Accidents under ESIC - What type of accident we have to report? - CiteHR
Harsh Kumar Mehta
Consultant In Labour Laws/hr
PTRC
Working With Ngo
Jeeni
Assistant Human Resource Manager
Rvravi
Manager Hr
Chintan99
Business
+4 Others

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Would like all of your advice on below mentioned querry:-

1-In case if an employee met with an accident, What is the maximum time in which an accident can be reported to ESIC? I suppose according to ESIC act, accident has to report within 24 hours to the branch office.

2- In case if till now we had not reported any accident to the esic, can we reported now the back dated cases to them (Some are 3-4 months back)? If yes what are process to follow.

3-In case if an employee is not covered under esic? what is the process to follow for such cases keeping in mind of other acts.

4-What type of accident we have to report? how can be distinguish that this accident should be reported or not?

5-Whther road accidents has to be reported in ESIC on safer side?

6- What are the forms to be submitted to the local ESIC office.

I would appreciate your prompt response on it.

Mr.Ranjeet,

Point 1: Employee covered under esic if any accident taken place,its statutory liability to submit accident report by employer with in 24 hours from the date of accident or you can take proof FIR from Police Department incase delay on justifiable grounds and submitting on back dates not encouraged by ESIC ,here you can claim Medical Expenses of hospitalization but sickness benefit can not be claimed legally.

point 2:Write a letter to ESIC Branch Manger/Commissioner/Asst Regional Director stating exact situation of delay caused to submit Accident Report and also FIR if required if they convince then its OK then domestic enquire takes place.incase you want to proceed legally liability will be employer side to pay benefits to the Employee if your counter documents are not justifiable.

Point3: If employee is out of ESIC Preview but still its employer liability to pay compensation any injury taken place.Please take Women compensation policy which is offered by various insurance companies valid legally cover all employees who are not into the preview of ESI.you can avoid risk of liability from employer end and you can take group med claim policy and Accidental Policy .my advice is go for Workmen Policy especially employees where risk is involved for dangerous.

Point 4:Submit accident report form-16 all necessary fields are specified very clearly.

Point5:Road accidents can be claimed only accident occurs during course of employment ,if employee coming on the way to the office(routine route)then he claim insurance at the same time FIR should be booked.

Point 5:IT revolution no need submit any forms to the ESIC other than Form 37 Employment/Re-Employment to avail medical treatment.

I hope i cleared up-to my extent of knowledge,Seniors please post your valuable advice.

Regards,

Naresh.Gadde

Dear Naresh,
Thanks a ton for your valuable explanation.
I would also like to clarify that we had never filed any FIR for such cases but due to some audit risk we want to file the same in ESIC office. till now we have paid all the wages to employees for their absence and all the medical expense incurred by the employer only.
can you please ealborate what we have to draft in a letter to esic office because this is the relavently new thing for me. Regarding purview over road accident that is while coming on shift and going back from shift has been no more concept in ESIC. What type of enquiry can be it.
In case if an employee not reported work only for 1-2 days whether we need to report such cases to ESIC.
Please suggest.
Also appreciate views from other senior member also.
Regards
Ranjeet

Dear Ranjit,

Write a covering letter to the dispensary To reimbursement bills incurred for hospitalization of the employees along with enclosed original medical bills and other documents submit to the dispensary.

Here claims should be processed through employee only employer is no more connected to that and tell employee to meet medical director /Asst.Director /Medical superintendent reimbursement pls dont tell to the ESI Authorities its has paid by employer.

request employee to narrate his situation/feelings really happened or taken place.only way is to convince the authorities.ESI reimbursement nearly 75%or 50% its depends.



Simple letter

To

The Medical Director

ESIC

Dear Sir,

Sub:Reimbursement of medical expenses reg

Ins .No:********,Emp:Code**********

Name of Establishment

Reference to the above subject total amount of Rs. spend towards hospitalization on unavoidable situation to avail treatment under ESI hospitals on date ****** Kindly reimburse the amount on medical considering of humanity grounds.

Kindly do needful on above subject.

Yours sincerely,

*******

You add further extent to this draft because iam not that much good in English to draft

Earlier accident occurs in the premises then only it is consider during course of employment but recently amendment in Act you can find this from ESI OR any other sources.Reason of saying FIR should book case of road accident taken place in public that to its valid document proof of taken place.

Thanks

Naresh

Dear naresh,
Thanks a ton for valuable guidance.
I can make out that we are only keen to report backdated accident cases in ESIC. We dont want to take reimbursement and all.
i will appreciate views of other memeber also.
Regards
Ranjeet

1-In case if an employee met with an accident, What is the maximum time in which an accident can be reported to ESIC? I suppose according to ESIC act, accident has to report within 24 hours to the branch office.

As per Regulation 65, the Insured person sustaining injury need to inform (notice- oral or written) employer or his representative and up on receiving the notice, employer need to make entry in Form 15- accident register. As per Reg.68, report of the accident has to be sent to the Local office and ESIS IMO in form 16. Information on 'period' is contradictory. IN the ESI Act by K.P.Srivastava, 3ed edition, 1986, on p. 723, period mentioned is 24 hours while in local office manual , 3ed edition, year 2000 the period mentioned is 48 hours. I also have another publication A Brief note on ESI Act published by SRO,ESIC, Vadodara which informs the period to be 48 hours on p.13. I think 48 hours is correct answer. This 48 hours are counted after the management comes to know.

2- In case if till now we had not reported any accident to the esic, can we reported now the back dated cases to them (Some are 3-4 months back)? If yes what are process to follow.

Yes you can giving valid reasons thereof; once the local office receives the information the Local office manager has to make inquiry to verify the details. The manager will then decide whether to admit the case or not as an employment injury. If the worker has any remnant permanent disability he can claim relevant benefits under the Act. If the accident is not reported by the management he can not claim any benefits.In that case he can directly make an application in the ESI Court to claim benefits.

As you claim, you do not intend to claim any cash benefits, then there is no meaning to send the form now. There is, as such no logic.The logic may be to get the accident registered so as to get reflected in the data of accidents. The forum for this is Factory Act where these data are compiled. Form 16 of Factory Act should be filled up and sent instead of ESIC in such circumstances. Still, if your management is insisting,better you first visit the Manager, Local office , explain the situation and seek his guidance before taking any action.



3-In case if an employee is not covered under esic? what is the process to follow for such cases keeping in mind of other acts.

It is Factory Act under which management need to intimate Factory Inspectorate. If employee is not covered under ESI Act then he is covered under E.C. Act. Under Section 10-B of the Act, employer is required to send a report to the Compensation Commissioner within 7 days of the incident.

4-What type of accident we have to report? how can be distinguish that this accident should be reported or not?

Pl. refer Sec.88, 88-A and 89 of Factory Act.

IN E.C.Act it is either death or serious bodily injury

In ESI Act, information of the personal injury sustained by insured person the form has to be sent

5-Whther road accidents has to be reported in ESIC on safer side?

After the latest amendments, Road accidents during commuting to and from work are considered employment injury and need to be reported.

6- What are the forms to be submitted to the local ESIC office.

Form 16 in case of accident and 16-A in case of occupational disease

I hope this will help you decide course of action on you part

Dear All, Let me know the registers to be maintained by employer under ESIC scheme Regards Lokesh.V
Dear Mr.PTRC, Can you please send me the court case or latest amendment where it was decided that road accident have to be reported. Regards Ranjeet
For SR.NO.6 Accident details to be furnished to ESI in the FORM NO. 12 instead of FORM NO. 16 as form 16 replaced by form no. 12. Krishna Yadav
Dear All,
Would like all of your advice on below mentioned querry
In my factory a worker was working and suddenly he fell down ,but none of anyphysical injury occured neither any cut mark appeared on his body.We gave him first aid,and then admitted him to ESIC Dispensary where he was refered to ESIC affilated pvt hospital and had been admiited there for four days.On the basis of non appearance of any sign or mark of injury we did not send his accident report.Now the worker has raised his objection that we should treat this incident as a accident and subsequently the concerned Branch mananger of ESIC also directed us to send a rport that why we did not send information to him in reuired form(Accident Report).My question is whether it was a case of accident? If yes then are we require to send report for any any kind of incident, where we dont find any cut mark,pain or any sign of accident.
Regards
Anand


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