury has been liberalised. Now, an accident arising in the course of employment is presumed also to have arisen out of him employment if there is no evidence to the contrary. Further, an accident brought about by wilful disobedience, negligence or breach of regulations etc. or an accident happening while traveling in a transport provided by the employer or while meeting an emergency is accepted subject to certain conditions, to have arisen in the course of and out of employment. Injuries suffered while under the influence of drinks and drugs take away the right of the employee to this benefit.

What are ‘Occupational Diseases’?
Occupational Diseases are such diseases as are susceptible of being traced back to their occupational origin. These are specified under Schedule III of the Employees'’ State Insurance Act, which enumerates the compensable Occupational Diseases and the corresponding industrial processes involving exposure to the diseases are thus recognized without any further evidence.

What are the Benefits granted?
Temporary Disablement Benefit is paid periodically in arrears as the evidence of incapacity (medical certificate) is produced. Permanent total disablement and permanent partial disablement benefits are paid in the form of pensions. Current employment for wages or engagement in any gainful activities is no bar to payment of permanent disablement benefits. An insured person suffering from an occupational disease is also entitled to full medical care.

How much is the Benefit Rate?
The daily benefit rate for permanent total disablement and temporary disablement is 40% more than the Standard Sickness Benefit rate and is roughly equivalent to about 70% of the wage rate. For permanent partial disablement, the rate of benefit is proportionate to the percentage of loss of earning capacity. The benefit is paid for Sundays also.
What are the Contributory conditions?
There are no qualifying conditions as to the length of employment or the number of contributions paid. Protection accrues from the very moment of entry into insurable employment.

What is the duration of Benefit?
Temporary Disablement Benefit is paid as long as disablement lasts. There is a waiting period of 3 days (excluding the day of accident), but if incapacity exceeds this period, benefit is paid from the very first day. The permanent disablement benefit is paid for the life-time of the beneficiary.

How is Permanent Disablement assessed?
There is indeed no way of adequately compensating a permanently disabled employee and yet some method of determining whether an employment injury has resulted in permanent disablement and of assessing the extent of permanent damage caused by that employment injury has to be adopted for the purpose of determining the scale of compensation for the loss of earnings. This is done by evaluating loss of earning capacity with reference to general disability for all work. The evaluation is done by a Medical Board whose decision can be appealed against to a Medical Appeal Tribunal presided over by a judicial officer, with a further right of appeal to Employees'’ Insurance Court or directly to Employees'’ Insurance Court. Pending an appeal, payment for permanent loss of earning capacity as recommended by the Medical Board is made, subject to adjustment later. Loss of wages and expenditure on conveyance occasioned by attendance before the Medical Board are compensated by the Corporation in accordance with rates framed for the purpose.
Where the assessment of loss of earning capacity by the Medical Board is not of a final character, the beneficiary is required to appear again before the Medical Board for a review of the assessment.

Can the decisions of Medical Board or of Medical Appeal Tribunal be reviewed?
Yes. If the Medical Board or the Medical Appeal Tribunal is satisfied by fresh evidence that a decision was given because of non-disclosure or mis-representation of a material fact, it can review its earlier decision at any time. A Medical Board can also review its earlier assessment of extent of disablement, if it is satisfied that there has been substantial and unforeseen aggravation of the results of the relevant injury and substantial injustice would be done by not reviewing it. Such review, however, cannot be made earlier than 5 years or in the case of the provisional assessment, earlier than 6 months of the date of assessment to be reviewed.

Is lumpsum Benefit allowed in place in Pension?
Yes. At the option of the beneficiary, permanent disablement pension, where the daily rate payable is not significant, can be commuted for a lumpsum payment subject to the fulfillment of the following two conditions:
(i) that the permanent disablement has been assessed as final, and
(ii) the daily rate of permanent disablement does not exceed Rs.5/- and the total commuted value does not exceed Rs.30,000/- (effective from April-03)

How to claim ‘Disablement Benefit’?
(a) Temporary Disablement:
(i) Notice of the injury should be given either orally or in writing personally or through an agent, to the employer/foreman/duty supervisor or particulars of the injury should be entered in the Accident Book kept in the factory, personally or through an agent.
(ii) A medical certificate of incapacity should be obtained from the Insurance Medical Officer/Insurance Medical Practitioner.
(iii) The claim form printed on the back of the medical certificate should be filled in and submitted promptly to Branch Office along with the medical certificate.
(iv) A final certificate should be obtained from the Insurance medical Officer/Insurance medical Practitioner and submitted to the Local Office before resumption of duty.

(b) Permanent Disablement:
(i) If suffering from permanent effects of employment injury, the insured person should make an application to the Regional Office of the Corporation for reference of his case to the Medical Board (reference to the Medical Board is made otherwise also by the Regional Office).
(ii) Where loss of earning capacity has been assessed and communicated to the insured person, he should submit a claim in the appropriate form to the Branch Office.
(iii) After the claim has been admitted, the beneficiary should submit at six-monthly intervals (with the claim for June and December every year) a life certificate in appropriate form duly attested by the prescribed authority.

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