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ESI roadblocks

By Suhasini Singh and R Sukanya

ESIS is a contributory health insurance scheme that is supposed to cater to 80 lakh workers and their families. But bureaucratic hurdles ensure that workers find it virtually impossible to access these resources. As a result, the ESIC has built up reserves of US$1.63 billion, even while workers and their families struggle to get medical services

The Employees State Insurance Scheme (ESIS), a contributory health insurance scheme headed by the ESI Corporation (ESIC), is supposed to cater to 80 lakh workers and their families. However, workers find it virtually impossible to access these resources due to various bureaucratic hurdles and the insensitivity of officials. As a result, the ESIC has built up reserves of US$1.63 billion, even while workers and their families go a-begging for medical services. Case studies from around the country demonstrate that ESI has largely been a mechanism to siphon funds from workers.

ESI vital statistics

  • Number of insured persons in 2007 (workers): 1,01,57,573
  • Number of women workers insured in 2007: 17,97,657
  • Total beneficiaries (workers+families) in 2007: 3,94,11,343
  • Total number of employers in 2007: 3,31,744
  • Total income in 2007 (which includes contributions, interest, fines): Rs 3,108 crore
  • Total contribution (from employers and employees) in 2006-2007: Rs 2,453.48 crore
  • Total expenditure in 2007: Rs 1,350 crore
  • Total medical and cash benefits in 2006: Rs 1,053.72 crore

Source: ESI Annual Report, 2007

Inaccessible healthcare

"I was unwell and feeling tired for a long time," said Bangalore-based Yamuna, a single parent and garment worker diagnosed with TB. "The doctors in the dispensary would not touch me or examine me. They are so indifferent to us. Finally I was sent to the Employees State Insurance (ESI) hospital in Rajaji Nagar, where the doctors found these swellings on my neck. I had to be operated. I was started on TB medicine. It was difficult to go every alternate day to the hospital. The medicines were given for a week. I could not take the medicines regularly as they were very strong. I couldn't go to the hospital to ask the doctor; I have to take leave to go there."

The Employees State Insurance Scheme is the only public sector social security scheme covering a vast proportion of the working masses. It offers medical care of reasonable quality through ESI dispensaries and hospitals. But that's if and when a worker can access it. Most workers find it difficult to get a timely diagnosis from the ESIS. It is even more difficult for them to get permission or leave from their factory/workplace to go to the ESI dispensary or hospital for treatment. The apathy of the primary care service and the inaccessibility of the secondary care facility causes delays in diagnosis and treatment of workers, especially those with tuberculosis.

For the 400,000 garment workers (and all the other workers in Bangalore) there is only one super-specialty ESI hospital.

ESI dispensaries are required to be open until 7 pm. But some dispensaries do not function at all, and at others there are no doctors in the evening. The facilities provided at ESI hospitals/dispensaries are not listed anywhere, and workers are not aware of the benefits they can avail of under the scheme. Like Rupa, who works at Texport Creations, and had a miscarriage. She was denied leave by the management and was not aware that she could avail of four weeks leave as maternity benefits ensured by the ESIS.

Workers are allotted ESI dispensaries on the basis of their residential address. But for every administrative procedure associated with the ESIS -- getting an ESI photo identity card, change of address, or getting a sickness certificate -- workers have to apply for leave and visit the local ESI office. Sheela, who works in Gokuldas Exports in Peenya, used to live in Sungarakatte. She was allotted a dispensary nearest her house. She later moved to Mysore Road and had to run from pillar-to-post to change her ESI dispensary. It took her six months to get her address changed from Sungarakatte to Mysore Road; during this period she was unable to avail of any medical benefits at the Mysore Road dispensary.

The ESI system doesn't take suo moto action even in known cases of workplace-related illness. During a recent outbreak of waterborne disease at a factory, all the workers were admitted to the ESI referral hospital for almost a week. But although they had hospital discharge summaries they had to first go individually to their local ESI dispensary medical officer for a sickness certificate and then to the ESI administrative office to avail of the sickness benefit. Most workers did not apply for the benefit as the paperwork was too confusing and intimidating.

The maze of ESI rules deters workers from using its services. If a worker does not go to the ESI dispensary for over two months, she will be told to get Form No 37 filled in by the management to say that she is employed and that her contribution is being paid regularly. Most ESI forms are in English and Hindi; as a result, workers find it difficult to understand and fill them in.

An employee's contribution towards ESI is deducted from her wages by the employer. If the employer does not pay his contribution towards ESI, the worker cannot avail of any treatment facilities at the ESI dispensary. "They make us wait for so long when we are ill. The doctor doesn't examine us. We know we are paying for the ESI service from our salary. Still we are shouted at!" says Yamuna.

(Suhasini Singh is a researcher and communications coordinator at Cividep India, which works on labour issues in the garments sector and on issues of corporate accountability. R Sukanya researches and teaches public health. She also works with the Community Health Cell, Bangalore)

It's a long road to compensation

By Raghunath Manwar

This is the story of Pepiben Dhanaji Marwadi's long and tedious journey to get compensation after an accident at her workplace. She finally died of her injuries before the Employees State Insurance Corporation was ordered by the courts to pay up

Born in 1961, in a small village in Rajasthan, Pepiben Dhanaji Marwadi came to Ahmedabad when she was barely 18 years old. Married to Dhanajibhai, a truck driver in the city, Pepiben started working as a contract worker in the Ahmedabad Electricity Company (AEC) in 1996. M/s Geeta Constructions, a contract labour company, hired her to work as a headloader in AEC.

The job required her to haul 40-45 kg of coal on to a truck several times a day, over a precariously balanced wooden plank. Every time she negotiated the climb, she risked a fall. One morning, on November 10, 2000, she slipped and fell off the plank.

An unconscious Pepiben was taken to the D1 Employees State Insurance (ESI) dispensary, where doctors advised that she be shifted to the Ahmedabad Civil Hospital. Pepiben had sustained severe internal brain injuries.

AEC blamed the fall on high blood pressure, an ailment Pepiben did not have. This is a common tactic employed by employers to avoid reporting accidents under the Factories Act.

While she was in hospital, the contractor paid Rs 1,500 for an MRI. After 14 days in hospital, Pepiben was discharged, on November 24, 2000. For a year, she could not go to work and had to regularly undergo treatment at the hospital. While at home, ESI gave her a sickness benefit allowance of Rs 4,000. Although entitled to disability benefit, which is 70% of her wages, Pepiben was given only 50% of her wages, according to the sickness benefit allowance. Since AEC had not filled out Form 16 or an accident form under the Factories Act, ESI did not have any record of Pepiben's accident.

The safety committee of AEC, which had worker representatives, wrote to the ESI and factory inspector telling them about the accident immediately after the incident. Neither the ESI nor the factory inspector considered the safety committee's report.

Finally, on May 5, 2001, the factory inspector called a meeting between the company management and representatives from the safety committee. At the meeting, the management was advised by the inspector to submit Form 16. On May 24, 2001, AEC sent Form 16 to the ESI and factory inspector, accepting that Pepiben had indeed been involved in an accident. Ironically, the ESI refused to accept the form as the form had come six months after the date of the incident. It sought a clarification from the company. AEC did not submit any clarification, and eventually the file relating to Pepiben's compensation was closed by the ESI.

But members of the safety committee did not let the matter rest. They sent Pepiben's case for examination to the ESI medical board. On July 3, 2007, seven years after the accident, a local ESI medical board examined Pepiben's case. By this time, Pepiben had almost lost her voice and could not walk. She was physically carried, in the heavy rain, for an examination by the ESI medical board. After examining Pepiben, the board too did not give a clear report, attributing her fall to 'hypertension'. Informal inquiries by a member of the safety committee revealed that board members had given the report following pressure from AEC.

Simultaneously, a complaint had been filed in the labour court, in 2002, for payment of disability compensation to Pepiben. The labour court considered the incident an accident and passed an order on June 14, 2005, telling the ESI to pay Pepiben temporary disability benefit and also legal expenses for the case. This worked out to Rs 18,000. But the ESI challenged the labour court's decision and appealed against it in the Gujarat High Court. The high court passed an order, on August 28, 2008, upholding the labour court's decision and ordered the ESI to compensate Pepiben by November 10, 2008, or face action. The ESI has not yet complied with the order.

Meanwhile, Pepiben died in a hospital due to her injuries on September 15, 2007, seven years after her fall at the factory.

(Raghunath Manwar is an Ashoka Fellow and a former worker at the Ahmedabad Electricity Company. After being thrown out of his job for raising the issue of unsafe work practices, he set up a voluntary group -- Occupational Health and Safety Association -- to identify victims of occupational disease and fight for compensation)


The ESI run-around

 Govind Devji worked for 30 years in the weaving department of a composite textile mill, Kanti Cotton Mill, in a small town called Surendranagar in Gujarat. In 1989, at a public meeting organised by his union, he heard that high levels of noise at work could lead to hearing impairment and that one could claim compensation for this from the Employees State Insurance Corporation (ESIC). A few days after the lecture, Govind approached his union seeking help in claiming compensation for his hearing loss. The union contacted the activist who had delivered the lecture. They were advised to conduct a medical examination and study the report. The activist told them that if they filed a claim they would be the first to do so in the whole of India.

Govind then visited the ESI clinic and was referred to an ESI ENT specialist in Ahmedabad. The expert examined him and advised him to take some medicines for two weeks and come back. Govind saw the expert several times within the next six months. He requested the doctor to issue him a certificate stating that his deafness was noise-induced. The doctor asked him to come to his private clinic. Govind went to the private clinic where he had to pay a high fee. Later, the doctor issued him the required certificate.

Once he got the certificate, Govind contacted the union for further advice. He was told to get the management to fill up Form 16-A. The management asked him to pick up a blank form from the ESIC office. He went to the local office of the ESIC, located in a neighbouring town. The manager of the office told him that he had been working there for the past 21 years but had never heard of any Form 16-A. Instead, he offered Govind Form 16. Govind explained the purpose of the form he was after. The manager told him there was no provision for compensation for hearing impairment under the ESI Act. Disappointed, Govind returned to the union office. Both the union and Govind expressed anger at the activist who had told them that noise-induced hearing loss was a compensable disease under the ESI Act. They contacted the activist and complained that he had wasted a lot of their time and energy. The activist assured them that the information was correct and told them to visit the manager again, this time referring to the section number in the Act. The union got interested. A representative accompanied Govind to the local office of the ESIC where they cited the relevant section number. The manager realised that the matter had become serious. He told them to pick up a blank form from the head office.

Office-bearers of the union went to the head office of the ESIC in Ahmedabad where they visited the director. The director told them to get a copy of the form from the store department. When they went to the store they were told that the form was not available. After a while, the manager at the local office informed them that he had managed to get a copy of the form.

The form was duly filled in by management at the mill, and submitted to the local office. After around six months, in 1992, Govind was told to present himself before the special medical board of the ESIC in Ahmedabad. Just as the session was about to commence an officer went up to Govind and told him to follow him into an adjoining room. The officer asked him a few questions and then informed him that he could hear properly and that he should withdraw the claim. Govind was aware that he was the first worker in India to claim compensation for noise-induced hearing loss (NIHL) under the ESI Act. He was determined not to budge under pressure. He tried to convince the officer of his genuineness, but to no avail.

The board resumed its meeting and Govind was asked to attend. When he went into the room he saw the same officer sitting among the assessors. He was asked a few questions; his documents were scrutinised and he was asked to leave. After a month or so he was informed that his claim had been turned down by the board. No reasons were given.

What now?

The activist, after studying his papers, advised them to make an application with the medical appeals tribunal in Rajkot. A lawyer was identified to help Govind file the appeal. Appeal No 2/93 was filed in 1993. The tribunal asked Govind to visit several hospitals in Jamnagar and Ahmedabad during the course of the hearing. By this time -- 1993 -- even the mill had closed down. Govind was now unemployed. It was difficult for him to visit Rajkot from Surendranagar on every hearing date. Still, his hopes and trust in the legal system remained intact.

After seven years, on November 22, 2000, the tribunal passed an order in favour of Govind. Govind was pleased with the verdict, but not the ESIC. The corporation challenged the order in the ESI court. The court heard both parties and passed an order in favour of Govind, on March 12, 2004. The ESIC was still not satisfied. It went to the Gujarat High Court, and Govind had to hire a high court lawyer to defend him. The high court dismissed the ESIC petition.

Govind ultimately won his claim, but after 13 long years. Although he was the first claimant in this particular category, workers in Mumbai who had filed their claims later were the first to win their cases!

-- Jagdish Patel

(Jagdish Patel, an occupational safety and health (OSH) activist, worked for 20 years with small and medium-scale chemical factories. He got involved in the trade union movement and helped establish VSS Mandal -- a pressure group on OSH -- and later Peoples' Training and Research Centre. He has been editing a Gujarati bi-monthly on OSH since 1988. He now works full-time for PTRC)

InfoChange News & Features, April 2009