Esi - family age limnit-kidney failure at 20 age
arun
(Querist) 03 December 2012
This query is : Resolved
Greetings of the day:-
My brother age is 21 years+03 months ,now from last 01 year he is suffering from CRF/100 % BOTH Kidney failure ,currently have Urea-525 & creatinine -20 ,so CAN he still get benefits of his father’s ESI smart card & esi benefits, if Dialysis continued from last 01 year through ESI when he was 20 years old & as 03 dialysis in a week is going on ,he is not in physical, mental or financial position to work/earn/self dependent.
How a person who can’t go outside, have food/water restrictions ,can’t talk, walk alone more than some steps is term as NOT DEPENDENT on his family.
Please help as we are from middle class family , doing private jobs & facing financial, physically, mental pain in going through brother’s helpless situation. He is a bright student ,done 12th from C.B.S.E board & computers,pursuing B.Com (2) year.
Clarify if family member of I.P. if getting medical from 20 year age ,is it feasible to terminate all ESI benefits in this KIDNEY failure patient to term as self dependent.
Is there any way to get relation or brother contionue get ESI benefits as earlier as he getting before attedning the age of 21.
Can any one have data that in case of continue age can be extended in case of 21 years for getting ESI BENEFITS ,or any way to get esi benefits after age of 21 years in Family members –in case of Long/chronocial disease EVEN if the same patient is receiving the ESI benefits from last 01 year.
I had already checked , i wish to knew any clause in ESI that allowed previous benefits to be continoue despaite son age 21 in case of both kidney failure disease.Please provide any circular if have in this regards at arun@mssl.motherson.com.
Regards
9999566179
Faridabad
Raj Kumar Makkad
(Expert) 03 December 2012
Earlier insured persons eligible under this scheme suffering from long duration of illnesses were experiencing great hardships on account of expiry of 91 days Sickness Benefit. It was often observed that such individuals that though they were not fit for duty, they were pressed for a Final certificate. Hence, a provision for paying Sickness Benefit for an extended period (Extended Sickness Benefit)of upto 2 years in a ESB period of 3 years was incorporated in the provisions of this Act.
An insured person suffering from certain long term diseases is entitled to avail ESB, only after totally exhausting Sickness Benefit to which he/she may be eligible. A common list of such long-term diseases for which ESB is payable is being constantly reviewed and updated by the Corporation from time to time.
The list was last reviewed in December 1999 and revised provisions of ESB became effective from January 2000. Currently this list includes 34 diseases which are grouped in 11 broad categories as per International Classification of diseases and the names of many existing diseases have been changed as enlisted below:
(I) Infectious Diseases
Tuberculosis
Leprosy
Chronic Empyema
AIDS
(II) Neoplasm
Malignant Diseases
(III) Endocrine, Nutritional and Metabolic Disorders
Diabetes Mellitus associated with proliferative retinopathy/diabetic foot/nephropathy
(IV) Disorders of Nervous System
Monoplegia
Hemiplegia
Paraplegia
Hemiparesis
Intracranial Space Occupying Lesion
Spinal Cord Compression
Parkinson’s disease
Myasthenia Gravis/Neuromuscular Dystrophies
(V) Disease of Eye
Immature Cataract with vision 6/60 or less
Detachment of Retina
Glaucoma
(VI) Diseases of Cardiovascular System
Coronary Artery Disease (CAD)
Unstable Angina
Myocardial infraction with ejection less than 45%
Congestive Heart Failure
Cardiac Valvular Diseases with failure/complications
Cardiomyopathy
Heart disease with surgical intervention associated with complications
(VII) Chest Diseases
Bronchiectasis
Interstitial Lung Disease
Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor pulmonale)
(VIII) Diseases of the Digestive System
Cirrhosis of liver with ascities/chronic active hepatitis
(IX) Orthopaedic Diseases
Dislocation of vertebra/prolapse of intervertebral disc
Non-union or delayed union of fracture
Post Traumatic Surgical amputation of lower extremity
Compound fracture with chronic osteomyelitis
(X) Psychoses
Schizophrenia
Endogenous depression
Manic Depressive Psychosis (MDP)
Dementia
(XI) Others
More than 20% burns associated with infection/complications
Chronic Renal Failure
Reynaud’s disease/Burger’s disease
In addition to the above list, Director General/Medical Commissioner have the authority to sanction ESB (Extended Sickness Benefit) for a maximum period up to 730 days in cases of rare but treatable diseases or under special circumstances for example adverse reaction to drugs which have not been incorporated in the aforesaid list. Moreover, it depends on the merits of each individual case, on the recommendations of RDMC/AMO or either authorized officers who are in-charge for implementing the medical scheme.
To be entitled to the Extended Sickness Benefit (ESB), an insured person should have been continuously employed for 2 years or more at the commencement of a spell of sickness in which the disease has been diagnosed and should also satisfy other contributory conditions.
So get benefit of this provision and personally I suggest to donate him kidney and this is the only permanent solution to all his miseries.
