Accident Attorney Colorado

 

INTRODUCTION

The Employees? State Insurance Act provides for certain benefits that constitute the backbone of the Act. These benefits are available to the insured employees, their dependants or certain other persons. The benefits include the following:

?Sickness benefit ?Maternity benefit ?Disablement benefit ?Medical benefit ?Funeral benefit The payment for all the above benefits except the medical benefit is made in cash. They are also known as cash benefits.

SICKNESS BENEFIT

1.An insured person shall be entitled to periodical payment in case of his sickness certified by a duly appointed medical practitioner or by any person possessing such qualifications and experience as the Corporation may, by regulations, specify in this behalf. 2.A person shall be qualified to claim sickness benefits for sickness (a) if it occurs during any benefit period and (b) if the contributions in respect of him were payable for not less than half the number of days of the corresponding contribution period. 3.The claim for sickness benefit shall become due on the date of issue of the medical certificate in respect of such period. 4.The insured person shall not, however, be entitled to sickness benefit for an initial period of two days. However, if the spill of sickness recurs within 15 days, he shall be entitled to recover the benefit even for the first two days in the second or subsequent spell. The sickness benefit shall not be paid to any person for more than 91 days in any two consecutive benefit periods. 5.The daily rate of sickness benefit, in respect of the insured person during any benefit period shall be the standard rate corresponding to the average daily wages of that person during the corresponding contribution period.

MATERNITY BENEFIT

1.An insured woman shall be entitled to periodical payments, in case of confinement or miscarriage or sickness arising out of pregnancy, confinement, premature death of a child or miscarriage if such woman is certified to be eligible for such payments by an authority specified in this behalf. 2.An insured woman shall be qualified to claim maternity benefits

for a confinement occurring or expected to occur in a benefit period, if contributions in respect of her were payable for not less than 80 days in the immediately preceding two consecutive contribution periods. 3.The qualification of an insured woman to claim maternity benefit, the conditions subject to which such benefit may be given, and the rates & period thereof shall be such as may be prescribed by the Central Government. 4.To obtain maternity benefit, the insured woman must submit certificates as prescribed. 5.The daily rate of maternity benefit is equal to twice the standard benefit rate corresponding to the average daily wages in respect of the insured woman during the corresponding contribution period. For e.g. an insured woman in the average wage group of Rs. 8 to Rs. 22 will get Rs. 20 daily as maternity benefit. 6.The insured woman who is qualified to claim maternity benefit shall be entitled to receive it at daily rate for all days on which she does not work for remuneration during a period of twelve weeks of which not more than six shall precede the expected date of confinement. 7.If the insured woman dies during her confinement or within six weeks thereafter, leaving behind the child, maternity benefit shall be paid for the whole of that period. 8.If the child also dies during the said period, maternity benefit shall be paid for the days upto and including the day of the death of the child. In both the cases, maternity benefit shall be paid to the person nominated by the woman for the purpose. If there is no such nominee, the money shall be paid her legal representatives. 9.In case of miscarriage, an insured woman who is qualified to claim maternity benefit shall be entitled, on production of such proof as may be required under the regulations, to maternity benefits at the rate specified for all days on which she does not work for remuneration during a period of 6 weeks immediately following the date of her marriage. 10.In case of sickness arising out of pregnancy, confinement, premature birth of child, or miscarriage, an insured woman who is qualified to claim maternity benefit shall, on production of such proof as may be required under the regulations, be entitled to an additional period exceeding one month for all days she does not work for remuneration. 11.An insured woman may be disqualified to receive maternity benefit if she fails without good cause to attend or submit herself to a medical examination when so required. She may, however, refuse to be examined by any person other than a female doctor or midwife.

DISABLEMENT BENEFIT

1.An insured person suffering from disablement because of an employment injury sustained as an employee under this Act and certified to be eligible for such payment by an authority specified in this behalf by the regulations shall be entitled to periodical payments. 2.Subject to the provisions of this Act and the regulations, if any a person who sustains: a.Temporary disablement for not less than 3 days; b.Permanent disablement, whether total or partial; 3.A claim for disablement benefit for temporary disablement for any period shall become due on the date of the issue of the medical certificate in respect of such period. 4.A claim for first disablement benefit for permanent disablement shall become due on the date on which an insured person is declared as permanently disabled. Claims for further payments of disablement benefit must be made on the last day of the month to which the claim relates. 5.Any question relating to disablement is to be determined and reviewed by a Medical Board to be appointed by the Corporation. If the insured person or the corporation is not satisfied with the decision of the Board, either party may appeal to: a.The Medical Appeal Tribunal, or b.The Employees? Insurance Court. 6.The daily rate of disablement benefit shall be 25 percent more than the standard benefit rate rounded to the next higher multiple of 5 paise. This rare is called ?full rate?. 7.Disablement benefit is payable from the first day of disablement. In case of permanent disablement, whether total or partial, the payment of disablement benefit continues for life. In case of temporary disablement, it continues during the period of disablement.

DEPENDANTS? BENEFIT

1.Dependants of an insured person, who dies as a result of an employment injury sustained as an employee under this Act, as are entitled to compensation under this Act, shall be entitled to periodical payments. 2.Whether or not he was in receipt of any periodical payment for temporary disablement in respect of the injury, dependants? benefit shall be payable to his dependants in accordance with the provisions of Schedule I. 3.In case the insured person dies without leaving behind him the dependants as aforesaid, the dependants? benefit shall be paid to the other dependants of the deceased in accordance with the provisions of the Schedule I. 4.If the total of the dependants? benefits distributed among the widows and legitimate or adopted children of the deceased person as aforesaid exceeds at any time the full rate, the share of each of the dependants is proportionately reduced, so that the total amount payable to them does not exceed the amount of dependants? benefit at the full rate. 5.In case the deceased person does not leave a widow or legitimate or adopted child, dependants? benefits shall be payable to the other dependants as follows: To a parent or grandparent, for life, at an amount equivalent to three-tenths of the full rate and if there are two or more parents or grandparents, the amount payable to them is equally divided among them; To any other male dependant, until he attains 18 years of age, female dependant until she attains 18 years of age or until marriage, whichever is earlier, or if widowed until she attains 18 years of age, at an amount equivalent to two-tenths of the full rate. But if there is more than one female dependant under this clause, the amount payable is equally divided among them.

MEDICAL BENEFIT

1.An insured person and/or a member of his family whose condition requires medical treatment & attendance shall be entitled to receive medical treatment for an attendance on insured persons. 2.The Corporation may at the request of the appropriate Government, 7 subject to such conditions, as may be laid down in the regulations, extend the medical benefits to the family of an insured person. 3.The medical benefit may be given either in the form of outpatient treatment & attendance in a hospital or dispensary, clinic or other institution or by visits to the home of the insured persons or treatment as inpatient in hospital. 4.The State Government shall provide for insured persons and their families in the State medical, surgical & obstetric treatment. 5.The Corporation may take provision for the establishment & maintenance of hospitals, dispensaries & other medical & surgical services with the approval of the State Government. The Corporation may take provision in any area by agreement with local authority, private body or individual for medical treatment & attendance of insured persons.

FUNERAL BENEFIT

1.If an insured person dies, the eldest surviving member of his family shall be entitled to payment towards the expenditure on the funeral of the deceased insured person. 2.Where the insured person did not have a family or was not living with his family at the time of his death, the person who actually incurs the expenditure on the funeral shall be entitled to payment. 3.The amount of such payment shall not exceed Rs. 1000. 4.Claim for such payment shall be made within three months of the death of the insured person or within such extended period as may be authorized by the Corporation or any such officer or authority.