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Section 43: Medical benefit

The Code on Social Security, 2020 (Act No. 36 of 2020) • Official Statutory Text & Plain English Practice Guide

Statutory Mandate
Chapter IV: Employees' State Insurance Corporation
Competent Labour Forum
Act No. 36 of 2020
Section 42 All 163 Sections of Code on Social Security, 2020 Section 44

Legal Commentary & Landmark Judgments: Section 43

Section 43 of the Code establishes the comprehensive entitlement of insured persons and their families to receive medical benefit under the ESI scheme, encompassing outpatient consultation, diagnostic imaging, inpatient hospitalization, and specialized surgical interventions.

  • Universal Medical Care Entitlement: Confers an enforceable statutory right to comprehensive medical care from the date the insured worker enters insurable employment.
  • Extension of Medical Benefit to Insured's Family: Explicitly extends full medical coverage to the spouse, dependent children, and dependent parents of the insured person, safeguarding the entire household.
  • Lifelong Medical Care for Retired & Disabled Workers: Provides for the continuation of medical benefits to retired insured persons and workers who suffer permanent disablement, upon payment of nominal annual contributory tokens.
Key Landmark Precedents:
  • Consumer Education & Research Centre v. Union of India (1995) 3 SCC 42: Supreme Court held that the right to health and medical care is a fundamental right under Article 21, and social security medical schemes are the constitutional vehicle to realize this right.
  • E.S.I.C. v. Joint Director (2008) 11 SCC 544: Affirmed that the Corporation is under a strict statutory duty to provide super-specialty medical treatment to insured workers and their families without arbitrary cost caps.
  • Royal Western India Turf Club v. E.S.I.C. (2016) 4 SCC 521: Reaffirmed that medical benefit provisions under the ESI framework are non-derogable social security imperatives.
Courtroom Practice & Strategic Litigation Guidance:

If an ESI dispensary or hospital lacks specialized tertiary medical facilities, file an immediate emergency referral application under Section 43 for treatment at a tie-up private super-specialty hospital, ensuring the full cost is directly settled by the Corporation.

Section 42 All 163 Sections of Code on Social Security, 2020 Section 44