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Mohammad Basha

One of my friends went to a private hospital for medical treatment, due to some unavoidable situations she didn't apply for ESIC benefits moreover she was helpless in terms of ESIC guidance. It's been more than 2 years, but can it claim the amount spent for that treatment? I need your support to guide her to claim the spent amount. The spent amount was nearly 2 lakhs.
From India, Delhi

If any employee who is under ESI needs any medical care the same shall be available from ESI medical dispensaries. If he/ she requires super specialty treatment, the ESI medical Officer only will refer him/ her to private hospital attached to ESIC. In case such hospitals do not have facility, then they will refer it to such hospital from where the insured can get such treatment. This is the process. The ESIC cannot admit any hospital bills produced without following these steps.

It is understood that your friend dis not go to ESI hospital but straight away went to private hospital. The ESIC used to admit such cases, especially in the case of accidents while on duty or when it becomes necessary to get admitted during night when the dispensary is closed, provided immediately after such admission in the private hospital, ie, at least next day of admission, an intimation of such admission and reasons behind are given to the ESI Local/ Branch Office. The same has also been dropped, I believe. Since your friend has not even informed the sickness and admission in private hospital even after getting discharged from the hospital, I don't think that the ESIC will entertain it. But you can advise her to visit the ESI Branch office and submit a request.

From India, Kannur
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