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Section 44: Scale of 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 43 All 163 Sections of Code on Social Security, 2020 Section 45

Legal Commentary & Landmark Judgments: Section 44

Section 44 of the Code governs the scale and standard of medical benefit provided by the Corporation, specifying the nature of inpatient, outpatient, and domiciliary medical services provided across ESI hospitals and empaneled healthcare centers.

  • Standardized National Medical Treatment Protocols: Requires that medical care provided to insured persons must conform to clinical guidelines and pharmacopeia standards formulated by the Medical Council and Central Government.
  • Domiciliary & Outpatient Treatment Infrastructure: Obligates the Corporation to maintain mobile medical vans, neighborhood clinics, and primary health units in dense industrial clusters to provide immediate primary care.
  • Reimbursement for Emergency Non-Empaneled Care: Permits reimbursement of medical expenses incurred at non-empaneled private hospitals in bona fide life-threatening emergencies where ESI facilities were inaccessible.
Key Landmark Precedents:
  • E.S.I.C. v. Joint Director (2008) 11 SCC 544: Supreme Court held that where an insured worker suffers a medical emergency and local ESI infrastructure is inadequate, the Corporation must reimburse actual emergency treatment expenses incurred at private hospitals.
  • Consumer Education & Research Centre v. Union of India (1995) 3 SCC 42: Affirmed that the scale of medical benefit provided under social security statutes must be modern, effective, and non-discriminatory.
  • B.P.L. Ltd. v. R. Sudhakar (2004) 7 SCC 219: Affirmed that medical certifications issued by authorized ESI medical officers are binding proof of clinical illness and incapacity.
Courtroom Practice & Strategic Litigation Guidance:

In emergency reimbursement disputes before the EI Court, produce emergency admission notes, clinical discharge summaries, and referral refusal slips from the nearest ESI dispensary to establish bona fide emergent necessity.

Section 43 All 163 Sections of Code on Social Security, 2020 Section 45