Rule 48: Assistance of medical expenses for treatment of major ailments of a registered construction worker [and his or her dependents(Karmika Chikitsa Bhagya)].
“Major ailments” means any heart operation, Kidney transformation [ eye operation, treatment of paralysis, orthopedics operation, uterus operation, treatment of asthama disease, maternity miscarriage cases, treatment of gall bladder related ailments, removal of kidney stone, treatment of brain hemorrhage, treatment of ulcer, cancer [dialysis, kidney related surgery, ENT treatment and surgery, neurosurgery, vascular surgery, esophagus treatment and surgery, gastrointestinal surgery, breast related treatment surgery, hernia surgery, appendicitis, surgery, treatment of fracture/dislocation, general surgery] or such other ailments as in the opinion of the Board be considered as major ailments and occupational diseases].
- Accident means any bodily injury resulting in permanent disablement (incapacitation) [Permanent partial disablement as defined in the Employees’ Compensation Act, 1923] or death directly from accident arising out of and in the course of his employment [or and on the regular route from home to his workplace and from the workplace to his home, the beneficiary met with an accident resulting in his death],
- "Eligibility" Every registered construction worker [and his or her dependents], who has major ailments specified in sub-rule (1) is eligible for medical expenses.
- Every registered construction worker [or his/her dependent in case of death of registered construction worker during the course of treatment] who is eligible for assistance of medical expenses under sub-rule (1) shall apply to the Board in Form XXII:
[Provided that a construction worker, who is eligible for assistance of medical expenses under sub-rule (1) shall produce to the Board a certificate in Form XXII-A by an Assistant Surgeon of a Government Hospital or the concerned Surgeon or Doctor who has treated the registered construction worker or Head of the Private Hospital specified in Schedule I of the Karnataka Government Servants’ (Medical Attendance) Rules, 1963 or the RSBY recognized hospitals.]
- [The Secretary or any other officer authorized in this behalf by the Board] shall examine for medical expenses in accordance with the provisions of this rule and may accept of reject the claim. The decision of the Board shall be final:
Provided that [the Secretary or any other officer authorised in this behalf by the Board] shall, before rejecting a claim for medical expenses, give the applicant a reasonable opportunity of making the representation.
- Amount of assistance for medical expenses: [The Secretary or any other officer authorized in this behalf by the Board] shall grant an amount upto Rs. 2,00,000/- (Rupees Two Lakh only) subject to the rates prescribed under the Central Government Health Service (C.G.H.S) in case of every application or an estimate of treatment/operation provided the applicant fulfils all the conditions. This doesn’t bar the applicant from claiming medical expenses under any other statue.] Supporting Document:
- Proof of Identity/Smart card issued by the Board
- Employment Certificate
- Proof of Bank Account
- Bills of hospital showing Admission and Discharge Dates and all treatment given
- Any medical documents on hospitalization of beneficiary/dependent in government/private
- hospital included in schedule1 of the Karnataka government servents(medical attendance)
- Rules 1963 or a hospital recognized under any insurance scheme of the state government.
- Form XXII-A
- Application can be submitted wihtin 6 months of hospitalisation commencement date.
- Application Fee : NA Procedure for applying:
- Applicant needs to submit the application
- Sumission of subcription certificate by SLI/LI
- Application processing and Verification by Senior/ Labour Inspector
- Preparation of inspection report by Labour Inspector
- Review and Approval by Labour Officer