How to Claim ESI Benefits in India Under the ESI Act 1948

The Employees' State Insurance (ESI) Act, 1948 is a social security legislation that provides a comprehensive package of medical and cash benefits to employees and their dependants in case of sickness, maternity, disablement, or death arising out of employment. The scheme is administered by the Employees' State Insurance Corporation (ESIC) and covers establishments with 10 or more employees where workers earn up to Rs. 21,000 per month (Rs. 25,000 for employees with disability). As of August 2026, the government is actively considering raising the wage ceiling to Rs. 30,000 per month, though no formal notification has been issued yet.

This guide explains how to register under the ESI scheme, the contribution structure, the types of benefits available, how to file claims through the ESIC portal, eligibility conditions, and employer obligations. Workers who are also covered under India's new labour codes should note that the ESI Act continues to operate as the primary social insurance framework pending full operationalization of the Code on Social Security, 2020.

Who Is Covered Under the ESI Scheme?

The ESI scheme applies to factories employing 10 or more workers and to shops, hotels, restaurants, cinemas, road transport undertakings, newspaper establishments, and other notified establishments with 10 or more employees. All employees drawing wages up to Rs. 21,000 per month are covered (Rs. 25,000 for employees with disability). Once covered, employees continue to receive benefits even if their wages subsequently exceed the ceiling during a benefit period. Every covered employee is assigned a unique 17-digit Insurance Number (IP number) that they use to access benefits.

The scheme also extends to gig workers and platform workers under the proposed framework of the Code on Social Security, though the specific rules for gig workers are yet to be notified.

Contribution Rates

The ESI scheme is funded through contributions from both employers and employees. The current contribution rates (as of 2026) are 3.25% of gross wages by the employer and 0.75% of gross wages by the employee, totaling 4% of eligible wages. Employers must deposit ESI contributions by the 15th of the following month. Late payment attracts interest at 12% per annum under Section 39(5)(a) of the ESI Act. Employees earning up to Rs. 176 per day are exempt from paying their share of the contribution.

Contribution Periods and Benefit Periods

The ESI scheme operates on two contribution periods and corresponding benefit periods each year. The first contribution period (April 1 to September 30) corresponds to the benefit period of January 1 to June 30 of the following year. The second contribution period (October 1 to March 31) corresponds to the benefit period of July 1 to December 31. Contributions paid in one period determine eligibility for benefits in the corresponding benefit period, with a lag of two to six months.

Types of Benefits Under the ESI Act

Sickness Benefit (Section 49)

Sickness benefit provides cash compensation at 70% of the average daily wages for a maximum of 91 days in any two consecutive benefit periods. To be eligible, the insured person must have paid contributions for at least 78 days in the relevant contribution period. A medical certificate from an ESI dispensary or hospital is required. Extended sickness benefit at an enhanced rate is available for specified long-term diseases such as tuberculosis, cancer, and mental illness, for a period of up to two years (at 80% of wages).

Maternity Benefit (Section 50)

Maternity benefit provides 100% of the average daily wages for a period of 26 weeks (extendable by one month on medical advice). The benefit is also available for miscarriage (6 weeks) and medical termination of pregnancy (6 weeks). To be eligible, the insured woman must have paid contributions for at least 70 days in the two preceding contribution periods. This benefit is in addition to medical care provided through ESI hospitals and dispensaries. If you are also entitled to gratuity upon resignation or termination, maternity benefit and gratuity are independent entitlements.

Disablement Benefit (Section 51)

Temporary Disablement Benefit is payable at 90% of the average daily wages for the entire duration of the disability. No minimum contribution period is required for employment injury benefits. Permanent Disablement Benefit is payable as a monthly pension at 90% of wages for total permanent disability, or a proportionate amount for partial permanent disability based on the assessed loss of earning capacity. The disability must arise out of and in the course of employment.

Dependants' Benefit (Section 52)

If an insured person dies as a result of an employment injury, dependants are entitled to a monthly pension at 90% of average daily wages. Dependants include the widow or widower, children (until age 25, or for life if infirm), and parents. No minimum contribution period is required for this benefit.

Funeral Expenses

Upon the death of an insured person, the ESIC pays funeral expenses of Rs. 15,000 to the person who incurs the expenditure on the funeral. This is payable irrespective of whether the death was caused by an employment injury or not, provided the deceased was an insured person at the time of death.

How to File a Claim on the ESIC Portal

Claims can be filed online through the ESIC IP Portal at esic.in. Log in using your 17-digit Insurance Number. New users must register first using their IP number and linked mobile number. Select the type of benefit you wish to claim, fill in the claim form with accurate details (period of sickness or disablement, hospital information, bank account for direct benefit transfer), and upload supporting documents such as medical certificates and discharge summaries. Submit the claim and note the reference number for tracking.

You can also check your contribution history, download your Pehchan card (ESIC identity card), and track claim status through the portal. If you face issues with the portal or your claim is rejected, you can approach the local ESIC branch office or file a complaint with the ESIC Regional Office. For broader issues involving NHRC complaints, such as denial of medical care at ESI facilities, that remedy is also available.

Employer Obligations

Employers must register within 15 days of the ESI Act becoming applicable. They must deduct employee contributions and deposit both shares by the 15th of the following month. Non-compliance attracts imprisonment up to 3 years and fines up to Rs. 10,000 under Section 85 for non-payment. Deducting contributions without depositing them carries a minimum 1 year imprisonment. Damages up to 100% of arrears may be levied under Section 85B. Employers covered under factory registration requirements or apprenticeship establishment registration must ensure simultaneous compliance with the ESI Act.

Key Takeaways

The ESI scheme provides sickness benefit (70% wages, 91 days), maternity benefit (100% wages, 26 weeks), disablement benefit (90% wages), dependants' benefit (90% wages as pension), and funeral expenses (Rs. 15,000). The wage ceiling is Rs. 21,000 per month, with a proposed increase to Rs. 30,000 under consideration. Contributions total 4% of wages (0.75% employee, 3.25% employer). File claims through the ESIC IP Portal using your Insurance Number. If you are also exploring DPDPA compliance obligations for handling employee personal data collected under the ESI scheme, ensure that your data protection framework covers ESIC-related records as well.