Rule 22: Qualification for claiming benefits

Finin2min analysis — operative rule mechanics

Full notified text — Rule 22

22. Qualification for claiming benefits.–(1) Subject to the provisions of the Code and the
regulations, a person shall be qualified to claim sickness benefit for sickness occurring during any
benefit period if the contributions in respect of him were payable for not less than seventy-eight days
in the corresponding contribution period and shall be entitled to receive such benefit at the rate of
seventy per cent. of the ―Standard Benefit Rate‖ of that person during the corresponding contribution
period rounded to the next higher rupee:

      Provided that in case of a person who becomes an employee within the meaning of Chapter IV of
the Code for the first time and for whom a shorter contribution period of less than one hundred and
fifty six days is available, he shall be qualified to claim sickness benefit if the contribution in respect
of him were payable for not less than half the number of days available for working in such
contribution period:

      Provided further that in case of an Insured woman in receipt of maternity benefit or an Insured
Person in receipt of temporary disablement benefit and owing to such fact, as the case may be, a
shorter contribution period is available to her or him, she or he shall be qualified to claim sickness
benefit in the corresponding benefit period if the contribution in her or his respect were payable for
not less than half the number of days available for working in such shorter contribution period:

     Provided also that he shall not be entitled to the benefits for the first two days of sickness except
in the case of a spell of sickness following, at an interval of not more than fifteen days, the spell of
sickness for which sickness benefits were last paid:

     Provided also that sickness benefits shall not be paid to any person for more than ninety-one
days in any two consecutive benefit periods.

(2) (a) The sickness benefit may be extended if the person is diagnosed to be suffering from any one
or more of the diseases specified in regulations made by the Corporation, provided that the Insured
Person has completed four contribution periods immediately preceding the beginning of the spell in
which the disease is first diagnosed and has paid contribution for a period of one hundred and fifty six
days in the four aforesaid contribution periods and he is eligible to claim sickness benefit at least in
one of the aforesaid four contributory periods.

(b) The extended sickness benefit shall be granted only if the Insured Person is otherwise entitled to
extended sickness benefit under foregoing provisions but has exhausted the sickness benefit due to
him under the fourth proviso to sub- rule (1) or is ineligible to sickness benefit in terms of sub-rule
(1).

(c) The sickness benefit may be extended for a maximum period of seven hundred and thirty days
including the sickness benefit under fourth proviso to sub-rule (1), subject to the conditions as
specified in the regulations made under section 157.

(d) The daily rate of the extended sickness benefit of an insured person shall be eighty per cent. of the
―Standard Benefit Rate‖.

(3) (a) An insured woman shall be qualified to claim maternity benefits for a confinement occurring or
expected to occur in a benefit period, if the contributions in respect of her were payable for not less
than seventy days in the immediately preceding two consecutive contribution periods.

(b) Subject to the provisions of the Code and the regulations, if any, an insured woman who is
qualified to claim maternity benefits in accordance with clause (a) shall be entitled to receive it at the
daily rate specified in clause (e) for all days on which she does not work for remuneration during a
period of twenty-six weeks of which not more than eight weeks shall precede the expected date of
confinement:

     Provided that where the insured woman dies during her delivery or during the period
immediately following the date of her delivery for which she is entitled to maternity benefits, leaving
behind child in either case, the maternity benefits shall be paid for the whole of that period but if the
child also dies during the said period, then, for the days up to and including the day of the death of the
child, to the person nominated by the insured woman in the manner as specified in the regulations
made under section 157, and if there is no such nominee, to her legal representative:

     Provided further that the insured woman shall be entitled to twelve weeks of maternity benefit
from the date the child is handed over to the commissioning mother after birth or adopting mother, as
the case may be:

      Provided also that the insured woman having two or more than two surviving children shall be
entitled to receive maternity benefits during a period of twelve weeks of which not more than six
weeks shall precede the expected date of confinement.

(c) An insured woman who is qualified to claim maternity benefits in accordance with clause (a) shall,
in case of miscarriage or medical termination of pregnancy, be entitled, on production of such proof,
as may be required under the regulations made under section 157, to maternity benefits at the rates
specified in clause (e ), for all days on which she does not work for remuneration during a period of
six weeks immediately following the date of her miscarriage or medical termination of pregnancy.

(d) An insured woman who is qualified to claim maternity benefits in accordance with clause (a) in
case of sickness arising out of pregnancy, confinement, premature birth of child or miscarriage or
medical termination of pregnancy shall, on production of such proof, as may be required under the
regulations made under section 157, be entitled, in addition to the maternity benefits payable to her
under any other provisions of the Chapter IV, for all days on which she does not work for
remuneration to maternity benefits at the rates specified in the clause (e) for all days on which she
does not work for remuneration during an additional period not exceeding one month.

(e) The daily rate of maternity benefit payable in respect of confinement occurring or expected to
occur during any benefit period shall be equal to the standard benefit rate in respect of the insured
woman during the corresponding contribution period, rounded to the next higher rupee.

(4) An insured woman and an Insured Person in respect of his wife shall be paid a sum of rupees
fifteen thousand per case as medical bonus on account of confinement expenses:

    Provided that the confinement occurs at a place where necessary medical facilities under the
Employees‘ State Insurance Scheme are not available:

         Provided further that confinement expenses shall be paid for two confinements only.

(5) (a) A person shall be qualified to claim disablement benefits for temporary disablement for not
less than three days (excluding the day of accident) for the period of such disablement sustained as an
employee under the Code.

(b) A person shall be qualified to claim periodical payment for permanent disablement sustained as an
employee under the Code whether total or partial, for such disablement:

      Provided that where permanent disablement, whether total or partial, has been assessed
provisionally for a limited period or finally, the benefit provided under this sub-rule shall be payable
for that limited period, or as the case may be, for life.

(c) The daily rate of disablement benefit shall be ninety per cent. of the standard benefit rate in the
contribution period corresponding to the benefit period in which the employment injury occurs,
rounded to the next higher rupee:

     Provided that where an employment injury occurs before the commencement of the first benefit
period in respect of a person, the daily rate of disablement benefit shall be —

         (i) where a person sustains employment injury after the expiry of the first wage period in
         the contribution period in which the injury occurs, ninety per cent. of his average daily wages
         in that wage period, rounded to the next higher rupee;

         (ii) where a person sustains employment injury before the expiry of the first wage period in
         the contribution period in which the injury occurs, ninety per cent. of his wages actually
         earned or which would have been earned, had he worked for a full day on the date of
         accident, rounded to the next higher rupee.

Explanation. — The disablement benefit calculated under the foregoing provisions of this sub-rule
shall be called the ―full rate‖.

(d)The disablement benefits shall be payable to the Insured Person as follows, namely: -

         (i) for temporary disablement, at the full rate;

         (ii) for permanent total disablement, at the full rate;

         (iii) for permanent partial disablement resulting from an injury specified, in Part II of the
         Fourth Schedule, at such percentage of the full rate which would have been payable in the
         case of permanent total disablement, as specified in the said Schedule as being the
         percentage of the loss of earning capacity caused by the injury;

         (iv) for permanent partial disablement resulting from an injury not specified in Part II of the
         Fourth Schedule, at such percentage of the full rate payable in the case of permanent total
         disablement as is proportionate to the loss of earning capacity permanently caused by the
         injury.

Explanation. — For the purposes of this sub-rule, where more injuries than one are caused by the
same accident, the rate of benefit payable under sub-clauses (iii) and (iv) shall be aggregated but not
so in any case as to exceed the full rate and in cases of disablement not covered by sub-clauses (i), (ii),
(iii) and (iv) at such rate, not exceeding the full rate, as provided in the regulations made under section
157.

(6) Dependants’ benefit shall be paid to the dependants of the Insured Person who dies as a result of
an employment injury, in the following manner, namely:-

(a) In the case of death of the Insured Person, the dependants‘ benefit shall be payable to his widow,
children and widowed mother as follows, namely: -

          (i) to the widow during life until remarriage, an amount equivalent to three-fifths of the full
          rate and, if there are two or more widows, the amount payable to the widow as aforesaid shall
          be divided equally between the widows;

          (ii) to each legitimate or adopted son, an amount equivalent to two-fifths of the full rate until
          he attains the age of twenty-five years:

          Provided that in the case of a legitimate or adopted son who is infirm and who is wholly
          dependent on the earnings of the Insured Person at the time of his death, dependants‘ benefits
          shall continue to be paid while the infirmity lasts;

          (iii) to each legitimate or adopted unmarried daughter, an amount equivalent to two-fifths of
          the full rate:

          Provided that in the case of legitimate or adopted daughter who is infirm and is wholly
          dependent on the earnings of the Insured Person at the time of his death, dependants‘ benefit
          shall continue to be paid while the infirmity lasts.

          (iv) to the widowed mother during life an amount equivalent to two-fifths of the full rate:

          Provided that if the total of the dependants‘ benefits distributed among the widow(s) and
          legitimate or adopted children and widowed mother of the deceased person as aforesaid
          exceeds at any time the full rate, the share of each of the dependants shall be proportionately
          reduced, so that the total amount payable to them does not exceed the amount of disablement
          benefits at the full rate.

(b) In case the deceased person does not leave widow or legitimate or adopted child or widowed
mother, dependants‘ benefits shall be payable to other dependants as follows, namely:-

      (i) to the widower during life until remarriage, at an amount equivalent to three-fifths of the full
          rate;
      (ii) to a parent other than the widowed mother or grandparent, for life, at an amount equivalent to
            two fifths of the full rate and if there are two or more parents (other than widowed mother) or
            grandparents the amount payable to the parents (other than widowed mother) or grandparents
            as aforesaid shall be equally divided between them;
      (iii) to any other —

(a) male dependant, until he attains the age of eighteen years,(b) female dependant, until she attains
the age of eighteen years or until marriage, whichever is earlier or if widowed, until she attains
eighteen years of age or re-marriage, whichever is earlier,

at an amount equivalent to two-tenths of the full rate:

        Provided that if there be more than one dependant, under sub-clause (ii), the amount payable
under this sub-rule shall be equally divided between them:

          Provided further that if the total of the dependants‘ benefits distributed among the other
          dependants of the deceased person under clause (b) exceeds at any time the full rate, the share

        of each of the dependants shall be proportionately reduced, so that the total amount payable to
        them does not exceed the amount of disablement benefits at the full rate.

(7) The daily rate of dependants‘ benefit shall be ninety per cent. of the standard benefit rate in the
contribution period corresponding to the benefit period in which the employment injury occurs:

        Provided that where an employment injury occurs before the commencement of the first
benefit period in respect of a person, the daily rate of dependants‘ benefit shall be —

        (i) where a person sustains employment injury after the expiry of the first wage period in the
        contribution period in which the injury occurs, ninety per cent. of his average daily wages
        during that wage period, rounded to the next higher rupee;

        (ii) where a person sustains employment injury before the expiry of the first wage period in
        the contribution period in which the injury occurs, ninety per cent. of wages actually earned
        or which would have been earned had he worked for a full day on the date of accident,
        rounded to the next higher rupee:

        Provided that the minimum total amount of the periodical monthly payment of dependants‘
benefit payable to all eligible dependants of a deceased employee, shall be as notified by the
Corporation.

(8) At any time when its funds so permit, the Corporation may review and alter the scale of any
benefit admissible under the Code and the period for which such benefit may be given.

Application and evidence

1. Primary statutory test — (1) Subject to the provisions of the Code and the regulations, a person shall be qualified to claim sickness benefit for sickness occurring during any benefit period if the contributions in respect of him were payable for not less than seventy-eight days in the corresponding contribution period and shall be entitled to receive such benefit at the rate of seventy per cent. of the ―Standard Benefit Rate‖ of that…
2. Additional operative limb — Provided that in case of a person who becomes an employee within the meaning of Chapter IV of the Code for the first time and for whom a shorter contribution period of less than one hundred and fifty six days is available, he shall be qualified to claim sickness benefit if the contribution in respect of him were payable for not less than half the number of days available for working in such contribution period:
3. Qualification / exception to test — Provided that in case of a person who becomes an employee within the meaning of Chapter IV of the Code for the first time and for whom a shorter contribution period of less than one hundred and fifty six days is available, he shall be qualified to claim sickness benefit if the contribution in respect of him were payable for not less than half the number…
4. Numerical or timing control — Qualification for claiming benefits.–(1) Subject to the provisions of the Code and the regulations, a person shall be qualified to claim sickness benefit for sickness occurring during any benefit period if the contributions in respect of him were payable for not less than seventy-eight days in the corresponding contribution period and shall be entitled…
5. Code Section mapping — 32. Read the mapped provision together with this text rather than treating the concordance as a substitute for it.
6. Evidence file — retain facts and records proving the role/status of: Employee / worker, Corporation / EPFO / Board.

Cross-references & prescribed forms

Worked example

Q&A — Rule 22

Primary sources