Industrial Relations
Harsh Kumar Mehta
Consultant In Labour Laws/hr
Hr Executive

Hi Seniors,
One staff of our organisation brought his wife to ESIC Hospital for emergency treatment. But unfortunately the attending doctor refused to attend her due to shortage of doctor and support staff and forced to admit her in outside nursing home. So, plz guide me where to complain and what is the procedure?

From India, Chennai
Dear Subrata
Without revealing the complete details regarding the case, one cannot give proper reply to you. Give complete details. You can maintain the anonymity about your company name and location.
What was your salary (is it above 15000/- or below 15000/-)
Do you have ESI Pehchan card for your family
Why don't you take the patient in day time.
What was the reason they told you for not attending the patient
Did you get the First Aid while you approach the ESI Hospital or the duty doctor rejected you prima-facie.
Have you asked the person available in night hours regarding the claiming procedure.
Have you asked the person available regarding the hospital where you can take the patient and the hospital referred by him is having the facility to treat the patient on Cashless as a ESI enlisted hospital.
Without giving the details simply asking about complaining will not fetch you good result.
Please give the details and our members will give you relevant reply.

From India, Kumbakonam
Dear Subrata, Kindly visit the local office assigned to you and lodge formal complaint alongwith the necessary subscribers' ID card copy, copies of admit card at nursing home, treatment given, details of hospital / address where the admission was denied, claim amount for the treatment given to your wife in the nursing home, send copies to the Regional Director at where the half yearly returns are being filed, send copy of the same to The Director General, ESIC, New Delhi, addresses you will get in the ESIC website, incase if you do not get any satisfactory answer within 2 months from the REgional Director, The Director General, ESIC, New Delhi, after visiting the assigned local office of ESIC for your claim, seve them a layers' notice or from your end, and file suit for recovery of money with the Consumer Court of your are, where you are residing, since it falls under the consumer act, also you can file the suit with related Labour Court. You can approach to the Labour Office of the area where you are working.
From India, New Delhi
1. Dear member, I think, there may be some reasons for not attending to the patient in emergency by the ESIC Hospital. Boss 2966 in his remarks as above has rightly raised some doubts on the issue.
2. However, all ESIC/ESIS hospital work under the guidance and control of Medical Commissioner, ESIC, Hqrs. New Delhi. You can find his e-mail from the website of ESIC and can ask proper and immediate action in the matter in case you were eligible for the medical treatment. In case, no satisfactory reply is received, you can further make representation to the Director General, ESIC, Hqrs. New Delhi.

From India, Noida
First of all I am thankful to BOSS2966, Mr. Sibal, Mr. Madanagopalaswamy and Mr. Mehta for your valuable opinion. And I am agreed with BOSS2966. It's really short of information. I am clarify your quarry as follows :

1. Yes, He (IP) is fully eligible for getting super-specialty facility from ESIC, and he has valid ESIC Pehchan Card for him and his family.
2. Actually she is pregnant and some serious problem happened on night. So, there was no time to wait for day time.
3. The attending doctor told that there was no sufficient provision for treatment of her and for better treatment and save the life of mother and baby it's need to admit her any private nursing home. He was also suggest a name of nearby nursing home. He even also not checked or did any first aid her. Just wrote some medicine and said him (IP) to take back.
4. At that time he was not in such mental condition to ask about the claiming procedure and. He was just confused and immediately took her to the nearby nursing home, that doctor suggested.
5. His mistake was that, he didn't inform that incident

Hope, it will be sufficient for clarification. Again thanks to all for giving such helpful advice.

From India, Chennai
Now instruct him to ask in the designated ESI Office about the procedure for reimbursement of medical expenditure of his spouse.
They will give the format. In that he will have to get it filled from the Private hospital authorities and alongwith the original discharge summary, original cash payment bills, prescriptions, original lab test reports, etc., to ESI Office.
You will be getting as per their rate fixed with the hospitals. It will be approximately 50 to 60%

From India, Kumbakonam
Dear member, it is very bad state of affairs of ESIC Hospital as narrated by you. If you desire, you can report the matter to the ESIC Hqrs. Medical Commissioner as well as Director General, ESIC about the treatment conditions in the said Hospital and can ask for immediate remedial measures so that any other insured person/insured woman and their family members may not suffer such harassment and mental tension. With best wishes.
From India, Noida
In future to have a hassle-free treatment from the speciality Hospitals you can book prior appointment through ESIC Hospitals & Dispensaries .
From India, Kumbakonam
Dear Subrata, Since you posted the matter on Cite HR, it is understood that you are a literate person knowing what you are writing, so I did't felt it right to teach you the clerical procedure, and informed to contact local office of ESIC where the IP is attached, since now you have been guided and you understood the system, kindly bear in mind that in any emergencies, the ESIC hospital are always open 24x7 all over India and any IP or his / her family members who are enrolled to get treatment, can easily get admitted or given medicines as the attending Doctor feel fit the case, so no need to go to private nursing homes, even one can go to the government hospital in case of emergencies, which are equally admissible in ESIC claims. Although it is not a fit to mention here, that some times, attending Doctors are hand-in-gloves with nursing homes. No need to write elaborately. Any one can understand by referring such happenings being reported in daily new papers.
From India, New Delhi
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