EPFO APFC 2023 General Studies · Question 28 of 120

Correct — C, (c) The Medical Board. Section 54 of the Employees' State Insurance Act, 1948 is headed 'Determination of question of disablement' and assigns the whole class of such questions to a medical board constituted in accordance with the regulations. The section is worth knowing in its parts, because each part is a possible stem on its own: whether the relevant accident has resulted in permanent disablement; whether the extent of loss of earning capacity can be assessed provisionally or finally; whether an assessment of the proportion of that loss is provisional or final; and, where the assessment is provisional, for what period it is to hold good. The Act gives this cluster a name of its own — the 'disablement question' — and that label is the giveaway in any stem, because the Act routes every disablement question to the same body. The logic of the allocation is that these are medical judgements dressed as legal ones. Deciding that a hand injury has cost an insured person forty per cent of his earning capacity, and that the loss is permanent rather than temporary, is not something an inspector or an adjudicator can do from the file; it needs clinical examination against a schedule of injuries. So the statute takes the question out of the ordinary adjudicatory channel — the Employees' Insurance Court under Sections 74 and 75, which decides other disputes under the Act — and gives it to a medical body, with its own appellate route. Section 54A then completes the structure: an assessment by the medical board may be reviewed by that board where it was obtained by fraud or misrepresentation or where there has been a substantial and unforeseen aggravation, and an appeal against its decision lies to the medical appeal tribunal, with a further appeal to the Employees' Insurance Court.

• (a)The Insurance Medical Practitioner — The insurance medical practitioner is the doctor at the coalface of the scheme — the person who examines an insured person, provides medical benefit and issues the certificates on which sickness benefit and temporary disablement benefit are paid. That is precisely why the option is tempting: a candidate reasons that a disablement question is a medical question and picks the nearest medical individual. But the Act distinguishes between certifying a person's current condition, which a single practitioner does routinely, and determining a disablement question, which fixes a percentage of permanent loss of earning capacity and with it the value of a benefit paid for years or for life. Section 54 reserves the second to a board, not to an individual practitioner.
• (b)The Social Security Officer — The Social Security Officer, the designation now used for the inspecting officers appointed under Section 45 of the Act, is an enforcement functionary. Such an officer requires employers to produce records, examines wage registers and returns, inquires into whether contributions have been correctly paid, enters premises and reports non-compliance. Nothing in that role is clinical, and the Act nowhere gives an inspecting officer a say in medical assessment. Confusing the two branches of the ESI machinery — contribution enforcement on one side, medical benefit and assessment on the other — is the underlying error this option is designed to catch.
• (d)The Medical Appeal Tribunal — The medical appeal tribunal is a real body under the Act, and it is the strongest distractor precisely because it appears in the same corner of the statute. But it sits above the medical board, not in its place: under Section 54A an appeal from the decision of the medical board lies to the medical appeal tribunal, with a further appeal to the Employees' Insurance Court, and an appeal may in certain circumstances be taken directly to that Court. A tribunal that hears appeals cannot also be the authority of first instance, so an option naming it answers the question 'who hears an appeal against the assessment' rather than the question actually asked, which is who determines the disablement question in the first place.

The Employees' State Insurance Act, 1948 is India's first comprehensive social insurance statute, running a contributory scheme financed by employer and employee contributions and administered by the Employees' State Insurance Corporation. Section 46 lists the benefits it pays: sickness benefit, maternity benefit, disablement benefit, dependants' benefit, medical benefit and funeral expenses. Disablement benefit turns on definitions the Act supplies — employment injury, temporary disablement, permanent partial disablement and permanent total disablement — and on a set of presumptions in Sections 51A to 51E that make claiming realistic: an accident arising in the course of employment is presumed, in the absence of evidence to the contrary, also to have arisen out of it; an accident is not excluded merely because the employee was acting in breach of a regulation, if he was acting for the purposes of the employer's trade; and accidents while travelling in transport provided by the employer, while meeting an emergency, and while commuting are treated as arising out of employment. Assessment of disablement is then split off from ordinary adjudication: a medical board determines the disablement question under Section 54, its assessment may be reviewed and appealed under Section 54A to a medical appeal tribunal and thence to the Employees' Insurance Court, while all other disputes — coverage, contributions, entitlement — go to that Court under Sections 74 and 75. Knowing which authority owns which question is the examinable structure.

The APFC paper tests social security statutes as an administrator's map of institutions: who decides what, and at which stage. That is why questions in this block so often print four bodies rather than four numbers. The technique that answers them is to identify the character of the question being asked — medical, enforcement or adjudicatory — and then the stage — first instance, review or appeal. Here 'any question relating to disablement' is medical in character and the stem asks about first instance, which fixes the medical board and rules out both the enforcement officer and the appellate tribunal. The same two-axis test disposes of most of the institutional questions on this paper, including those about the Employees' Insurance Court, the Employees' Provident Funds Appellate Tribunal and the Commissioner under the Employees' Compensation Act. It is also worth remembering that an employee covered by the ESI scheme is generally barred from claiming under the Employees' Compensation Act for the same employment injury, so the two statutes examined side by side in this block are alternatives rather than cumulative remedies.

• Section 54 of the Employees' State Insurance Act, 1948 provides that any question whether an accident has resulted in permanent disablement, whether loss of earning capacity can be assessed provisionally or finally, whether an assessment is provisional or final, and for what period a provisional assessment holds good, shall be determined by a medical board; the Act calls this class of questions the disablement question.
• Section 54A allows the medical board's assessment to be reviewed where it was obtained by fraud or misrepresentation or where there has been substantial and unforeseen aggravation, and provides an appeal to the medical appeal tribunal with a further appeal to the Employees' Insurance Court.
• The insurance medical practitioner treats insured persons and issues the certificates on which sickness and temporary disablement benefits are paid, while the Social Security Officer — the designation for inspecting officers appointed under Section 45 — enforces contribution and record-keeping obligations; neither determines a disablement question.
• Benefits under Section 46 are sickness benefit, maternity benefit, disablement benefit, dependants' benefit, medical benefit and funeral expenses, financed by employer and employee contributions and administered by the Employees' State Insurance Corporation.
• Sections 51A to 51E supply the presumptions that make employment-injury claims workable, including that an accident arising in the course of employment is presumed also to arise out of it, and that accidents while travelling in the employer's transport, while meeting an emergency and while commuting are treated as arising out of employment.

• Choosing the nearest medical person rather than the body the statute names — an insurance medical practitioner certifies a current condition, but a disablement question, which fixes permanent loss of earning capacity, goes to a board
• Naming the appellate authority when the stem asks about first instance; the medical appeal tribunal exists, but it sits above the medical board under Section 54A
• Mixing the enforcement wing with the medical wing: Social Security Officers inspect records and pursue contributions, and have no role in assessment
• Sending a disablement question to the Employees' Insurance Court, which decides other disputes under the Act but not this one — Section 54 carves it out expressly

Institutional questions of this kind are a staple of the labour and social security block, and they come in a predictable family: who determines a disablement question, who decides a dispute about contributions, who hears an appeal from a medical board, who may review an assessment, and which authority under the Employees' Compensation Act corresponds to which under the ESI Act. Build the answer as a flow — practitioner, board, medical appeal tribunal, Employees' Insurance Court, High Court — and the whole family becomes one diagram to remember rather than five separate facts.

No directly related past PYQ was found.

• practice — not a real PYQ

  Under the Employees' State Insurance Act, 1948, an appeal against the decision of a medical board on a disablement question lies to which one of the following?

  • (a)The Employees' State Insurance Corporation
  • (b)The Medical Appeal Tribunal
  • (c)The Social Security Officer
  • (d)The High Court

  Answer(b) The Medical Appeal Tribunal — Section 54A provides that an appeal from the decision of the medical board lies to the medical appeal tribunal, from which a further appeal lies to the Employees' Insurance Court, and in certain circumstances an appeal may be taken directly to that Court. The Corporation administers the scheme rather than hearing such appeals, the Social Security Officer is an enforcement functionary, and the High Court comes in only on a substantial question of law from the Employees' Insurance Court.

• practice — not a real PYQ

  Which one of the following is not among the benefits enumerated under Section 46 of the Employees' State Insurance Act, 1948?

  • (a)Sickness benefit
  • (b)Dependants' benefit
  • (c)Gratuity on termination of employment
  • (d)Medical benefit

  Answer(c) Gratuity on termination of employment — Section 46 lists sickness benefit, maternity benefit, disablement benefit, dependants' benefit, medical benefit and funeral expenses. Gratuity is not an ESI benefit at all; it is payable under the Payment of Gratuity Act, 1972 by the employer to an employee who has rendered continuous service, and it has no connection with the contributory insurance scheme run by the Corporation.