Business Laws and Ethics · Employees State Insurance Act, 1948

Benefits under the ESI Scheme for CMA Intermediate

Updated 10 October 2026 · Fact-checked

The ESI scheme gives insured persons six benefits: sickness, maternity, disablement, dependants', medical and funeral expenses. The first four are periodical cash payments. Medical benefit is treatment and attendance. Funeral expenses are a payment to the eldest surviving family member. Learn each benefit's trigger, who receives it, and the rules that stop benefits from overlapping.

Understand Benefits under the ESI Scheme

ESI is social insurance. An employee covered by the scheme is an insured person. When something goes wrong (illness, childbirth, injury at work, death), the scheme replaces lost income or pays for care. The list of benefits is in section 46 of the Employees' State Insurance Act, 1948. The Code on Social Security, 2020 repeats the same list in section 32. Use the section number of whichever law your question names.

There are six benefits. Sickness benefit is periodical cash payment when the insured person is sick, certified by a duly appointed medical practitioner (or another person with qualifications the Corporation specifies by regulations). Maternity benefit is periodical payment to an insured woman for confinement, miscarriage, or sickness arising out of pregnancy, confinement, premature birth or miscarriage. She must be certified eligible by an authority specified in the regulations.

Disablement benefit is periodical payment to an insured person disabled by an employment injury sustained as an employee under the Act. Again, certification by the specified authority is needed. Dependants' benefit is periodical payment to dependants of an insured person who dies from an employment injury, if the dependants are entitled under the Act. Notice the link: both disablement and dependants' benefit depend on an employment injury. Sickness and maternity do not.

Medical benefit is medical treatment and attendance for insured persons. It may be given as out-patient treatment in a hospital, dispensary or clinic, as home visits, or as in-patient treatment. It can be extended to the insured person's family under conditions in the regulations. Funeral expenses are paid to the eldest surviving member of the family, or, if there was no family or the person was not living with it, to whoever actually paid for the funeral. The claim must be made within three months of death, or within an extended period allowed by the Corporation or its authorised officer. The amount cannot exceed what the Central Government prescribes.

The rates, qualifying conditions and period of cash benefits are not fixed in these sections. They are left to the Central Government by rules (section 32(3) of the Code). So do not quote percentage rates or days unless your study material gives them. The Act text here sets the structure and the conditions.

Key rules to remember

Six benefits (section 46 of the ESI Act; section 32 of the Code): Sickness + Maternity + Disablement + Dependants' + Medical + Funeral expenses; Cash benefits are periodical payments for the first four. Medical is treatment. Funeral expenses are paid to the eldest surviving family member, or else to the person who actually incurs the funeral expenditure.
No double benefit for the same period (section 65 of the ESI Act; section 41(4) of the Code): Not both: sickness + maternity; sickness + temporary disablement; maternity + temporary disablement; If entitled to more than one, the person chooses which one to receive (section 65(2) of the ESI Act; section 41(5) of the Code).
Conditions for sickness or disablement benefit recipients (section 64 of the ESI Act): Stay under treatment; do nothing to retard recovery; do not leave the treatment area without permission; allow medical examination; Applies to sickness benefit and disablement benefit other than benefit granted on permanent disablement.
Funeral expenses claim: Claim within 3 months of death (extendable); amount ≤ prescribed limit; Paid to the eldest surviving family member, else to the person who actually incurs the expense.
Medical benefit period (section 56(3) of the ESI Act): Entitled while contributions are payable, or while qualified for sickness or maternity benefit, or in receipt of disablement benefit that does not disentitle; Family can get it only where medical benefit is extended to the family.
Cash benefit on death (section 41(6) of the Code): Unpaid cash benefit up to and including the day of death goes to the nominee, else the heir or legal representative; Nomination must be in writing in the form specified by regulations.

How to solve Benefits under the ESI Scheme questions

Use this method for any question that asks you to name, explain or apply an ESI benefit.

1Identify the event: illness, childbirth or miscarriage, injury at work, death from injury at work, need for treatment, or death of the insured person.
2Match the event to the benefit: sickness, maternity, disablement, dependants', medical or funeral expenses.
3Check the trigger. Disablement and dependants' benefit need an employment injury sustained as an employee under the Act.
4Check who receives it: the insured person, the insured woman, the dependants, or the eldest surviving family member or person who paid for the funeral.
5Apply the conditions: certification, the three-month limit for funeral claims, and the conduct rules for sickness and disablement recipients.
6Test for overlap. The same person cannot take sickness with maternity, sickness with temporary disablement, or maternity with temporary disablement for the same period. The person chooses one.
7Say that rates and qualifying conditions are as prescribed by the Central Government, then write the conclusion.

Quickest way: Event-to-benefit match

When to use it: For MCQs and short-note questions where you have under two minutes.

Underline the event word: sick, confinement, injury, died, treatment, funeral.
Write the benefit next to it. Injury leads to disablement. Death by injury leads to dependants'. Any death leads to funeral expenses.
Look for a trap: same-period overlap, funeral claim after three months, or a non-work injury.
Pick the option that respects the exact condition.

Common mistakes in Benefits under the ESI Scheme

Giving disablement or dependants' benefit for any injury or death.
Students read 'injury' loosely.
Fix: Both benefits need an employment injury sustained as an employee under the Act. A death from illness gives funeral expenses, not dependants' benefit.
Allowing sickness benefit and maternity benefit together for the same period.
Both seem to fit a pregnant woman who is unwell.
Fix: Section 65 bars this. She chooses one for that period.
Applying the overlap bar to permanent disablement.
The word 'disablement' is read without 'temporary'.
Fix: The bar covers disablement benefit for temporary disablement only. Also, the treatment-conduct conditions exclude benefit granted on permanent disablement.
Saying the funeral payment goes to the nominee or to any relative.
Mixing it up with unpaid cash benefit on death.
Fix: Funeral expenses go to the eldest surviving family member, or to the person who actually incurs the expense if there is no family or the person was not living with it.
Quoting exact rates or days as part of the Act text.
Memorising figures from guides.
Fix: The sections leave rates, qualifying conditions and period to rules made by the Central Government. State that, and give figures only if your study material supplies them.
Assuming family members always get medical benefit.
Medical benefit is called a family benefit in practice.
Fix: Under section 46(2) of the ESI Act, the Corporation may extend it to the family only at the request of the appropriate Government and subject to regulations. Section 32(2) of the Code has no request condition. Either way, it is not automatic.

Worked examples

Example 1

Ramesh, an insured person, is on certified sick leave and receives sickness benefit. During the same days he also becomes eligible for disablement benefit for temporary disablement from an employment injury. Can he receive both? What conditions must he follow while on benefit?

Show the solution

Identify the benefits: sickness benefit and disablement benefit for temporary disablement.
Apply section 65 of the ESI Act (section 41(4) of the Code): both cannot be received for the same period.
Under section 65(2) of the ESI Act (section 41(5) of the Code), where he is entitled to more than one, he chooses which to receive.
Conditions while on sickness or disablement benefit (other than permanent disablement), under section 64: remain under medical treatment and follow instructions; do nothing to retard recovery; not leave the treatment area without permission; allow himself to be examined by an authorised medical officer.

Answer: Ramesh cannot receive both for the same period. He must choose one. While on the benefit he must follow the four conduct conditions of section 64.

Example 2

Sunita, an insured person, dies of a heart ailment, not an employment injury. She lived with her husband, who was the eldest surviving family member. Her husband claims dependants' benefit and funeral expenses four months after her death. Advise.

Show the solution

Dependants' benefit needs death from an employment injury sustained as an employee under the Act. Death from a heart ailment does not qualify, so there is no dependants' benefit.
Funeral expenses are payable on the death of any insured person, to the eldest surviving family member. Her husband qualifies.
The claim must be made within three months of death, or within an extended period allowed by the Corporation or an authorised officer. Four months is late.
So the claim for funeral expenses succeeds only if the Corporation or its authorised officer allows an extension. The amount is capped at what the Central Government prescribes.

Answer: No dependants' benefit is payable. Funeral expenses are payable to the husband, but as the claim is beyond three months it needs an extension from the Corporation or its authorised officer. Payment is limited to the prescribed amount.

Exam tips

Write the section numbers in pairs where the question allows: section 46 and section 32 for the list, section 65 and section 41(4) for overlap.
In MCQs, check the words 'employment injury' and 'temporary'. These two words decide most answers.
For long answers, give each benefit as: trigger, recipient, condition. Then add one line on overlap and one on conduct rules.
Do not write rates in numbers unless the question supplies them. Say 'as prescribed by the Central Government'.
Case-based questions often test the three-month funeral claim limit. Always check the date gap.

Practice questions from Employees State Insurance Act, 1948

Benefits under the ESI Scheme: frequently asked questions

What are the types of benefits under the ESI Act?

Section 46 lists six: sickness, maternity, disablement, dependants', medical and funeral expenses. The Code on Social Security, 2020 lists the same six in section 32.

What is the difference between temporary and permanent disablement benefit?

Both are paid for disablement from an employment injury. Temporary disablement benefit cannot be taken with sickness or maternity benefit for the same period. The treatment-conduct conditions of section 64 do not apply to benefit granted on permanent disablement.

Who is eligible for ESI maternity benefit?

An insured woman in case of confinement, miscarriage, or sickness arising out of pregnancy, confinement, premature birth or miscarriage. She must be certified eligible by an authority specified in the regulations. Rate and qualifying conditions are as prescribed by the Central Government.

When are dependants' benefits paid?

They are paid to dependants of an insured person who dies as a result of an employment injury sustained as an employee under the Act, if the dependants are entitled under the Act. Death from a non-employment cause does not give this benefit.

Can a person claim ESI benefit and also employer compensation?

Under section 41(7) of the Code, a person eligible for dependant or disablement benefit cannot claim Employees' Compensation from the employer under Chapter VII. A woman eligible for ESI maternity benefit cannot claim maternity benefit from her employer under Chapter VI.