Medical Assistance for Construction Workers — Sikkim

What is medical assistance for construction workers in Sikkim?

Medical Assistance for Construction Workers is one of eight cash benefits paid by the Sikkim Building and Other Construction Workers Welfare Board, which operates under the Labour Department, Government of Sikkim at Shram Bhawan, Sokaythang, Gangtok. The Board is financed by the welfare cess collected on construction works under the Building and Other Construction Workers' Welfare Cess Act, 1996.

According to Labour Department Notification No. 22/DL dated 14 June 2018, published in Sikkim Government Gazette Extraordinary No. 347 on 9 July 2018, the Board fixed a schedule of financial assistance for registered workers and their immediate dependants. Medical appears at serial number 5 of that schedule with an amount of Rs 10,000, and its "applicable to" column reads "Registered worker & their immediate dependants". The notification was issued under the scheme framed in clause (h) of sub-section (1) of Section 22 of the BOCW Act, 1996, and supersedes the earlier Notification No. 19/DL dated 18 May 2013.

The Board had earlier notified a list of 22 welfare schemes vide Notification No. 06/DL dated 12 March 2015. The 2018 rate notification is the document that actually fixes the money payable, and it is the one a district office works from.

Construction work in Sikkim is largely informal and rarely carries employer-paid health cover. A registered worker who is hospitalised loses wages and pays for treatment at the same time. Rs 10,000 released against a medical certificate is not designed to cover a full hospitalisation, but it is meant to blunt the first shock of one.

How much is paid, and how does medical assistance fit the Board's schedule?

The complete financial assistance schedule notified in 2018 reads as follows.

A later notification, No. 24/DL dated 13 August 2018 in Gazette Extraordinary No. 424, inserted the words "One Time" against serial numbers 6 and 8.

Reading across the schedule matters when a worker is hurt rather than ill. A minor injury sustained in the course of employment is a separate Rs 10,000 entry at serial number 3, and a partial disability at work is graded from Rs 10,000 up to Rs 1,00,000 according to the percentage recorded on the medical certificate. A worker injured on site should have the doctor record the percentage of disability, because the medical row and the disability rows are claimed differently and the disability band is far larger.

Beyond the cash, the Labour Department's BOCW welfare schemes information sheet of April 2022 lists a one-time pension of Rs 2,00,000, free education for the children of registered workers with hostel accommodation in Gangtok, and cover under the Pradhan Mantri Shram Yogi Maandhan Yojana and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. A registered worker facing a large hospital bill should check the Ayushman Bharat card first, that scheme pays treatment costs directly to the hospital, while the Board's Rs 10,000 is a cash reimbursement.

The national myScheme entry for this benefit additionally describes the medical assistance as directed at serious ailments such as tuberculosis, cancer, heart disease, kidney disease, eye disease, leprosy and nerve-related conditions, and mentions an application in Form XL. The 2018 gazette notification itself does not set out an ailment list, so treat that list as guidance rather than a statutory restriction and confirm the current practice with your District Labour Officer before assuming an illness is outside the scheme.

Who is eligible for medical assistance in Sikkim?

You can claim if all of these are true.

• You are registered as a beneficiary of the Sikkim BOCW Welfare Board and hold the identity card issued in Form XXVIII under rule 266 of the Sikkim BOCW Rules, 2010.
• At registration you were between 18 and 60 years of age and had completed 90 days of service as a building worker in the preceding twelve months. Rule 264 sets both conditions.
• Your Rs 20 per month contribution to the Sikkim Building and Other Construction Workers Welfare Fund is current.
• The treatment is for you or an immediate dependant, the husband or wife, minor sons and unmarried daughters of the worker, or parents solely dependent on the worker.
• You hold a medical certificate from a recognised doctor covering the ailment and the treatment.

You cannot apply, or are not eligible, in these situations.

• You are an unregistered construction worker. The benefit is not available to workers who never applied to the Beneficiary Registering Officer, whatever their years on Sikkim sites.
• You defaulted on the contribution for a continuous year. Rule 267(2) says such a beneficiary ceases to be a beneficiary of the Fund. Membership can be resumed on payment of arrears with the Secretary's permission, but not more than twice.
• The patient is not the worker or an immediate dependant as defined in the Rules, a sibling, a nephew or a non-dependent parent, for example.
• You were 60 years or older at registration, or had not completed 90 days of construction work in the preceding twelve months, so the registration was never valid.
• You are a contractor or an employer rather than a building worker. The Board's schemes run to workers and beneficiaries, not to establishments.
• You have no medical certificate, only bills or a pharmacy receipt. The certificate is the document the notification names.

What documents are needed for a medical assistance claim?

How to apply for medical assistance in Sikkim

1. Register as a beneficiary first, if you have not already. Apply in Form XXVII to the Beneficiary Registering Officer authorised by the Sikkim BOCW Welfare Board. Rule 265 requires three small photographs, attested proof of date of birth from a school certificate, the Registrar of Births and Deaths, a local authority, a panchayat body, an MLA, an MP or a municipal councillor, the employer's certificate of engagement as a building worker, and documents showing payment of a registration fee of Rs 20.
2. Collect the identity card issued in Form XXVIII, file a nomination in Form XXXI, and keep the Rs 20 per month contribution current, it is remitted once every three months at a bank specified by the Board in your district.
3. Get the medical certificate. Ask the treating doctor at the government or recognised hospital for a certificate naming the ailment and the treatment given. Where the illness followed a workplace injury, ask the doctor to record the percentage of disability as well, so the disability entries in the schedule remain open to you.
4. Assemble the claim, the establishment letter, your Form XXVIII identity card, the medical certificate, and the treatment records and bills. Ask the District Labour Office for the financial assistance claim form and complete it for the medical category.
5. Submit the claim to the concerned District Labour Officer, and send a copy of the information to Head Quarter, Labour Department, Shram Bhawan, Gangtok, East Sikkim, exactly as the 2018 notification directs. Keep the acknowledgement or reference number.
6. Follow up with the district office or the BOCW Nodal Officer, quoting the reference number, once the Board has had a reasonable period to verify the registration and contribution record.

How to check the status of a medical assistance claim

The Sikkim BOCW Board has no online claim-tracking portal. The Labour Department's BOCW page at labour.sikkim.gov.in carries the acts, rules, forms, circulars and notifications, but not a beneficiary login. Status is therefore checked in three ways:

1. Call the District Labour Office where the claim was filed, quoting the acknowledgement or reference number and the identity card number.
2. Call the BOCW Nodal Officer on 70769-26998, or the toll free labour helpline on 1800-345-1474, if the district office is not responding.
3. Check the bank account into which the Board pays, since sanctioned assistance is credited electronically and often arrives before any written intimation.

Who to contact in each district

The Labour Department's BOCW welfare schemes sheet publishes these numbers:

• BOCW Nodal Officer to 70769-26998
• East — 90643-89842
• Pakyong to 90028-33969
• South to 96098-63959
• West to 95477-16798
• North to 96359-98441
• Toll free helpline for labourers to 1800-345-1474

The Labour Department headquarters can be reached on 03592-201474 and at sikkimlabour@gmail.com, at Shram Bhawan, Sokaythang, Gangtok.

Why medical assistance claims get rejected

• Registration lapsed because contributions were unpaid for a continuous year.
• No medical certificate, only bills, prescriptions or pharmacy receipts.
• No letter from the establishment, which the notification lists as the first required document for every claim category.
• The patient is not an immediate dependant under the definition in the Rules.
• The claim was filed at the wrong office, for example directly at headquarters without routing it through the District Labour Officer.
• The identity card cannot be produced, so the Board has no way to match the claim to a registration.

Where a claim is refused, rule 271(6) of the Sikkim BOCW Rules, 2010 provides an appeal to the Board within 60 days of receiving the order, and the Board's decision on the appeal is final. A separate 30-day appeal right applies against a refusal to register a worker as a beneficiary under rule 266(2).

No fee is payable to claim medical assistance, and no agent or middleman can charge for filing the claim on a worker's behalf.