Insured Status And Qualifying Contribution
Identify the controlling facts, current Code/Rule requirement, saved operational detail, evidence and responsible owner.
Sickness benefit and medical certification
Current Code, 2026 Central Rules, saved regulation controls, evidence and remedies.
Decision path
Medical Certification
Identify the controlling facts, current Code/Rule requirement, saved operational detail, evidence and responsible owner.
Claim And Abstention
Identify the controlling facts, current Code/Rule requirement, saved operational detail, evidence and responsible owner.
Payment, Suspension And Appeal
Identify the controlling facts, current Code/Rule requirement, saved operational detail, evidence and responsible owner.
Implementation controls
- Lock the insured-person, employer and event identifiers before computation or claim.
- Separate current Code/Rule law from saved 1950 procedure and later ESIC directions.
- Reconcile payroll/contractor, medical, family and contribution data according to the benefit.
- Preserve submission, deficiency, decision, payment, review and appeal timestamps.
- Restrict medical/dependant data access and retain a reasoned exception trail.
Current Code and Rules
Saved operational regulations
Regulation 44Claim for benefitsRegulation 45When claim becomes dueRegulation 48Evidence in support of claimRegulation 52Benefits when payableRegulation 53Evidence of sickness and temporary disablementRegulation 54Persons competent to issue medical certificateRegulation 55Medical certificateRegulation 56Time of granting medical certificateRegulation 57Medical certificate on first examinationRegulation 58Final medical certificateRegulation 59Intermediate medical certificateRegulation 60Final medical certificate before commencing work for wagesRegulation 61Intermediate certificate for a longer periodRegulation 63Form of claim for sickness or temporary disablementRegulation 64Failure to submit medical certificateRegulation 99Suspension of sickness or temporary disablement benefit