Group Compliance Manager
Manager - Hr & Ir
Assistant Manager Hr
We are in fast food services. We are having restaurants all over India.One of my employee located at Ranchi resturants had meet with an robbery while going back to home after night shift duty and he got seriously injured by knife by the dacoits on his head and neck. He was hospitalized at Raj Hospital and research centre to ICU as his condition was serious.
During the course of his treatment company has incurred cost of Rs.12000/- amount.
After the incident we have submitted accident report and sent an employee to ESI Branch office as well as letter of intimation to Administrative Medical officers, ESIC, Rranchi main office.
Then after we did not get any support from ESIC.
Can you pls guide me how to reimburse the same from ESIC. I am having Reimbursement Form of ESI.
8th November 2013 From India, Delhi
#AnonymousOn continuation previous case of Ranchi incident......
The private hospital was under ESIC medical superspeciality hospital of Ranchi. We had approached them and tried to convince but all efforts were in vain.
8th November 2013 From India, Delhi
While sending the ESI covered employee on official works to out of station. Along with PEHACHAN CARD it is advisable to carry ESI FORM - 105 for utilising the ESI benefits if he suffered any illness or accidents etc. The copy of the Form - 105 is attached.
8th November 2013 From India, Kakinada
1. To obtain Discharge Summary or Discharge card where the IP take treatment from Private Hospital.
2. To obtain All Bills including Cost of operation, Doctor\'s Charges, Anastetian charges, Nursing Charges, Room service Charges, ICU Charges, Cost of Medicines, Tests examination charges with supporting bills etc., from the hospital.
3. Obtain Emergency Certificate from the treatment hospital.
4. Essentiality Certificate from the treatment hospital
5. No stock certificate from ESIC to purchase from out side for treatment.
6. Eligibility certificate from ESIC
7. Advanced Stamped Receipt for payment.
8. Bank A/c Details
9. Documents to be submitted as per Check list issued by ESIC for Reimbursement.
10. ESIC Pehchan Card/Permanent ID Card copy
11. Scrutiny Certificate.
12. All Bills to be certified by Treatment doctor and Medical Officer of ESI Hospital where the IP attached along with paid by me by the IP.
13. Letter from IP for submission of Bills for MR.
14. Letter forward from the Employer by the IP
15. Post Card for intimation from ESIC.
To submit the same along with above documents to DIMS office for MR by the IP.
Thanks & Regards,
V R RAO PULIPAKA
8th November 2013 From India, Chennai
please make sure that you have to fulfill all the formalities like
1. OPD slip from ESIC medical Hosiptal
2.ESIC Card of Employee
3. Reimbursement from and duly sign by medical officer of ESIC with stamp
4. All the bill must sign by who treated the paitent
8th November 2013 From India, Shimla
Thank you for your suggestions,
It will help me a lot.
When I visited ESI dispensary they say reimbursement is not possible because IP is not referred by the ESI medical officer from his attached dispensary to the private doctor. is there any clause like this in bill reimbursements. Should IP first take reference from medical Officer?
8th November 2013 From India
I cannot exactly quote the clause, but I understand it from the ESI Officials that prior intimation is required. This is to avoid misuse of super specialty treatment especially when treatment facilities are available in ESI hospitals. The concept is if advanced treatment is not available with ESI hospitals, we can take treatment in private hospitals on their reference.
But this is not strictly required in the case of accidents and critical illnesses.
9th November 2013 From India, Coimbatore
Greetings For The Day,
In My Company One Worker In My Company One Worker Took Treatment Of multiple sclerosis From A Private Hospital Without Referring ESIC In February 2016, Because Of His Ignorance Towards ESI Benefits and He Is Listed In ESIC. And His Medical Expenses Are More Than His Paying Capacity.
Now We Want Claim His Medical Expenses Form ESI Department As We Are Paying His Contribution. Is It Possible To Claim His Expenses From ESIC In This Case If Yes Than What Is The Complete Procedure For This?
19th March 2016 From India, Bengaluru
Insured person has to registered his ESI card in his ESI branch office
In ESI speciality treatment the ESI has been tie up with the private hopitals. if your insured person has got treatment under the ESI tie up hospital the medical expenses can be reimbursed .
Incase if he is already got treatment in private hopital he has to submit all his medical expenses with the enclosed of Discharge slip to the ESI. After submitting to ESI office they will examine and enquire the details from the hospital. Approximately 90% of the bills will be reimbursed. Hope it will be useful
19th March 2016 From Kazakhstan, Aktau
This is to bring to your kind notice i subroto bera would like to reapply for a new card as the previous card was linked to my ex-Spouse.
what is the producer to link my new card to my current spouse.
please let me know how to move
21st September 2016 From India, Kolkata
So most of the ESI card holders never go to ESI dispensary. For one, if you are working some far away places, there is only one or two dispensaries, you will have to take leave from your work, which the employer grudingly allows. Secondly there are various formalities to fulfill.
Why don't the Govt introduce some bills that if a person doesn't go to an ESI dispensary, his accumulated money be returned to him so that at least he could go to a private hospital of his choice. Or a member may go to a private doctor and produce his bills to claim money - since it is his money that he is asking for.
27th April 2017 From India, Lucknow
However all Branch officials are not helpful. branch office under central government and dispensary under state government. IP's contribution paid to central government not to state government. For treatment when IP goes to dispensary, there is some different rules regulation shown by dispensary and branch office.
I think government should introduce something like if any employee, who is unsatisfied from ESI facility regarding treatment/medicine will not pay any contribution to ESIC.
20th May 2017 From United States, Cambridge
Above topic , i have one clarification one of our employee also going same issues. but same procedure followed. claims bills rejected due to employee dosen't hold the icic bank a/c.
please let me know is it complusory they have issued reimbursement amount to only icic account?
24th August 2017 From India, Bengaluru
i have an questions regarding maternity benefit for wife of IP.
1)can she take treatment in private hospital?
2)what is the process to claim for esic after taking treatment in private hospital?
3)how much contribution of company in total bill payment?
4th September 2017 From India, Pune
i have a query regarding ESIC medical reimbursement. I have an employee who was covered under esic. he admitted his mother to an esic tie-up hospital in emergency situation. He informed the ESI dispensary after 3 days. The esic dispensary gave him the referral letter to the tie-up hospital where his mother was admitted. But the irony was that the tie-up hospital refuse to accept the referral letter. he was told by hospital authority that they had stopped taking esic patients as esic is delaying/not paying their payments for months. he had no other choice but to pay the bills himself. Now is there any way to claim reimbursement from esi.If yes whats the complete procedure to claim it.
20th September 2017 From India, Guwahati
Greetings for the day,
I have a query regarding ESIC, I am the worker took treatment for my father of PSORIASIS and MTX TOXICITY febrile neutropenia from a PGI hospital in Chandigarh without referring ESIC in Febuarary, because of my ignorance towards ESI benefits, and he is listed in ESIC. and his medical expenses are more than his paying capacity.
Now I want claim his medical expenses form ESI department as we are paying his contribution. is it possible to claim his expenses from ESIC in this case if yes than what is the complete procedure for this?
7th March 2018 From India