Misuse of ESI Benefits: How Can We Address False Medical Claims and Extended Leaves?

Misuse of ESI Benefits by Operators

Few of our operators are misusing ESI benefits in the following ways:

• Frequently, they avail themselves of sickness benefits for excessively long leave periods.
• Even for the treatment of minor injuries, they take extended leaves.
• Maternity leave is also being extended beyond the prescribed period.

Upon personal investigation, it has been found that they are 100% medically fit and are enjoying their personal lives. All of the above are being claimed falsely at the ESI dispensary. Even the ESI personnel are encouraging such practices for their personal interests.

Could I be guided on tackling such issues? Can the authenticity of medical rest advice issued by the ESI dispensaries on false grounds be challenged?

Please collect all the sickness certificates of all the employees, prepare a statement, submit it to the local office manager, and inquire about the fitness of those employees or request a certificate of unfitness.

Upon receiving this information, the local office manager will promptly contact the Hospital Superintendent or the medical officer of the relevant dispensary. It is crucial to note that there may be significant pressure from the operators on you, as the local office manager, the hospital superintendent, and the medical officer may be hesitant to take responsibility due to concerns regarding the workmen and related unions. Therefore, they are likely to communicate that they do not object to extending benefits but cannot proceed without a formal complaint from management, which may lead to agitation from the workers and unions.

I have personally dealt with a similar situation and managed to resolve it effectively. I also shared a copy of the documentation with the regional director. Additionally, the concerned Medical Officer of the dispensary was subsequently transferred. Despite initial challenges, there have been no further instances of false ESI leaves.

Regards, Kamesh