Harsh Kumar Mehta
Consultant In Labour Laws/hr
Working With Ngo
Assistant Human Resource Manager
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.
25th November 2011 From India, Hyderabad
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.
Also appreciate views from other senior member also.
25th November 2011 From India, New Delhi
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.
The Medical Director
Sub:Reimbursement of medical expenses reg
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.
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.
25th November 2011 From India, Hyderabad
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
26th November 2011 From India, Coimbatore
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.
26th February 2012 From India, Ranchi
I am surprised and shocked! You admit that he "suddenly fell down" Suddenly felling down itself amounts to 'accident'. You say that there was "no injury" or "sing of injury" ans still you claim to have given him first aid treatment and then sent him to ESI. Your statements are contradictory. When there was no injury what first id treatment was given and why? You must immediately send accident report in Form 16 and apologize ESIC for the delay in sending. That will help worker claim disablement benefit. In absence of it he will be only given sickness benefit. If as a result of injury he has any permanent injury, he can get benefit for that too. If you do not do that worker has right to go to ESI court for his claim and you will be in trouble
27th February 2012 From India, Coimbatore
when accident occured compliances required under the following act.
1. ESIC (Submission Form 12 under regulation 68) to Local Office ESIC
2. Factories Act (Submission of Form 18, Notice of Accident or Dangerous Occurance under HP Rules) under sections88
Any thing other else (Comliance)???
1st June 2013 From India, Mumbai
#Anonymouswhen i upload an accident report by mistake i have point wrong time of accident,is there any way to correct that report which is i already submitted,from portal,
15th April 2017 From India, undefined
2. If so, your establishment should have immediately covered the said employee and allotted him insurance number etc. and complete all formalities regarding registration of employee under ESI Act, 1948 and rules/regulations framed thereunder.
3. After allotment of insurance number of said employee, you can submit online accident report to the appropriate branch office of ESIC to which your unit is attached and pursue the matter with the said office. Your submission of accident report at this stage will, however, be treated as late.
4. The employee who met with an accident may be getting some treatment from some of hospital or dispensary. After allotment of insurance number and completion of registration formalities, he can visit and get treatment from the ESIS dispensary as may be allotted online by the said office.
5. In case of any difficult, I think, you can visit appropriate branch office of ESIC and get suitable advice/instructions in the matter.
22nd April 2017 From India, Noida
2. Since Brain Hemorrhage shows some illness etc., hence I think, the important aspects will be the post mortom report, causes of death and the medical opinion of the competent authority. Hope, you will submit complete and correct facts in the said accident report and contact the concerned Branch Office Manager to which your unit is attached. Perhaps, the contents and findings in FIR (if filed with police authorities) will also be of some relevance.
17th July 2018 From India, Noida
I Want to ask, if the accident of an employee gets out of the company, and his family members can admit it to the private hospital, and his esic payment is from 1 month. So what can I get the claim. they inform to hr after 48 hours. what is the right decision.
27th December 2018 From India, Faridabad
I am an Employer and my Employee died of heart attack while on his way to work. He was waiting for the doctor near his residence as he felt breathless. While waiting for the doctor he wanted to go to washroom so people helping him took him to his building but he used a washroom of some society member on ground floor (employee stays on 3rd Floor). He suffered massive heart attack after coming out of washroom and while waiting for doctor.
My question is the ESIC officers say that there is break in duty as he returned midway. But i argued that he had not reached home and was waiting for the doctor.
Any court judgement or any other material in favour of the employee which i can produce to ESIC Office
16th March 2019 From India, Mumbai