Navigating ESI Coverage: Can We Process Salary and Claim Treatment Costs for an Injured Employee?

Hi friends,

I am working as an HR Executive. One outsourced employee working in my organization met with an accident and is receiving treatment from a private hospital, even though he is covered by ESI. Since the date of the accident, he has been on leave.

In this case, I would like to inquire about the following:
1. Can we process his salary as he has been on leave for more than a month?
2. Can he claim the entire expense of his treatment from ESI? He is regularly visiting an ESI hospital.

I am looking forward to receiving some helpful insights from all of you.

Regards,
Vivek

Hi dear,

You cannot process his salary based on the mentioned ground, and you cannot reimburse the bill as he is not receiving treatment from ESI.

Hi,

For taking treatment with ESI, first, they have to go to the ESI Dispensary allotted to them and obtain a reference from the concerned doctor to visit an ESI Hospital or an ESI Authorized Hospital. Only then will they be able to avail the benefits from ESI.

Thanks,
Vaitheeswaran S

Hello Vivek,

As you mentioned that he is an outsourced employee, the responsibility for salary processing lies with the outsourced agency.

For availing the benefits provided by ESIC, we first need to inform the ESI Dispensary assigned to that particular employee along with the Accident Form (if an accident occurred during employment). The Medical Officer of the ESI Dispensary can refer the employee for hospitalization to an ESI Hospital or any local Government Hospital. For a leave of 3 days or more, ESIC issues an illness certificate to the employee. It is the employee's duty to submit it to his Employer as soon as possible.

During the period of Medical Leave through ESIC, benefits including salary/wage as per the standard benefit rates under Rule 54 of ESI (Central) Rules, 1950 shall be provided by the ESIC.

In your situation, if the employee is covered under the ESI Act and regularly visits the ESI Hospital, then you can instruct your outsourcing agency to obtain a Medical Certificate from him. If the employee provides a Medical Certificate from a Registered Practitioner, then the outsourcing agency can process his salary by deducting his Medical or Earned Leave.

If the employee obtains a medical certificate from ESI advising him to rest/take leave, then you do not need to process his Salary. He will receive all benefits from ESIC, including coverage for his medical bills.

Regards,

Anuj

Hi Vivek,

I am working as an HR Executive. One outsourced employee, who is working in my organization, met with an accident and is currently undergoing treatment at a private hospital, even though he is covered under ESI. Since the date of the accident, he has been on leave.

In this case, I would like to clarify the following:
1. Can we process his salary if he is on leave for more than a month?
2. Can he claim the entire expense of his treatment from ESI? He is regularly visiting the ESI hospital.

As the individual who was injured is from an outside agency, how will you handle the preparation of his salary? The outsourcing agency should be responsible for this. If the outsourcing agency prepares or pays his salary during this period, the individual will not receive any cash benefits from the ESI Branch office.

Regarding reimbursement, since he is receiving medical treatment solely from the ESI hospital at no cost to him, he will only receive cash benefits from the ESI Branch office for the days he was absent from duty.

Looking forward to some valuable input from all of you.

Regards,
Vivek

Hi Vivek,

I am an HR professional. It is important to note that the outsourced employee, who is currently on leave due to an accident and is receiving treatment at a private hospital while being covered under ESI, may have specific implications for his salary processing and reimbursement of medical expenses.

As the injured employee is associated with an external agency, the responsibility for salary processing may lie with the outsourcing agency. If the outsourcing agency continues to pay his salary during his absence, he might not be eligible for cash benefits from the ESI Branch office for that period.

In terms of medical expenses, since he is utilizing services solely from ESI Hospital, any reimbursement would likely come from the ESI Branch office for the days he was absent from work. It's crucial to consider these factors while managing the situation effectively.

Best regards,
H.R. Shah