The ESI Court erred in allowing the application for sickness benefits as it was filed beyond the three-year limitation period prescribed by Section 77(1-A) of the Employees State Insurance Act, 1948.

ORAL JUDGMENT

This miscellaneous first appeal is filed challenging the order dated 13.08.2015 passed on ESI Application No.45/2013 by the Employees State Insurance Court, Bangalore.

2. Heard the learned counsel appearing for the respective parties.

3. The factual matrix of the case of the respondent/applicant before the ESI Court that he is an insured person under Section 2(9) of the Employees Insurance Act, 1948 as amended from time to time. It is also his case that under the ESI Scheme from June 1993, he has paid contributions up to October 2006 i.e., for 13 years. He has been allotted insurance number as IP No.16040051. It is also his case that the applicant suffered a brain stroke during 2006 and availed treatment from the ESIC dispensary up to 31.05.2007. The applicant was still unwell and was not in a position to carry on his duties. Hence, he approached the local office of the ESI Corporation at Yeshwanthpur for further leave. But, the same was refused inspite of producing the ESB certificate. The applicant represented to the Manager, Local Office, ESIC Peenya, Bangalore vide letter dated 18-21.06.2007 and requested the concerned authority to clarify as to why he was not granted further leave and also to refer the matter for reexamination of his fitness and to take an early action in this regard. The applicant was informed by the respondent to wait for a call letter from ESI Corporation. But the applicant did not receive any call letter and hence, the applicant lodged a complaint with the Medical Superintendent, Model Hospital, Rajajinagar, Bangalore to further extend the monetary benefits. The applicant received a letter dated 31.08.2008 from the Medical Superintendent to again approach the dispensary doctor for further action. The applicant had already waited for 14 months for the call letter and had not received any medical benefits and when nothing came out of it, the applicant being frustrated by the treatment meted out to him, complained to the State Medical Commissioner along with a copy of the Medical Superintendent, Model hospital, Rajajinagar.

4. It is further contend that after repeated follow-up, directions were given by the Deputy Director by way of endorsement on the letter dated 13.08.2008 wherein a direction was issued to the Manager, local office to refer the case to the Medical Board, if necessary. But the matter was never referred to the Medical Board and the monetary benefits from 19.10.2007 to 21.08.2008 were also not paid. The applicant thereafter pursued his case with the Commissioner of State/Regional Director, Medical Director, Binnypet by forwarding a copy of the letter at Annexure-A and the Deputy Director vide letter dated 10.09.2008 directed the Manager, local office, Peenya to refer the matter to the Medical Board. Thereafter, the applicant was asked to appear before the Medical Board on 24.06.2009. The medical board on examination extended the sickness benefit for a period of six months i.e., up to 24.12.2009. However, the period in question that is from 19.10.2007 to 21.08.2008 was not paid and remains unpaid to this day. It is also the case of the applicant that till date he has been denied benefits from 19.10.2007 to 21.08.2008 although he had given several representations to that effect. Hence, he had approached the ESI Court seeking for benefit. ESI Court issued the notice to the respondent and the respondent appeared and filed the statement of objections.

5. The main contention of the respondent before the ESI Court that the very application is not maintainable since the same is barbed by limitation. The details of the period during which the applicant availed the sickness benefit are also stated and denied all the allegation made in the application and also contend that the applicant has utterly failed to submit any ESB certificate for the period stated above and in the absence of any medical certificate, the applicant is not entitled to any claim muchless the benefit of payment of money