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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
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Tuberculosis
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Leprosy
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Chronic Empyema
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AIDS
II Neoplasms
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Malignant Diseases
III Endocrine, Nutritional and Metabolic Disorders
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Diabetes Mellitus-with proliferative retinopathy/diabetic
foot/nephropathy.
IV Disorders of Nervous System
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Monoplegia
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Hemiplegia
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Paraplegia
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Hemiparesis
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Intracranial Space Occupying Lesion
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Spinal Cord Compression
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Parkinson’s disease
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Myasthenia Gravis/Neuromuscular Dystrophies
V Disease of Eye
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Immature Cataract with vision 6/60 or less
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Detachment of Retina
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Glaucoma
VI Diseases of Cardiovascular System
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Coronary Artery Disease:-
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Unstable Angina
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Myocardial infraction with ejection less than 45%
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Congestive Heart Failure- Left , Right
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Cardiac Valvular Diseases with failure/complications
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Cardiomyopathies
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Heart disease with surgical intervention alongwith complications
VII Chest Diseases
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Bronchiectasis
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Interstitial Lung Disease
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Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor
Pulmonale)
VIII Diseases of the Digestive System
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Cirrhosis of liver with ascities/chronic active hepatitis
IX Orthopaedic Diseases
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Dislocation of vertebra/prolapse of intervertebral disc
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Non union or delayed union of fracture
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Post Traumatic Surgical amputation of lower extremity
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Compound fracture with chronic osteomyelitis
X Psychoses
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Sub-group under this head are listed for clarification
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Schizophrenia
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Endogenous depression
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Manic Depressive Psychosis (MDP)
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Dementia
XI Others
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More than 20% burns with infection/complication
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Chronic Renal Failure
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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).
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