ESI will pay the periodic payments to the eligible dependant family members if the Insured Person’s death is due to COVID 19. This scheme is effective from 24 March 2020 for a period of 2 years.
The ESIC has notified (No. P-11/14/11/COVID-19 Relief Scheme/2021-Bft II dated 03.06.2021) the COVID 19 Relief Scheme to the Insured Persons (IP) covered under the ESI Act.
In case a person insured under the ESI dies due to COVID 19, the eligible dependant family members of such Insured Person, under this Relief Scheme will receive the periodic payments directly to the bank account subject to certain criteria as mentioned in the notification.
The extract of the Scheme is shared here for your reference.
1. What is ESIC COVID 19 Relief Scheme?
This is a welfare measure taken by the ESIC to help and support the families of the insured persons by providing certain relief measures.
If a person insured under the ESI Act (IP), dies due to COVID 19 infection, the eligible dependant family members of such deceased IP can claim certain benefits and the payments will be directly paid to the bank account.
The ESIC is empowered to promote measures to improve the health and welfare of the IPs and for the rehabilitation and re-employment of disabled/injured IPs. Moreover, the purpose of ESI Act is to provide certain benefits to the IPs during contingencies to protect their families.
2. What is the validity period to claim benefits under this Scheme?
This Scheme is effective from 24 March 2020 for a period of 2 years i.e., till 23 March 2022.
3. What are the eligibility criteria to claim these benefits?
The death of the IP must be due to COVID 19 infection.
Such deceased IP must have been registered on the ESIC online portal at least 3 months prior to the date of diagnosis of COVID 19 disease resulting in his/her death.
The deceased IP must have been in employment on the date of diagnosis of COVID 19 disease.
The contributions for at least 70 days should have been paid or payable in respect of him / her during a period of maximum 1 year immediately before the diagnosis of the disease resulting in death.
4. Who can claim the benefits under this Scheme?
The periodical payments can be claimed by the following relatives of the IP:
Spouse, a legitimate or adopted son who has not attained the age of 25 years, an unmarried legitimate or adopted daughter;
A widowed mother;
If wholly dependent on the earnings of the IP at the time of IP’s death, a legitimate or adopted son or daughter who has attained the age of 25 years or is infirm;
In case the deceased IP does not have any of the abovementioned relatives , then the following relative, if wholly or in part dependant on the earnings of the IPS at the time of IPs death:
A parent other than a widower mother;
A minor illegitimate son, an unmarried illegitimate daughter, or a daughter legitimate or adopted or illegitimate if married and a minor or if widowed and a minor;
A minor brother or an unmarried sister or a widowed sister if a minor;
A widowed daughter-in-law;
A minor child of pre-deceased son;
A minor child of a pre-deceased daughter where no parent of the child is alive; or
A paternal grand-parent if no parent of the IP is alive.
5. How are disbursement of periodic payments made under this Scheme?
90% of the average daily wages of the deceased IP will be considered as full rate of relief payable under this Scheme in the following manner.
To the spouse during life, an amount equivalent to three-fifths of the full rate. If there are two or more widows, the amount payable to the spouse as aforesaid shall be divided equally between the widows.
To each legitimate or adopted son, an amount equivalent to two-fifths of the full rate until he attains the age of 25 years. In the case of a legitimate or adopted son who is infirm and is wholly dependent on the earnings of the IP at the time of IP’s death, the relief shall continue to be paid while the infirmity lasts.
To each legitimate or adopted unmarried daughter, an amount equivalent to two-fifths or the full rate. In the case of legitimate or adopted daughter who is inform and is wholly dependent on the earnings of the IP at the time of IP’s death, the relief shall continue to be paid while the infirmity lasts.
To the widowed mother during life an amount equivalent to two-fifths of the full rate.
If the total of the relief distributed under the Scheme among the spouse, legitimate or adopted children and widowed mother of the deceased IP as aforesaid exceeds at any time the full rate, the share of each of these dependants shall be proportionately reduced, so that the total amount payable to them does not exceed the amount of relief at the full rate.
In case the deceased IP does not leave spouse, or legitimate or adopted child or widowed mother the relief shall be payable to other dependants as follows:
To a parent other than the widowed mother or grand-parent, for life, at an amount equivalent to three-tenths of the full rate and if there are two or more parents (other than widowed mother) or grand-parents the amount payable to the parents (other than widowed mother) or grand-parents as aforesaid shall be equally divided between them.
To any other –
male dependant, until he attains the age of 18 years,
female dependant, until she attains the age of 18 years, or until marriage, whichever is earlier or if widowed, until she attains 18 years of age or re-marriage, whichever is earlier at an amount equivalent to two-tenths of the full rate and if there be more than one dependant under this category the amount payable shall be distributed equally.
The minimum relief under the Scheme shall be Rs.1,800/- per month.
6. How to make a claim under this Scheme?
The claimant has to submit the claim for relief under the Scheme in Form CRS-I enclosing the COVID 19 positive report (in original or attested copy) and original death certificate of the deceased IP in nearest ESIC branch office.
The proof of the age and identify of dependants shall be given by means of Aadhar or Birth Certificate issued by the competent authority.
For the IPs who were availing maternity benefit (MB), or extended sickness benefit (ESB) or temporary disablement benefit (TDB) and died due to COVID 19 and who fall short of the required 70 days contribution due to being on MB, ESB or TDB during the period of one year to the diagnosis of COVID 19 will be considered eligible for relief under the Scheme.
The Regional Director or Sub-Regional Office In-Charge are empowered to decide on the claims as the case may be.
If the death of IP occurs within 30 days of recovery from COVID 19 and discharge from hospital, then the case shall be decided by Regional Director / Sub-Regional Office In-Charge on recommendation of a Medical Board comprising of Medical Superintendent of nearest ESIC/ESIS Hospital, Specialist (Pulmonology / Chest disease) and Specialist (Medicine), ESIC/ESIS Hospital.
In cases where the date of recovery cannot be ascertained for want of COVID 19 negative report, then Post COVID 19 death after 45 days of testing COVID 19 positive shall also be considered for relief under this Scheme.
The spouse of the deceased IP shall be eligible for medical care as provided to the widow of a deceased IP who died due to employment injury or depositing Rs.120/- lumpsum for one year.
Upon the receipt of complete claim, it will be settled within 15 days.
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