Employee Bitten by Snake: How to Claim ESI for Emergency Hospitalization?

One of my employees was bitten by a snake and was in critical condition. The ESI government dispensary was far away and would have led to the death of the person. Hence, he was taken to the nearest civil hospital where he was put in ICU and was on a ventilator. His shifting was not possible without risking his life. What is the procedure to claim the treatment and hospitalization expenses?

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 the employer's responsibility, even if the employee is covered under ESI. You can still submit the accident report to the ESI department (F-16) along with a letter from your company justifying the delay in the submission of the accident report.

Hi,

In this case, which is an exception to the normal cases, you should consider the following points:

1. Check whether your employee has a Permanent/Temporary ESIC Card.
2. Verify if he is registered/enrolled with his nearest ESIC Doctor.
3. Ensure that the RCC is submitted and his name is mentioned.

Afterwards, please draft a letter to the ESIC Incharge detailing all the points mentioned above and specifying the date, time, and location of the incident. This letter should be submitted to the nearest ESIC Office promptly. Additionally, send a separate letter to the ESIC Doctor where the employee is enrolled. The subject of this letter should be "Information about employee name & ESIC number."

If the ESIC officer deems the matter genuine, they will allow you to proceed with ESIC cash benefits; otherwise, not.

Thank you.

Dear,

You can benefit from ESI. Please talk to them, and they will guide you on how to get all bills reimbursed.

Regards,
JS Malik

Dear,

Though it is mandatory to have hospitalization in the enlisted ESI hospitals in order to avail the benefits for an employee, this may also depend on a case-to-case basis. In the case mentioned by you, I think you have a perfect justification for shifting him to some other hospital rather than the enlisted one. You must talk to the ESI officials for the same and get this sorted. I would also request you to send us a reply regarding 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 the ESIC officer. If the case is genuine, they will surely consider it.

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. Explain the situation under which the employee was admitted to a hospital other than ESI approved. You should strictly follow their advice; otherwise, you 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 benefits which he can get from ESIC:

1. He will get the sickness benefit from ESIC. For that, he has to submit the admit and discharge certificate to the ESIC, which he will get from the hospital.
2. For hospital expenses, medical tests, medicine expenses, you need to go to the local AMO office and request the Administrative Medical Officer (State Govt. Office) to reimburse all expenses. You should communicate with them the urgency of the situation that led to his admission to the nearest hospital. I think they will guide you on which form and documents you need to submit there.

Regards, Dibyendu Ghosh

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 to submit the admit & discharge certificate to the ESIC which he will get from the hospital.

2. For hospital expenses, as well as other medical tests and medicine expenses, you need to go to the local AMO office and request the Administrative Medical Officer (State Govt. Office) to reimburse all expenses. You should communicate with them the urgency of the situation for which you had to admit him to the nearest hospital. I think they will guide you on which form and document you need to submit there.

Regards,

Dibyendu Ghosh

Dear Sushil Chauhan,

You should have informed the concerned ESIC Dispensary about what has happened, and as an emergency case, you should admit him to the nearest civil Hospital. Since it is an emergency case, you can avail ESI benefits for that employee by providing all relevant documents related to hospitalization, treatment, etc., given in the civil Hospital. One thing I would like to mention is that even in the case of any emergency, you should first try to inform the concerned ESI Dispensary within 24 hours of the incident/accident if the person is covered under ESIC.

The documents to be submitted in order to claim ESI benefits are as follows:

1. Doctor's certificate as an emergency case.
2. Discharge summary.
3. All bills related to treatment and medicines.
4. Form 37.
5. Permanent ESI card.
6. Employment certificate from the employer to claim ESI benefits.
7. Entitlement certificate from the Dispensary.
8. Running letter from the Local Office.

With regards,

Dharaneesh Kumar.V
HR/Admin Executive

Hi,

In the above case, the ESI Act 1948 clearly states that in case of an emergency, if an employee is unable to reach an ESI Hospital (for certain diseases), then he can receive primary treatment from a nearby hospital and will be reimbursed for that. However, as soon as he is in a position to be shifted to an ESI hospital, he must do so. The employee just needs to obtain a certificate from the ESI doctor for treatment in a private hospital.

In situations involving a matter of life and death for an employee, their dependents can request a certificate from the relevant ESI doctor and seek reimbursement in the future.

Thank you.

It is not clear from your question where the snake bit. Whether it is in the work spot or at his house.

If it is in the work spot, it will definitely come under the definition of an accident under sec. 2(8) of the ESI Act, 1948, and that employee is entitled to both the Temporary Disablement Benefit and Medical reimbursement. In case of death as a result of a snake bite, the dependents will receive the Dependant Benefit. For all this, the employer has to submit the Form 12 (old Form 16) to the concerned Branch Office. No contributory condition and no past service are required.

Even if you don't submit the declaration form now, it can be submitted along with the valid reasons under what circumstances you have not submitted the declaration form and obtained the temporary or permanent card.

On the other hand, if the snake bite is at his home or elsewhere (not in the work spot or office), he will get the reimbursement of the medical expenditure from the ESI Corporation on submission of the medical bills and claim form through his dispensary.

For getting the medical reimbursement under the super specialty treatment, the employee has to be in the insurable employment for 9 months or more, and he should have contributed for at least 78 days during the relevant contribution period corresponding to the benefit period. If he satisfies the above condition, he can get the medical reimbursement in case the snake bite is outside the employment.

Dear All,

Can anybody tell me about the rules of the Shop & Establishment Act and Minimum Wages Act in West Bengal?

Which rules do we have to maintain, which returns, due date, register has to be maintained?

Please help me out with this problem.

Regards,

Dibyendu Ghosh
dibyendu23@rediffmail.com

Dear All,

Firstly, you have to submit the accident report explaining the nature of the injury and the actions taken to the local office. A copy can be submitted to the dispensary to which the employee is attached. Once the employee is out of danger, they could be moved to the ESI hospital. You will need to collect all bills for hospitalization and medicines purchased. Once the employee is fit, they should go to the attached dispensary and apply for a refund. The doctor at the dispensary will recommend the refund amount (subject to the rates fixed by the government) and recommend to the local office for the release of this amount.

Thus, the employee will not only receive accident benefits but also the cost of medication and hospitalization, subject to the conditions detailed above. You may then collect the money spent on the employee from them.

That is all.

Take care.

Regards

Dear Sushil,

My gentle advice is, first of all, you talk to the ESIC branch manager. He will suggest the right way. But according to my knowledge, after the accident, an accident report should be submitted to the ESIC branch office within 24 hours in a prescribed Form-16. After that, they will continue the treatment.

Sanjeev

Dear team,

Is it compulsory to admit my wife in ESIC to get benefits (wife is pregnant)? Can I get any benefits from ESIC?

Regards,
Omswami.