Harsh Kumar Mehta
Consultant In Labour Laws/hr
+2 Others

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Hello,
I have few questions with ESIC benefits. Please check and help me with your valuable answers.
1. When employee and their dependents will eligible to get hospital treatment after registrations?
2. If employees have to go near ESIC hospital for treatment or they can go any ESIC hospitals?
3. Is any employee directly go to ESIC hospital without added by any panel doctors?
Looking for your valuable feedback.
Thanks,
Sandip Kumar Ghosh
Accounts Administrator
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1. The ESIC covered employee is covered with ESIC benefits at the very beginning in accident case.
2. Family benefit after three month, he may go to ESIC hospital and may be referred to other hospitals if there not facility in ESIC hospital
3. Yes.
1. Dear member, as soon as a person becomes an "employee" within the meaning of ESI Act, 1948 and he obtains TIC or Identity Cards under said Act from his appropriate ESIC office, then he/she and his family members becomes entitled for medical treatment (which is called Medical Benefit) from ESIS dispensary/Panel Doctor to which he/she/family members are attached. Employee or his family members are required to firstly report to the ESIS dispensary or a ESIC Panel Doctor and only such institution or Panel Doctor can recommend the case to ESIC Hospital or to any authorised private hospital. If employee will directly go to an authorised private hospital, then I think, treatment will not be free and in the end it is also difficult to obtain any reimbursement from ESIC. I think, ESI Hospital will not entertain the employee (except in emergency cases) without a referral slip from concerned ESIS Dispensary or Panel Doctor, if any.

2. ESIC has formulated and enforced its own referral policy for medical treatment in such cases from private authorised hospitals/ESI Hospitals. I think, every insured person/covered employee should comply with the instructions prior to obtaining such treatments from higher hospitals. Copies of such instructions of referral policy were earlier also uploaded by me in some other threads some time back. If desired, you can also confirm the position from ESIC Branch Office as well as from ESIS dispensary or Panel Doctor, if any, to which you are attached for such benefit.
Dear Sandip, Please find the attached document for detailed benefits and eligibility criteria for ESI Thanks, Murali 9440706968

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File Type: pdf ESI Benefits.pdf (1.63 MB, 787 views)

Dear Harsh Kumar Mehta sir,
our employee's right hand
Has been factured during the working Hours. Hence He is unable to perform
his duty. Pls clarify :- how to get him
Admitted in ESI Hospital and Required
form & procedure to be followed for
the same :- also clarify that Since He is
Unable to perform his duty How much Cash benefit
He will get from ESI and How Long however
His Gross salary is 12700 PM?
Please Guide its Urgent....
Thanks
Amit
1. Dear Amit ji, thanks for writing me through citeHR as above.

2. I may submit that if you are an employer or HR or concerned person in your estt./factory, then kindly firstly ensure that the employee who suffered accident is having all relevant documents viz. his ESIC Identity Card and also that your establishment has submitted an Accident Report to the appropriate Branch Office of ESIC as well as to concerned ESIC dispensary. Please also ensure that your establishment has deposited contribution in time and he is eligible for such benefits. Concerned ESI dispensary Incharge (Dr.) is the appropriate authority who can refer any employee to any ESIC or other authorised hospital for further treatment. The institution of ESIC Branch Office is more important since this office has to pay Benefits (except medical treatment) to the insured person based on documents i.e. the accident report, the data of contribution the said office has received in respect of injured person from his employer and the medical certificates issued by appropriate ESIS dispensary/hospital etc.

3. I think, you can generate Accident Report online and submit the same to appropriate offices as above, if considered appropriate at this stage.

4.The question is not whether the said injured employee is able to perform his duties or not, but important question is whether the said employee has obtained medical certification from appropriate ESIS dispensary or not. If he got himself checked up or medically treated in said dispensary, then I may presume that the doctor must have issued him required medical certificates. Only on the basis of such medical certificates issued by ESI dispensary or referred hospital, the employee will be in a position to claim benefits - i.e. Temporary Disablement Benefit (TDB) or Permanent Disablement Benefit (PDB)( if certified by any ESIC Medical Board).

5. The present rate of TDB as mentioned above, is 90% of average daily wages of the employee as calculated based on as laid down in ESI (General) Regulations or Central Rules, 1950. I hope, your establishment and your employee may contact designated offices as mentioned above, if he require any benefits under ESI Act, 1948 and rules/regulations as mentioned above. With best wishes.
Respected Sans,
My query is related to ESIC benefits:- One of Employee who has contributed ESIC contribution for more than 20 Years, and from last Two Years he was out of ESIC contribution limit salary ( Drawing more than 15K), now again he come under the preview of ESIC contribution as his salary is less than 21K (01/01/2017).
He is suffering from Heart problem and doctor has advice him to under go for surgery.
please clarify will he get ESIC benefits.
highly thankful for your valuable advise.
Regards
1. Sir, since the employee has again re-entered in ESIC coverage w.e.f. 01/01/2017, hence at present, he will be again entitled for Medical Benefit only ( i.e. medical treatment from ESIS hospitals, dispensaries etc., which, as I think, will also include reimbursement of expenses incurred in ESI authorised hospitals, if referred by ESIC as per their referral policy).

2. However, the said insured person/employee will not be entitled for cash benefits (which is called Sickness Benefit because his benefit period has not so far started and perhaps due to his illness his contributing days will be less).

3. I will suggest to ask the employee concerned to firstly obtain Permanent Identity Card (if not already obtained) from concerned ESIC Branch Office and also discuss the issue of his entitlement for medical treatment from ESIC institutions including treatment, if required, in ESIC sponsored other hospitals.

4. Concerned ESIC Branch Office as well as ESIS dispensary are the appropriate offices/authorities which can certify and give guidance locally about the entitlement or otherwise of employee/insured person about his eligibility/entitlement about any type of benefits and medical treatment under said Act. Therefore, I think, it is in the interest of concerned employee/insured person to remain in touch with such offices.
Dear Mehta sir, Pls enlighten me the difference between sick benefit and medical benefit? Regds Amit
1. Sir, Sickness Benefit is a benefit paid in cash from ESIC Branch Office, whereas as you know Medical Benefit medical treatment/facilities and therefore is in kind. There are eligibility conditions for various cash benefits in ESI Act, 1948 and rules/regulations framed thereunder.
2. For details, I hope, you will download necessary details from the website of ESIC for further guidance on the subject, if required. Online link is also mentioned as follows:-
Information - Benefits | Employee's State Insurance Corporation, Ministry of Labour & Employment, Government of India
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