Navigating ESIC Accident Reporting: How to Handle Timely and Backdated Cases?

I would like all of your advice on the below-mentioned queries:

1. Reporting Accidents to ESIC

In case an employee meets with an accident, what is the maximum time within which an accident can be reported to ESIC? According to the ESIC act, accidents have to be reported within 24 hours to the branch office.

2. Reporting Backdated Accidents

In case we have not reported any accidents to ESIC until now, can we report backdated cases to them (some are 3-4 months old)? If yes, what is the process to follow?

3. Handling Non-ESIC Covered Employees

If an employee is not covered under ESIC, what is the process to follow for such cases, considering other acts?

4. Types of Accidents to Report

What type of accidents do we have to report? How can we distinguish which accidents should be reported or not?

5. Reporting Road Accidents

Do road accidents have to be reported to ESIC, just to be on the safer side?

6. Required Forms for ESIC

What forms need to be submitted to the local ESIC office?

I would appreciate your prompt response to this.

Point 1: Reporting Accidents to ESIC

Employees are covered under ESIC. If an accident occurs, it is a statutory liability for the employer to submit the accident report within 24 hours from the date of the accident. Alternatively, proof of an FIR from the Police Department can be obtained in case of a delay due to justifiable grounds. Submitting reports on back dates is not encouraged by ESIC. In such cases, medical expenses for hospitalization can be claimed, but sickness benefits cannot be legally claimed.

Point 2: Communicating with ESIC Authorities

Write a letter to the ESIC Branch Manager/Commissioner/Assistant Regional Director explaining the exact situation causing the delay in submitting the Accident Report and, if necessary, the FIR. If they are convinced, a domestic inquiry will take place. If legal action is preferred, the liability will be on the employer to pay benefits to the employee if the counter documents are not justifiable.

Point 3: Compensation for Non-ESIC Covered Employees

Even if an employee is not covered under ESIC, it is still the employer's liability to provide compensation for any injury that occurs. Consider a Women's compensation policy offered by various insurance companies to cover all employees not under ESI preview. This helps in avoiding liability risks for the employer. Additionally, opt for group medical claim policies and accidental policies. It is advisable to go for Workmen's Policy, especially for employees in risky or hazardous roles.

Point 4: Submission of Accident Report

Submit the accident report using Form-16, ensuring all necessary fields are clearly specified.

Point 5: Road Accidents and Insurance Claims

Road accidents can only be claimed if they occur during the course of employment. If an employee is traveling on the routine route to the office, insurance can be claimed, provided an FIR is filed.

Point 6: Forms Required for ESIC

In the IT revolution, there is no need to submit any forms to ESIC other than Form 37 Employment/Re-Employment to avail medical treatment.

I hope I have clarified to the best of my knowledge. Seniors, please share your valuable advice.

Regards,

Naresh Gadde

Thank you very much for your valuable explanation. I would also like to clarify that we have never filed any FIR for such cases, but due to some audit risk, we want to file the same in the ESIC office. Up to now, we have paid all the wages to employees for their absence and all the medical expenses incurred by the employer only.

Drafting a Letter to the ESIC Office

Could you please elaborate on what we have to draft in a letter to the ESIC office because this is a relatively new thing for me? Regarding the purview over road accidents while coming on shift and going back from shift, it is no longer a concept in ESIC. What type of inquiry can it be?

Reporting Short Absences to ESIC

In the case where an employee has not reported to work for only 1-2 days, do we need to report such cases to ESIC? Please suggest. We also appreciate views from other senior members as well.

Regards,
Ranjeet

Dear Naresh, Thanks a ton for the valuable guidance. I can see that we are only interested in reporting backdated accident cases in ESIC. We don't want to seek reimbursement or anything like that. I would appreciate the views of other members as well.

Regards,
Ranjeet

Reporting Accidents to ESIC: Time Frame and Procedures

In case an employee meets with an accident, what is the maximum time within which an accident can be reported to ESIC? According to the ESIC Act, an accident has to be reported within 24 hours to the branch office.

As per Regulation 65, the insured person sustaining injury needs to inform (notice - oral or written) the employer or his representative. Upon receiving the notice, the employer needs to make an entry in Form 15 - accident register. According to Regulation 68, the report of the accident has to be sent to the local office and ESIS IMO in Form 16. Information on the 'period' is contradictory. In the ESI Act by K.P. Srivastava, 3rd edition, 1986, on p. 723, the period mentioned is 24 hours, while in the local office manual, 3rd edition, year 2000, the period mentioned is 48 hours. I also have another publication, "A Brief Note on ESI Act," published by SRO, ESIC, Vadodara, which informs the period to be 48 hours on p.13. I think 48 hours is the correct answer. These 48 hours are counted after the management comes to know.

Reporting Backdated Accidents to ESIC

In case we have not reported any accident to the ESIC until now, can we report now the backdated cases to them (some are 3-4 months back)? If yes, what is the process to follow?

Yes, you can, giving valid reasons thereof. Once the local office receives the information, the Local Office Manager has to make an inquiry to verify the details. The manager will then decide whether to admit the case or not as an employment injury. If the worker has any remnant permanent disability, he can claim relevant benefits under the Act. If the accident is not reported by the management, he cannot claim any benefits. In that case, he can directly make an application in the ESI Court to claim benefits.

As you claim you do not intend to claim any cash benefits, then there is no meaning to send the form now. There is no logic. The logic may be to get the accident registered so as to get reflected in the data of accidents. The forum for this is the Factory Act where these data are compiled. Form 16 of the Factory Act should be filled up and sent instead of ESIC in such circumstances. Still, if your management is insisting, it is better you first visit the Manager, Local Office, explain the situation, and seek his guidance before taking any action.

Process for Employees Not Covered Under ESIC

In case an employee is not covered under ESIC, what is the process to follow for such cases keeping in mind other acts?

It is the Factory Act under which the management needs to intimate the Factory Inspectorate. If the employee is not covered under the ESI Act, then he is covered under the E.C. Act. Under Section 10-B of the Act, the employer is required to send a report to the Compensation Commissioner within 7 days of the incident.

Types of Accidents to Report

What type of accident do we have to report? How can we distinguish that this accident should be reported or not?

Please refer to Sec. 88, 88-A, and 89 of the Factory Act. In the E.C. Act, it is either death or serious bodily injury. In the ESI Act, information of the personal injury sustained by the insured person, the form has to be sent.

Reporting Road Accidents to ESIC

Whether road accidents have to be reported in ESIC on the safer side?

After the latest amendments, road accidents during commuting to and from work are considered employment injuries and need to be reported.

Forms to Submit to ESIC

What are the forms to be submitted to the local ESIC office?

Form 16 in case of an accident and 16-A in case of an occupational disease.

I hope this will help you decide the course of action on your part.

Regards

Registers Required Under the ESIC Scheme

Please let me know the registers that need to be maintained by the employer under the ESIC scheme.

Regards,
Lokesh.V

Could you please provide me with the court case or the latest amendment where it was determined that road accidents must be reported?

Regards, Ranjeet

Correction for Form Submission

For SR. NO. 6, accident details should be furnished to ESI in FORM NO. 12 instead of FORM NO. 16, as Form 16 has been replaced by Form No. 12.

Regards,
Krishna Yadav

I would like all of your advice on the below-mentioned query. In my factory, a worker was working, and suddenly he fell down, but no physical injury occurred, neither did any cut marks appear on his body. We gave him first aid and then admitted him to the ESIC Dispensary, where he was referred to an ESIC-affiliated private hospital and was admitted there for four days. Based on the non-appearance of any sign or mark of injury, we did not send his accident report. Now, the worker has raised his objection that we should treat this incident as an accident, and subsequently, the concerned Branch Manager of ESIC also directed us to send a report explaining why we did not inform him in the required form (Accident Report).

My Question

Was this a case of an accident? If yes, then are we required to send a report for any kind of incident where we don't find any cut marks, pain, or any signs of an accident?

Regards,
Anand

I am surprised and shocked! You admit that he "suddenly fell down." Suddenly falling down itself amounts to an 'accident.' You say that there was "no injury" or "sign of injury," and still, you claim to have given him first aid treatment and then sent him to ESI. Your statements are contradictory. When there was no injury, what first aid treatment was given and why? You must immediately send an accident report in Form 16 and apologize to ESIC for the delay in sending. That will help the worker claim disablement benefit. In the absence of it, he will only be given sickness benefit. If as a result of an injury, he has any permanent injury, he can get a benefit for that too. If you do not do that, the worker has the right to go to the ESI court for his claim, and you will be in trouble.

Regards,
Jagdish

When an accident occurs, the compliances required under the following acts are as follows:

1. **ESIC:** Submission of Form 12 under Regulation 68 to the Local Office ESIC.
2. **Factories Act:** Submission of Form 18, Notice of Accident or Dangerous Occurrence under HP Rules, under Section 88.

Is there anything else required for compliance?

Regards,
Karamjit Singh
[Phone Number Removed For Privacy Reasons]

When I upload an accident report by mistake and have entered the wrong time of the accident, is there any way to correct that report that I have already submitted through the portal?

Dear Sir,

One of our employees has met with an accident in the company. He is not registered in ESIC. He is a new joiner, having joined just six days ago.

Is it possible to claim benefits in ESI? Please guide me.

Confirmation of Employee Coverage Under ESI Act

1. Please confirm whether the wages of the employee who met with an accident are within the coverable limit, i.e., up to Rs. 21,000 per month.

2. If so, your establishment should have immediately covered the said employee, allotted him an insurance number, and completed all formalities regarding the registration of the employee under the ESI Act, 1948, and the rules/regulations framed thereunder.

3. After the allotment of the insurance number to the said employee, you can submit an online accident report to the appropriate branch office of ESIC to which your unit is attached and pursue the matter with the said office. Your submission of the accident report at this stage will, however, be treated as late.

4. The employee who met with an accident may be receiving treatment from a hospital or dispensary. After the allotment of the insurance number and completion of registration formalities, he can visit and receive treatment from the ESIS dispensary as may be allotted online by the said office.

5. In case of any difficulty, you can visit the appropriate branch office of ESIC and receive suitable advice/instructions on the matter.

Would like all of your advice on the below-mentioned query:

1. Is an accident report filed in the case of an employee's brain hemorrhage on the road after duty off?

I believe the employer can file any accident report as they deem proper under the provisions of the ESI Act, 1948, and the rules/regulations framed thereunder. However, whether an accident or injury is a result of or occurred during the course of employment needs to be examined by the competent officer of ESIC. I anticipate that they will inform you of their decision after reviewing the accident report and the facts of the case.

Since brain hemorrhage indicates an illness, the key aspects to consider will be the post-mortem report, the causes of death, and the medical opinion of the competent authority. Please ensure you provide complete and accurate information in the accident report and reach out to the concerned Branch Office Manager to which your unit is attached. The contents and findings in the FIR (if filed with the police authorities) may also be relevant.

Thank you.

Hi everyone! Ravish here. I want to ask, if the accident of an employee gets out of the company, and his family members can admit him to the private hospital, and his ESIC payment is pending for 1 month, what claim can I get? They informed HR after 48 hours. What is the right decision?

Thank you.

This is a road accident at the leave time. What can HR do.

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This is a road accident that occurred at the time employees were leaving work. In such a situation, HR should immediately respond to ensure the safety and well-being of the employees involved. HR can initiate emergency protocols, contact medical services if needed, and provide support to the affected employees and witnesses. Additionally, HR should investigate the accident to understand the causes and prevent similar incidents in the future. It is crucial for HR to communicate effectively with all staff members regarding the incident and any follow-up actions that will be taken.

I am an employer, and my employee died of a heart attack while on his way to work. He was waiting for the doctor near his residence as he felt breathless. While waiting for the doctor, he wanted to go to the washroom, so people helping him took him to his building, but he used a washroom of some society member on the ground floor (employee stays on the 3rd floor). He suffered a massive heart attack after coming out of the washroom and while waiting for the doctor.

Question about ESIC and duty break

My question is, the ESIC officers say that there is a break in duty as he returned midway. But I argued that he had not reached home and was waiting for the doctor. Is there any court judgment or any other material in favor of the employee that I can produce to the ESIC office?