(1) A claim for compensation in respect of a workman contracting any disease specified in Part C of Schedule III to the Act shall be supported by a certificate of a qualified medical practitioner issued in Form „AJ appended to these rules.
(2) Where the contracting of a disease, referred to in sub-rule (1) results in death or permanent disablement of a workman, the claim for compensation in respect of such a workman shall also be supported by an endorsement on the certification in the form given in Form „B‟ appended to these rules.
(3) Where there is a difference of opinion between the qualified medical practitioner and the Medical Board, the opinion of the Medical Board shall in such a case prevail.
FORM „A* Certificate of Disability /Death {See Rule 7) This is to certify that Sri ....................................... son of .................................... , age ............................... years is/who died on......................................... was suffering from pneumoconiosis/pneumoconiosis with pulmonary tuberculosis and the contracting of the diseases is/was reasonably attributed to his employment in
(1) Temporary disablement.—(1) The disability is in my opinion of a temporary nature likely to last for ............................................... years ........................
months ....................................... He is unfit/He is fit for work in his present employment (state employment for which he is considered fit).
(2) Permanent disablement. —The disability is of a permanent nature and is assessed at ................................. per cent.
(3) Death.—Death is attributable to the contracting of the diseases.
(Cancel out portion not applicable) Signature of the Qualified Medical Practitioner.
Place ................................
Date .................................
FORM „B‟ Endorsement to be made by Medical Board in cases of permanent disability or death This is to certify that Sri ................................................... is/was suffering from pneumoconiosis/pneumoconiosis with pulmonary tuberculosis and the contracting of the disease is/was reasonably attributable to this employment in..
(1) Permanent disability.—It is certified that the disability is of a permanent nature and is assessed at ................................... per cent.
(2) Death.—It is certified that the death of Sri ................................................ is attributable to the contracting of the disease.
Place ...................................
Date ....................................
Signature of Member of Medical Board.