ESIC Form 10 Sickness/Disablement Claim

An ESIC Form 10 Sickness/Disablement Claim in India captures the information the relevant authority needs for the matter it concerns and creates a dated written record of what was submitted.

The Employees' State Insurance Act 1948 established the ESIC as a self-financing social security scheme for workers in factories and covered establishments. Section 46 of the Act specifies the benefits payable, including Sickness Benefit under Section 46(1)(a), Temporary Disablement Benefit under Section 46(1)(c), and Enhanced Sickness Benefit under Rule 56 of the ESI (Central) Rules 1950. Form 10 is the prescribed application form under Rule 52 of the ESI (Central) Rules 1950 for claiming these cash benefits.

Sickness Benefit under the ESI Act pays 70% of the insured person's average daily wages for up to 91 days per benefit period, subject to a two-day waiting period. Extended Sickness Benefit — available to workers with at least two years of continuous coverage and 156 contributions in the preceding four contribution periods — extends compensation at 80% of wages for up to 730 days for specified long-term ailments listed in the ESI (Central) Rules. Enhanced Sickness Benefit pays 100% of wages for workers undergoing sterilisation operations.

Temporary Disablement Benefit (TDB) applies specifically to employment injury cases — accidents at the workplace or occupational diseases notified under Schedule III of the ESI Act. TDB is payable at 90% of wages from the first day of disablement, with no waiting period. This higher rate reflects the employer's responsibility for workplace safety under the Factories Act 1948 and related occupational health legislation.

ESIC operates on a contribution period and benefit period cycle. The first contribution period runs from 1 April to 30 September, and the corresponding benefit period runs from 1 January to 30 June of the following year. Workers must contribute for at least 78 days in the relevant contribution period to qualify for Sickness Benefit in the corresponding benefit period. For TDB arising from employment injury, no minimum contribution requirement applies.

The ESIC insurance number — a 17-digit Insured Person (IP) number — is the primary identifier on Form 10. Workers receive this number upon first registration by an employer covered under the ESI Act. Establishments employing 10 or more persons with power (or 20 or more without power) in notified areas must register under the Act and contribute 3.25% of wages (employer) and 0.75% of wages (employee), totalling 4% of wages monthly. Workers earning up to ₹21,000 per month (₹25,000 for persons with disabilities) are covered.

ESIC Form 10 must be filed whenever a covered employee requires wage compensation during medically certified absence from work due to illness or employment injury in India.

An insured worker must file Form 10 when absent from work for three or more consecutive days due to illness certified by an ESI medical officer, panel doctor, or authorised insurance medical practitioner (IMP). The first two days of illness constitute the waiting period under the ESI (Central) Rules 1950, and benefit becomes payable from the third day. Workers must submit Form 10 within 21 days of the commencement of sickness at the ESI Branch Office covering their area.

For employment injury cases — accidents at the factory, worksite, or during commute as covered by Section 51E of the ESI Act — Form 10 for Temporary Disablement Benefit must be filed from the very first day of absence, since no waiting period applies. Manufacturing workers, construction labourers, and workers in hazardous process establishments under Chapter IVA of the Factories Act 1948 particularly need this form after workplace accidents.

Workers diagnosed with specified long-term ailments — including tuberculosis (TB), mental illness, malignant diseases (cancer), and other conditions notified under Rule 54 of the ESI (Central) Rules — require Form 10 to access Extended Sickness Benefit at 80% of wages for periods up to 730 days per two-year block, provided the two-year continuous employment and 156-day contribution conditions are met.

Male workers who have undergone vasectomy or female workers who have undergone tubectomy for sterilisation should file Form 10 for Enhanced Sickness Benefit, which pays full wages for seven days (vasectomy) or fourteen days (tubectomy) of convalescence. No separate form exists — Form 10 covers this benefit category.

Nominees or legal heirs of a deceased insured person may use Form 10 or the appropriate benefit claim form to recover any Sickness Benefit or TDB that became payable before the insured person's death but remained unclaimed, subject to the limitation period under the ESI Act.

A properly completed ESIC Form 10 must contain specific particulars to enable the ESIC Branch Office to verify eligibility and authorise payment without delay.

Insured Person's details form the opening section: the full name, 17-digit ESIC insurance number (IP number), permanent and communication address, and the name and address of the employer or factory. The IP number is the ESIC's primary identifier and must be accurate — a wrong IP number delays processing because the system cannot locate the contribution record. Workers can find their IP number on their Pehchan card (the digital ESI card) downloadable from the esic.in IP Portal.

Employer's details and certification occupy the reverse of the standard Form 10. The employer must certify that the insured person was absent from work during the entire period claimed and that wages were not paid for the absent period. Employers who pay wages during sickness (as a matter of service terms or gratuity) cannot claim that the insured person is simultaneously entitled to Sickness Benefit — the benefit is designed to compensate for lost wages. The employer's TAN and ESI code number are required for cross-referencing the monthly contribution return filed under Form 5.

Medical Certificate (Form 9) is a mandatory attachment. The ESI-authorised medical officer or IMP must certify the nature of illness, the date of onset, the period of incapacity, and the expected date of fitness to return to work. For TDB, the certificate must specify that the disability arose from an employment injury. The Form 9 certificate and Form 10 claim are typically submitted together. Late submission of the medical certificate (beyond 10 days from issue) may cause difficulty in processing.

Period of sickness claimed specifies the start and end dates of the illness (in DD/MM/YYYY format) and the total number of days claimed. Since benefit is paid for actual absence days after the waiting period, accurate dates are essential. Dates must match the employer's attendance register and the medical certificate exactly.

Bank account details for direct credit are now required by most ESIC branches. The insured person's bank account number, IFSC code, and bank name must be provided for direct benefit transfer (DBT) under the government's Jan Dhan to Jan Suraksha framework. Workers without a bank account must open one — preferably a zero-balance Jan Dhan account — before filing.

Signature or thumb impression of the insured person confirms the accuracy of the information and the claim. For illiterate claimants, a left-hand thumb impression is accepted in the presence of a witness whose details must also be provided.

Declaration of non-receipt of wages confirms that the insured person did not receive wages from the employer during the claimed period, satisfying the ESI Act's requirement that Sickness Benefit compensates for wage loss and is not an additional payment on top of wages. The forms-legal.com ESIC Form 10 Sickness/Disablement Claim template covers the mandatory elements under Industrial Disputes Act, 1947.