Saswatabanerjee
Partner - Risk Management
Harsh Kumar Mehta
Consultant In Labour Laws/hr
+3 Others

Revered seniors i am working in textile company as a welfare officer .one worker is my company when he came factory on his duty time he had accident on the road and he is cover under esi.but he was very serious so he admitted private hospital and his expenses in hospital 5 to 6 lacks .what is the rembursement process please guide me what is procedure in detail.
18th May 2015 From India, Ghaziabad
you need to register accident report with ESIC of your area. Further if possible the injured person has to be brought before doctor of ESI Hospital for claiming any compensation. Taking treatment in a private hospital is not an offense, but the spent money, you cannot claim from ESIC. He is eligible for Medical leave for his absence, and any compensation according to his loss of earning capacity.
18th May 2015 From India, New Delhi
In most cases, in absence of prior approval of ESIC, amount spent in private hospitals is not reimbursed. However it would be a good idea for you to approach the local ESIC office and explain the matter. They may agree to reimburse part of the expenses.
Further, if this is a motor car accident, he may be eligible for compensation from the insurance company of the consent very good. You should check out how he can get it
18th May 2015 From India, Mumbai
1.Sir, ESIC has its own referral policy and procedure for reimbursement. As mentioned by seniors and experts in above remarks, I hope, the company/firm concerned official will immediately submit Accident Report to the appropriate Branch Office of ESIC and IMO incharge of ESIC dispensary to which the said employee was attached.
2. The action for reimbursement of expenses incurred as well as claims for temporary disablement benefit or permanent disablement benefit, if any, in respect of said employee can be discussed with above authorities, which are appropriate authorities for such claims.
18th May 2015 From India, Noida
Emergency treatment in private hospital may have to be done in case of accident.

Regulation 69 authorises employer to arrange for First-aid Medical care and transport of accident cases till the injured IP is examined by the IMO/IMP and the employer is entitled to reimbursement of expenses incurred in this regard upto the maximum of scale as laid down . However it is to be noted that, reimbursement is not permissible, if the employer is required to provide such medical aid free of charge under any other enactment/law or rule.

The cost of provision of such emergency treatment would be reimbursed to the employer by the Director/AMO (ESI Scheme) of the respective State and, therefore, all claims duly supported by relevant receipts and vouchers should be submitted to him for verification and necessary payment action

One must refer regulation 96 A also.

With these regulations laying down some sort of arrangement for emergency care one must visit local ESIC centre and find out exact procedure and documentation for claiming reimbursement.

Other learned members may comment.
18th May 2015 From India, Pune
If an Insured Person meets with an accident, you must fill in online accident form; stake claim or not.
23rd May 2015 From India, Mumbai
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