Sickness Benefit - Extended Sickness Benefit
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 the names of many existing diseases have been
changed as under :-
I Infectious Diseases
Tuberculosis
Leprosy
Chronic Emphysema
AIDS
II Neoplasm's
Malignant Diseases
III Endocrine, Nutritional and Metabolic Disorders
Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy.
IV Disorders of Nervous System
Monoplegia
Hemiplegia
Paraplegia
Hemi paresis
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:-
Unstable Angina
Myocardial infraction with ejection less than 45%
Congestive Heart Failure- Left , Right
Cardiac Valvular Diseases with failure/complications
Cardiomyopathies
Heart disease with surgical intervention along 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 Orthopedic Diseases
Dislocation of vertebra/prolapsed of intervertebral disc
Non union or delayed union of fracture
Post Traumatic Surgical amputation of lower extremity
Compound fracture with chronic osteomyelitis
X Psychoses
Sub-group under this head are listed for clarification
Schizophrenia
Endogenous depression
Manic Depressive Psychosis (MDP)
Dementia
XI Others
More than 20% burns with infection/complication
Chronic Renal Failure
Reynard'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 running 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).
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