Hi,
Please help me,
I met with an accident, suffered with knee fracture
I Took Treatment Of my knee From A Private Hospital Without Referring ESIC In last week,
Is It Possible To Claim my Expenses From ESIC In This Case If Yes Than What Is The Complete Procedure For This?
please let me know what i do, please help me,
Thanks
MUZAMMIL HASSAN

From India, Delhi
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You will have to go to your ESIC clinic and submit all medical case papers.
Urgent or emergency treatment was necessary due to off hours of ESIC clinic.
You can try and convince ESIC authorities.
Read Regulation 69 and 96 A of ESIC which deals with accident cases etc.

From India, Pune
Dear ,
Now a days cashless card facility has made it easy.
ESIC hospitals refers patients to private hospital only when they are unable to provide complete treatment. In this case they also reimburse the expenses upto maximum extent. Hence one needs to visit ESI hospital first.
Now, in your case, you may try to convince the ESI personnel by showing last minute urgency of your case for hospitalisation and there was no esic hospitals nearby etc etc, if it is true.

From India, Delhi
Dear Muzamil,
ESI is for employees’ welfare. You should have intimated your ESI dispensary immediately by your relatives or through your employer. Accident case can be treated as emergency and you have not intimated them.
Collect all your medical case history, expense bill and letter from the hospital where you are treated mentioning that your case was an emergency case/ accident case.
Ask your employer to provide covering letter stating to ESIC that you faced an accident and was unable to intimate in time/ delayed intimation and may be allowed for medical expense reimbursement.
Then deposit it in the ESI dispensary and they will forward it to their ESI hospital. There you need to convince the medical officer/ authorized person.
Once they are convinced they will forward it to regional office and your bills will be reimbursed. It will take around one month time.
Hope you will avail the monetary benefit.

From India, Bhubaneswar

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