5.4 Extended Sickness Benefit (ESB)
IPs suffering from long term diseases were experiencing great hardship on expiry of 91 days Sickness benefit. Often they, though not fit for duty, 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.
1. An IP suffering from certain long term diseases is entitled to ESB, only after exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable, is reviewed by the Corporation from time to time. The list was last reviewed on 5.12.99 and revised provisions of ESB became effective from 1.1.2000 and at present this list includes 34 diseases which are grouped in 11 groups as per International Classification of diseases and theo names of many existing diseases have been changed as under :-
I Infectious Diseases
- Chronic Empyema
- Malignant Diseases
III Endocrine, Nutritional and Metabolic Disorders
- Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.
IV Disorders of Nervous System
- 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
VI Diseases of Cardiovascular System
- Coronary Artery Disease:-
- Unstable Angina
- Myocardial infraction with ejection less than 45%
- Congestive Heart Failure- Left , Right
- Cardiac Valvular Diseases with failure/complications
- Heart disease with surgical intervention alongwith complications
VII Chest Diseases
- 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
- Sub-group under this head are listed for clarification
- Endogenous depression
- Manic Depressive Psychosis (MDP)
- More than 20% burns with infection/complication
- Chronic Renal Failure
- Reynaud’s disease/Burger’s disease.
1. In addition to the above list, Director General/Medical Commissioner are authorised to sanction ESB for a maximum period upto 730 in cases of rare but treatable diseases or under special circumstances, such as, adverse reaction to drugs which have not been included in the above list, depending on the merits of each case, on the recommendations of RDMC/AMO or either authorised officers runniong the medical scheme.
2. To be entitled to the Extended Sickness Benefit an Insured Persons should have been in continuous employment for 2 years or more at the beginning of a spell of sickness in which the disease is diagnosed and should also satisfy other contributory conditions.
3. ESB shall be payable for a period of 124 days initially and may be extended up to 309 days in chronic suitable cases by Regional Dy. Medical Commissioner/Medical Referee/Administrative Medical Officer/Chief Executive of the E.S.I. Scheme in the State or his nominee on the report of the specialist(s).