ESI Benefits - Employee Benefits [Thread 198602]

One of my employee was bitten by snake and was in critical condition. The esi govt dispensary was far away and would have led to death of the person. Hence he was taken to nearest civil hospital whera he was put in icu and was on ventilator. His shifting was not possible without loss to his life. What is the procedure to claim the treatment and hospitalisation expenses?

u cannot claim it from esic. to avail benefits under esic u must admit the concern employee into an esic hospital.

i think, in this case, you still can get the ESI benefits for that employee. Providing first aid in case of any kind of accident is employer's responsibility, even if employee is covered under ESI. You can still submit the accident report to ESI department (F-16) along with a letter from you company justifying delay in submissoin of accident report.

Hi
In this case which is exeption to the normal cases.You look into the below mentioned points.
1. Check whether your employee is having Permanent / Temp ESIC Card.
2. Whether he is registered / enrolled to his nearest ESIC Doctor or not.
3. Whether RCC is submitted & his name is mentioned or not.
After that, please draft a letter to ESIC Incharge mentioned all the points and also mentioned that this was happen on such date & time, location also. This letter must be submitted to Nearest ESIC Office at the earliest and also send separate letter to ESIC Doctor where he had enrolled. The subject of this letter will be "information about employee name & esic number".
Then, if the esic officer feel that matter is geniune then he/she allow you to go for esic cash benefit otherwise not.

dear
you can get benefit from ESI .you please talk to them and they will will guide you how you will get all bills reimbrused.
regards
js malik

Dear,
Though is mandatory to have have hospitalization in the enlisted ESI hospitals in or to avail the benefits for an employee..but this also may depend from case to case. In the case metioned by you, i think you have a perfect justification for shifting him to some other hospital rather than the enlised one. U must talk to the ESI officials for the same & get this sorted.
Would also request to send us a reply of the same...
Regards
Sumiksha Koul

Dear Sushil,
The employee can get cash reimbursement under Regulation 96A as per ESIC Norms and subject to State Government regulations depending on the quantum of reimbursement claimed. Kindly ask the employee to preserve the bills and have them indexed properly.
All the best,
Patrick Ryan

Kindly keep all the original bills and details and speak to ESIC officer, if the case is genuine they surly will consider.
Sarfaraz

Dear All,
This is a very special case for which ESIC has some special provisions. Take a photocopy of the hospital admission slip of your employee which must specify snake bite and meet the ESI officials having jurisdiction over your office and explain the situation under which the employee was admitted in a hospital other than ESI approved. You strictly go by their advice else u might lose the cash benefit. Preserve all the receipts/ cash memos/admission and discharge slips.

Dear Sushil,
Mayank Chandra is right, you have to check all the points which he has mentioned. Please note the following benefit which he can get from ESIC.
1. He will get the sickness benefit from ESIC, for that he has submit the admit & discharge certificate to the ESIC which he will get from hospital.
2. For hospital expenses & others medical test & medicine expenses, you need to go to the local AMO office and request to the Administrative Medical Officer (State Govt. Office) for reimburse the all expenses. You should communicate with them the urgency of that situation for which you had to admit him to the nearest hospital. I think, they will guide you which form & document you need to submit there.
Regards,
Dibyendu Ghosh