Employee Road Accident: Can We Claim ESI Benefits and How Do We Start?

Dear Sir,

One of our employees has met with a road accident recently. He is covered under the ESI Scheme.

Is it possible to claim the benefits in ESI? If 'yes', please guide me.

Regards,
Jothi

Hi Jothi,

Was he on duty at the time of the accident? Or was he outside of the company premises for official work and met with the accident? If yes, he can get the benefit from ESIC. For getting the benefit from ESIC, the employer has to submit one letter stating that all staff with a certificate from the State Police of the accident (if registered) and other ESIC forms.

Regards,

If one is covered under the ESIC Act and is on duty at the time of the accident, then they are definitely entitled to receive the benefits of the accident under this act. You have to submit Form No. 16 (intimation of accident) under this act.

Swati

Dear,

I agree with Tushar, please submit the accident report and obtain a copy of the FIR from the police. Also, submit all required forms so that his family can receive maximum compensation.

Regards,

Vipin
:icon1::icon1:

Hi,

Please check if the time he met an accident was during duty hours or elsewhere on the premises. If it happened on duty, then only can he claim for ESI benefits. An application letter, ESIC form, and police report are required to be submitted to the ESIC office for this benefit. First, you should verify the eligibility for this ESI scheme.

That's all from my side.

Thanks & Regards,
C. Bhushan Sharma

Dear Sir,

This is Shekhar Srivastava. I would like to know about the duty time in the case of an accident of an ESI-covered employee.

Seniors,

Please guide if an employee covered under ESI meets with an accident while coming to duty from home or while going home after finishing his duty.

Please clarify.
Prasad

Dear Mr. Prasad,

Basically, when an employee reaches and stays inside the premises of the organization, then only he is eligible for any benefits in case of an accident.

In some cases, it is also considered that if a person is using the same way/path for incoming and outgoing to the factory/organization and if he or she meets an accident outside the premises but on the same path which he or she usually uses to go and come to work, then in some cases, he or she is also eligible to benefit under the ESI scheme. However, this does not fall under general practice but is a highly special case that will be considered by the ESIC Authorities and Court.

This is my perspective. Let others share their thoughts on this.

Thanks & Regards,
C. Bhushan Sharma

Dear Jothi,

Greetings!

As per the ESI Act:

51C. Accidents happening while traveling in employer's transport
(1) An accident happening while an insured person is, with the express or implied permission of his employer, traveling as a passenger by any vehicle to or from his place of work shall, notwithstanding that he is under no obligation to his employer to travel by that vehicle, be deemed to arise out of and in the course of his employment if:
(a) the accident would have been deemed so to have arisen had he been under such obligation; and
(b) at the time of the accident, the vehicle
(i) is being operated by or on behalf of his employer or some other person by whom it is provided in pursuance of arrangements made with his employer, and
(ii) is not being operated in the ordinary course of public transport service.
(2) In this section "vehicle" includes vessel and an aircraft.

51D. Accidents happening while meeting emergency
An accident happening to an insured person in or about any premises at which he is for the time being employed for the purpose of his employer's trade or business shall be deemed to arise out of and in the course of his employment if it happens while he is taking steps, on an actual or supposed emergency at those premises, to rescue, succor, or protect persons who are, or are thought to be or possibly to be, injured or imperiled, or to avert or minimize serious damage to property.

Hi Prasad,

As you asked the question, that particular person will not be eligible for any benefits from the ESIC Department. However, he or she can receive free treatment from an ESIC doctor if they have already registered with one.

Regards,

Hi friends,

ESI does not apply to notional extension, which refers to the journey from home to the workplace and back. ESI is applicable to any accident that occurs during employment, arising out of the employment, or while carrying out assigned duties.

If a vehicle carrying employees from their homes to the workplace meets with an accident, the question arises whether ESI is applicable in such a situation. The answer is NO. The reason being notional extension is not covered under ESI. For reference, please see the judgments from Andhra Pradesh and the Supreme Court.

Regards,
Michael Nicholas

Dear Friends,

If he is on duty, then he can get benefits under ESIC. But please follow the following conditions:

1. He is on duty.
2. Send Form-16 accident report to the local office.
3. Pay 9 contributions of employees for major treatment benefits and salary for absent days.

Thank you.

Hi,

If the employee was on duty during the time of the accident, he must benefit from the ESIC. It should be reported to the ESIC local office within 24 hours by filing Form 12 (in triplicate), duly attested by the employer, enclosing all the facts related to the accident. For example, enclose the attendance sheet showing the employee was on duty, a xerox copy of the OD slip/OD register attested by a competent authority showing that at the time of the accident, the employee was on duty. Also, enclose a copy of the police report to strengthen the case. Additionally, mention the same in Form 11 (accident register), which may be checked by ESIC authorities during report submission. The entire process should be completed within 24 hours. If any week off/holidays fall within this period, it should be reported to the ESIC dispensary allocated to the IP in the form of an application detailing all the facts. Acknowledge the same.

Lastly, the salary of the IP must be Rs. 10,000/- (per month) or above; otherwise, no benefits will be provided to employees.

Thanks and regards,

Sumit Kumar Saxena
M-09899669071, 0120-4131277

Dear Mr. Tushar,

Do IT companies come under ESIC which have more than 20 employees? Please suggest.

Dear Tusar Sir,

You mentioned that the particular person will not be eligible to receive any benefits from the ESIC Department. However, he or she can still receive free-of-cost treatment from an ESIC doctor if they are already registered with one. I would like to understand the procedure for registering with an ESIC doctor.

Regards,

Shekhar Srivastava
Sr. Executive HR
Fusion Electronics Pvt. Ltd.
Lucknow
9005625107

He will get ESI benefits if the employee was at the time of the accident on the way to/from the workplace. You have to submit an accident report to this effect.

Hi Shekhar,

That is not a big process. Employees need to bring the TIC or PIC (Temporary or Permanent Insurance Card) along with Form 37 and family members' photo. It should be submitted to the regional ESIC doctor. Once he/she and their family members register, then afterward, they are eligible to get the free benefits from the ESIC doctor.

Dear Srinivas,

In India, many places are similar, where ESIC is not applicable because those places do not have ESIC facilities, and there is no ability to provide medical facilities through ESIC. Therefore, ESIC has designated those places as non-ESIC areas.

In that case, employees in those areas must be registered under the "Workman Compensation policy," meaning the employer has to provide any other medical facilities to them.

Regards,

Hi Akhilesh,

As per the ESIC Act, every employer must register under the ESIC if they have 20 or more employees. This implies that there is no substitute for IT organizations.

My employee went on duty when he met with an accident, resulting in the loss of his left hand. What steps should be taken to claim the benefits?

If a person meets with an accident outside while on duty due to an emergency, and they are admitted to a private hospital, can they avail themselves of the benefits if possible?

How much claim would a dependent receive if they got into an accident under the ESI scheme, considering the accident occurred outside the company?

Dear Mr. Tushar, Do IT companies come under ESIC if they have more than 20 employees? Please suggest. How much claim can dependents get in an accident under the ESI scheme when the accident occurs outside the company?

I am working in a service company. I got into a road accident (my bike slipped due to a puncture) on the company's bike on November 26, 2016, while returning to the company from the client site. I received treatment at a private hospital as I was not aware of the ESIC benefits. I have taken leave from the ESIC office by providing a medical certificate. I am still on leave. Our company has not reported the accident yet.

Registering the Accident with ESIC

How do I register the accident in ESIC? What benefits will I receive if I register the accident after 2 months? Can I claim my medical expenses, and if so, to whom? What is the procedure for that?

Thank you.

ESIC Accident Reporting and Benefits Procedure

1. ESIC has an established procedure for the submission of accident reports and the payment of Temporary Disablement Benefits (TDB) to employees/insured persons who have accidents during the course of employment. You should report the accident to your employer, and an entry should be made in the Accident Register maintained by your employer, if available.

2. The appropriate office for the payment of TDB, if approved by the department, is the Branch Office of ESIC to which you are attached. If some permanent disability remains after recovery and the accident is not approved by ESIC, you will not be entitled to Permanent Disablement Benefit (PDB) from the office. You can find the address of the concerned office on the ESIC Identity Card.

3. If you have obtained medical treatment from private sources, I am not sure whether you can get reimbursement for those expenses at this stage, as ESIC has its referral and medical reimbursement procedure. You can view the instructions on the ESIC website.

4. At this stage, you can complain in writing to the Branch Manager of the ESIC Branch Office, with a copy to the Sub-Regional Office, ESIC. Inform them that your employer has not submitted the accident report and request them to ask the employer to submit it immediately and pay you the benefits (TDB and PDB) as admissible. You can also submit copies of details of any medical treatment obtained.

With best wishes.

Dear Sir,

One of our employees has met with a road accident recently while going home. He is covered under the ESI Scheme. Is it possible to claim benefits in ESI? If 'yes', please guide me.

Regards,
Harish

Dear Harish,

Without wasting time, file an online accident report and follow up with your ESI local office.

While going or returning from duty, if one meets with an accident, they will receive accident benefits if reported. However, the question remains: within how many kilometers?

BKNayak

Dear All,

Our employee met with an accident outside the premises while he was not on official duty. He can receive some ESIC benefits from the ESIC hospital.

Please explain.

Thanks & Regards,
Rajesh