Seeking Guidance on ESI Benefits After a Family Member's Passing: What Are Our Options?

Dear seniors, My father passed away on 4th November 2014 due to heart failure. Both my brother and I are members of ESI. Is there any scheme available to receive any amount from ESI? The ESI deduction from my salary is only Rs. 104, whereas for my brother, it is Rs. 187. I would like to know who is eligible to receive the maximum amount and what the procedure is. Our family does not have any financial support. Your assistance is greatly appreciated.

Thank you in advance.

I'm sorry about the thing that happened. If your father was under the ESI scheme and he died while working, then you can claim an amount from ESI. I don't understand your second question. Just because you and your brother are under the ESI scheme does not necessarily mean that you will receive money from ESI. The scheme is designed to cover your medical expenses in case of illness or sickness.

Thank you.

Thank you for your reply. My father is not a member of ESI. My second question is regarding the ESI deductions from our monthly salaries. The amount deducted from my salary is Rs. 104, and from my brother's salary, it is Rs. 187. Only my brother and I are ESI members.

ESI Benefits Inquiry

My question is, does ESI provide any amount in case of our father's death? If so, who should apply for this, sir?

I don't think ESI will provide any compensation for your case. Your father may receive benefits because you are covered by ESI, which includes your family. However, in the event of your father's or guardian's death, ESI will not provide any compensation.

Sir, one more thing. I spent Rs 40,000 on hospital treatment for my dad. I admitted my father to Apollo Hospital. Yesterday, I went to the local ESI for claim reimbursement. They said we are not eligible to get a claim because Apollo Hospital is not tied up with ESI. ESI only gives reimbursement for treatment at tied-up hospitals. Sir, what can I do now for this issue?

I am very sorry to hear that your father is no longer with us, and I pray to God to give you the courage and strength to bear this immense loss. I have gone through your thread with responses from everyone. Firstly, the title of the thread "ESI for member death" is misleading.

You are not entitled to any amount from ESIC due to the passing of your father. However, you can approach the ESI Branch office for reimbursement of medical expenses that you incurred for your father's treatment in a private hospital or non-tie-up hospital. To do so, you need to convince the corporation of the following:

1. Hospitalization was necessary at private hospitals due to extreme emergency or life-threatening situations.
2. Explain the reason for not informing the ESI Corporation of the hospitalization at a private hospital.
3. Justify the delay in submitting the claim for medical reimbursement.

For hospitalization at private hospitals in extreme emergencies or life-threatening situations, ESIC provides reimbursement of medical expenses at actuals without any limit. This reimbursement is completely separate from your contributions.

Each Branch office or RO may have its own procedure for claiming medical expense reimbursement. I am attaching a claim form devised by the MO at Pune, Maharashtra. The claim form at the Branch office you are associated with may be different.

I suggest you give it a try. Best of luck.

Regards

In an ESI hospital or ESI tie-up hospital, you do not need to spend a single paisa. All treatments, including medicines, are free of cost. I am surprised how you spent 30K in an ESI tie-up hospital. According to me, the tie-up arrangements are meant to provide cashless treatment. ESI treatment is not related to your salary or ESI contribution, as I mentioned earlier. There is no upper limit, but it is based on the actual expenses.

Thank you so much for your elaborate reply. I went to the ESI hospital for my father's treatment claim. They said to attend a meeting in Chennai. Every month, on the second Tuesday, they conduct this meeting for cases like this. I forgot the meeting name; I think it's "sikkayath" or "sikkath," but I'm not sure. I went to Chennai on the 9th; they said the meeting is canceled. On the 8th, I confirmed with the local ESI about the meeting, but in Chennai, they said the meeting is canceled. They asked me to come to the next meeting. What can I do for this? What documents do they need? Kindly clarify for me.

Thank you so much for your valuable words.

Regards,
Ankitha

You can claim the amount from ESI without the need for any intimation. However, intimation within 24 hours is required in the case of an employment injury or accident.

Please let me know if you need any further assistance.

Regards