The Code on Social Security (Gujarat) Rules, 2021 have been framed by the Government of Gujarat in exercise of the powers conferred under the Code on Social Security, 2020. These Rules operationalise and give procedural effect to the provisions of the Code within the State of Gujarat.
The Rules lay down detailed mechanisms for implementation, administration, and enforcement of social security benefits relating to employment injury, medical benefits, sickness, maternity, disablement, dependants’ benefits, gratuity, and other allied matters. They supplement the substantive provisions of the Code by prescribing conditions, forms, timelines, eligibility criteria, and compliance requirements for employers, employees, and authorities.
Applicability
These Rules apply to:
1) Establishment employing ten or more persons other than a seasonal factory
2) Establishment carrying hazardous/notified life threatening activities with 1 or more employees
3) Est. being a plantation & opts for ESIC
The Rules shall be read in conjunction with the Code on Social Security, 2020 and the Code on Social Security (Central) Rules, 2020.
Compliance Requirements under the Rules in Accordance with the Code
All employees must be insured. Employer must register every new hire on the Specified Portal (except those already registered) using name & Aadhaar. A temporary 10-day registration number is issued, during which employee & family details must be updated to generate Aadhaar-linked ID.
The employer shall pay in respect of every employee, whether directly employed by him or by or through a contractor, both the employer’s contribution and the employee’s contribution each @ three and one-fourth per cent of the wages payable to an employee.
Insured persons/their dependents are entitled to following:
a) Sickness benefit-Periodic payments during sickness certified by a designated medical practitioner
b) Maternity benefit-Periodic payments to women during confinement/miscarriage/pregnancy-related sickness/certified by authorized authority
Sickness benefit can be claimed if person has at least 78 days of contributions in corresponding period. Benefit is 70% of “Standard Benefit Rate,” rounded up to nearest rupee. First-time employees with shorter contribution period qualify if they have contributions for at least half the available working days.
If insured woman receiving maternity benefits/person receiving temporary disablement benefits has shorter contribution period, they qualify for sickness benefits if contributions were paid for at least half the available working days. Benefits are not provided for first 2 days of sickness unless it follows a previous sickness within 15 days. Sickness benefits are capped at 91 days in any two consecutive benefit periods.
Sickness benefit may be extended if insured person is diagnosed with disease specified in Regulations framed under Code, has completed 4 contribution periods before diagnosis, paid contributions for 156 days within those periods & is eligible for sickness benefit in one of those periods.
An insured woman qualifies for maternity benefits if she has min 70 days of contributions in two consecutive periods preceding benefit period. An eligible insured woman receives maternity benefit at specified daily rate for up to 26 weeks, with no more than 8 weeks before expected date of confinement.
i) If an insured woman dies during or after delivery, maternity benefits are paid for the entire period or until the child’s death, to her nominee or legal representative.
ii) An insured woman is entitled to 12 weeks of maternity benefit upon the child’s handover to the commissioning or adopting mother.
iii) With two or more surviving children, maternity benefits are 12 weeks, with up to 6 weeks before the expected confinement.
iv) For miscarriage or medical termination, benefits are given for 6 weeks.
v) For pregnancy-related sickness, an additional month of benefits may be provided.
vi) The daily rate of maternity benefit is the standard benefit rate, rounded up.
An insured woman or the insured person for his wife shall receive ₹7,500 per case as a medical bonus for confinement expenses, provided the confinement occurs where necessary medical facilities under the ESIC are unavailable. This bonus is limited to two confinements only.
A person can claim disablement benefits for temporary disablement lasting at least three days (excluding the day of the accident) sustained as an employee under the Code.
i) A person can claim periodical payments for permanent disablement, whether total or partial, sustained as an employee under the Code. If assessed provisionally for a limited period or finally, the benefit is payable for that period or for life.
ii) The daily rate of disablement benefit is 90% of the standard benefit rate in the contribution period corresponding to the benefit period in which the employment injury occurs, rounded up to the next rupee. If the injury occurs before the first benefit period, the daily rate of disablement benefit shall be:
a) where injury is sustained after the expiry of first wage period in the contribution period, 90% of the average daily wages in that period, rounded up.
b) where injury is sustained, before the expiry of the first wage period in the contribution period, 90% of the wages actually earned or would have been earned had he worked for a full day on the date of the accident, rounded up.
7. Quantum of payment for disablement of insured employee in Gujarat (Section 32(1), Rule 23(4)(d) of Code on Social Security (Central) Rules, 2020)
The disablement benefits shall be payable to the Insured Person as follows:
(i) for temporary disablement, at the full rate;
(ii) for permanent total disablement, at the full rate;
Benefit payable to dependants of Insured who dies from employment injury:
i) If a legitimate or adopted child is infirm & wholly dependent on Insured’s earnings at time of death, dependents’ benefits will continue as long as infirmity lasts.
ii) If total dependents’ benefits for widow/widows, legitimate or adopted children, and widowed mother exceed the full rate, share of each dependent will be proportionately reduced so total does not exceed full rate of disablement benefits.
iii) Daily rate of dependant’s benefit shall be 90% of standard benefit rate. If injury occurs before first benefit period, daily rate of disablement benefit shall be as prescribed.
Minimum total monthly payment of dependents’ benefits to all eligible dependents will be as notified by ESIC.
Where deceased insured person does not leave a widow/legitimate/adopted child/widowed mother, benefits to be paid to others as:
i) Widower: 3/10 of full rate for life
ii) Parent other than widowed mother/grandparent: 3/10 of full rate, shared equally if multiple parents
iii) To any other:
Provided for more than one dependant under sub-clause (iii) amount payable to be equally divided.
Minimum total monthly payment of dependents’ benefits to all eligible dependents will be as notified by ESIC.
If an employee is injured while taking action to rescue or protect people or property during an emergency at their workplace, the accident is considered to have occurred in the course of their employment.
Commute-related accidents to or from work are deemed work-related if a clear connection to employment is established. This includes accidents during travel with employer-permitted vehicles. The nexus between accident circumstances and employment must be evident for coverage under employment laws.
An accident happening while an employee is, with the express or implied permission of his employer, travelling as a passenger by any vehicle to or from his place of work shall be deemed to arise out of and in the course of his employment, if- a)the accident would have been deemed so to have arisen had he been under such obligation (b) at the time of the accident, the vehicle— (i) is being operated by or on behalf of his employer or some other person by whom it is provided in pursuance of arrangements made with his employer; and (ii) is not being operated in the ordinary course of public transport service
Accidents during employment are considered work-related even if the employee is acting against the law or employer’s orders, as long as the accident would have occurred regardless and the action is connected to the employer’s trade or business.
If an employee contracts an occupational disease listed in Part A, B (after six months), or C (as specified by regulations) of the Third Schedule, it will be deemed an “employment injury” unless proven otherwise.
Save as herein provided, no benefit shall be payable to an employee in respect of any disease unless the disease is directly attributable to a specific injury by accident arising out of and in the course of his employment.
An Insured Person or their family member requiring medical treatment is entitled to medical benefits, which can include outpatient or inpatient care at a hospital, clinic, or other institution, or home visits.
Medical benefits are provided during periods of paid/payable contributions or when qualifying for sickness/maternity benefits. Disablement benefit recipients get medical benefits; after permanent disablement, only for employment-related injuries. -Newly insured get 3 months of medical benefits; extended if employed for 3 months -With 78 days of contributions, medical benefits last until next benefit period. New employees get benefits with half the available days’ contributions -Extended sickness benefit qualifies for medical benefits until extended period ends -Medical benefits resume immediately upon re-employment & registration -Family benefits last as long as insured is eligible or would have been -Benefits are only as provided by designated institutions -No reimbursement for medical expenses unless specified -Permanently disabled due to work injuries and their spouses get benefits with proof & advance contribution
No employee shall receive sickness or temporary disablement benefits for any day on which they work, are on paid leave, holiday, or strike. A beneficiary must remain at the treatment facility, follow medical directions, and not leave without permission or act against recovery.
i) Insured shall not be entitled to receive for same period— a) both sickness & maternity benefit; or b) both sickness & disablement benefit for temporary disablement; or c) both maternity & disablement benefit for temporary disablement
ii) Where a person is entitled to more than one benefits mentioned above, he shall be entitled to choose which benefit he shall receive
iii) If a person dies while entitled to a cash benefit, amount up to day of death will be paid to their nominee or heir
iv) Those eligible for dependents’ or disablement benefits cannot claim Employees’ Compensation & women eligible for maternity benefits cannot claim Maternity Benefit under Chapter VI
v) Anyone receiving benefits they are not entitled to must repay the Corporation, or their legal representative must repay from deceased’s assets
vi) Value of non-cash benefits is determined by specified authority, whose decision is final
vii)Amounts recoverable can be collected as specified in sections 129 to 132
Penalty & Punishment
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