Hi Friends,
Good Evening...
Our employee was met with accident, while he was picked by the company arranged vehicle (Rental vehicle) from his native place along with some other employees from 4 different place(districts). In this accident 1 person died on the spot of accident others admitted in the hospital with some injury's and recovered.
In this case died employee wage was 20500/- upto March month then from April month his wage is 25000/- as per ESI eligibility. as per ESI act we missed to make "out of coverage" in the month of April. so we decided to pay contribution for the upcoming months upto contribution period ends. But unfortunately the accident happened in the month of June.
We have submitted all the relevant accident form and other documents. ESI official have gone enquiry on this case and they rejected the claim with stating that "The case NOT been admitted as one of employment Injury, as the alleged accident does not merit consideration to be treated as an employment Injury. Reason for rejection in brief: Not an employee on the date of accident as defined under section 2(9) of ESI Act, 1948".
In this case if the employee not met with accident means we have tp pay upto his contribution period ends.
My question is we are paying the contribution during the accident then why ESI officials not accepting this claim.
Please provide your suggestion for the above mentioned case for my further understanding.
From India, Coimbatore
Good Evening...
Our employee was met with accident, while he was picked by the company arranged vehicle (Rental vehicle) from his native place along with some other employees from 4 different place(districts). In this accident 1 person died on the spot of accident others admitted in the hospital with some injury's and recovered.
In this case died employee wage was 20500/- upto March month then from April month his wage is 25000/- as per ESI eligibility. as per ESI act we missed to make "out of coverage" in the month of April. so we decided to pay contribution for the upcoming months upto contribution period ends. But unfortunately the accident happened in the month of June.
We have submitted all the relevant accident form and other documents. ESI official have gone enquiry on this case and they rejected the claim with stating that "The case NOT been admitted as one of employment Injury, as the alleged accident does not merit consideration to be treated as an employment Injury. Reason for rejection in brief: Not an employee on the date of accident as defined under section 2(9) of ESI Act, 1948".
In this case if the employee not met with accident means we have tp pay upto his contribution period ends.
My question is we are paying the contribution during the accident then why ESI officials not accepting this claim.
Please provide your suggestion for the above mentioned case for my further understanding.
From India, Coimbatore
All these things happened last year, right?
The employee's salary was revised in April, but in the records it remained as Rs 20500 only and hence he was an insured person at the time of death. The claim can not be rejected.
You revised the salary in April and in the ESI records also you did it as Rs 25000. Then he is not an insured person wef April. Even though you had contributed the contributions, it did not go in to the concerned employee. If so, obviously, the ESIC will disown their liability. You can adjust the amount paid erroneously.
Please note that while preparing contributions with rs 25000 the the system would have given a warning that the insured wages exceeds Rs 21000 and you just ignore it. The system/ ESIC will accept contribution even if the wages exceeds Rs 21000 just because the contribution is on the total wages INCLUDING OVERTIME WAGES. If you just ignore the warning, the system will accept contribution on Rs 25000.
You can either fight for coverage saying that ESIC had collected/ received contributions in respect of the employee and if he was not an employee the ESIC should have rejected it right when the employer remitted the contribution of April. I am not sure what will be the fate of the case. But you can try.
Since there was an omission on the part of the employer/ the person concerned of the employer to buy workmen compensation policy for the employee who went out of ESI coverage, this is an issue of dereliction of duty. In the absence of such a policy, the employer will have to bear it from the working capital. The amount of compensation will be as decided by the workman compensation commissioner.
From India, Kannur
3891The employee's salary was revised in April, but in the records it remained as Rs 20500 only and hence he was an insured person at the time of death. The claim can not be rejected.
You revised the salary in April and in the ESI records also you did it as Rs 25000. Then he is not an insured person wef April. Even though you had contributed the contributions, it did not go in to the concerned employee. If so, obviously, the ESIC will disown their liability. You can adjust the amount paid erroneously.
Please note that while preparing contributions with rs 25000 the the system would have given a warning that the insured wages exceeds Rs 21000 and you just ignore it. The system/ ESIC will accept contribution even if the wages exceeds Rs 21000 just because the contribution is on the total wages INCLUDING OVERTIME WAGES. If you just ignore the warning, the system will accept contribution on Rs 25000.
You can either fight for coverage saying that ESIC had collected/ received contributions in respect of the employee and if he was not an employee the ESIC should have rejected it right when the employer remitted the contribution of April. I am not sure what will be the fate of the case. But you can try.
Since there was an omission on the part of the employer/ the person concerned of the employer to buy workmen compensation policy for the employee who went out of ESI coverage, this is an issue of dereliction of duty. In the absence of such a policy, the employer will have to bear it from the working capital. The amount of compensation will be as decided by the workman compensation commissioner.
From India, Kannur
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Circular Dated 28-10-2016 for settlement of PF Death Case Claims within 7 days.pdf
PF Death case Composite Claim Form No 20,10D & 5IF.xls