Facing a Medical Emergency: How to File a Complaint Against ESIC Hospital's Refusal to Treat?

Hi Seniors,

One staff member of our organization brought his wife to ESIC Hospital for emergency treatment. Unfortunately, the attending doctor refused to treat her due to a shortage of doctors and support staff, and instead, insisted on admitting her to an outside nursing home. Could you please guide me on where to file a complaint and what the procedure is?

Thank you.

Without revealing the complete details regarding the case, one cannot give a proper reply to you. Please provide complete details, maintaining anonymity about your company name and location.

Clarification Needed

Could you clarify:
- What is your salary (is it above ₹15,000 or below ₹15,000)?
- Do you have an ESI Pehchan card for your family?
- Why don't you take the patient in the daytime?
- What reason was provided to you for not attending to the patient?
- Did you receive First Aid when you approached the ESI Hospital, or was your request rejected by the duty doctor outright?
- Have you inquired with the person available during night hours about the claiming procedure?
- Have you asked the available person about the hospital where you can take the patient, and whether the hospital referred by them has the facility to treat the patient on a cashless basis as an ESI-enlisted hospital?

Remember, merely asking about complaining without providing details will not yield a good result. Please share the necessary details, and our members will respond appropriately.

Kind regards, [Your Name]

Procedure for Filing a Complaint with ESIC

Kindly visit the local office assigned to you and lodge a formal complaint along with the necessary documents: a copy of the subscriber's ID card, copies of the admit card from the nursing home, details of the treatment given, the hospital address where the admission was denied, and the claim amount for the treatment given to your wife in the nursing home.

Send copies to the Regional Director where the half-yearly returns are being filed, and send a copy of the same to The Director General, ESIC, New Delhi. You can find the addresses on the ESIC website.

If you do not receive a satisfactory answer within two months from the Regional Director or The Director General, ESIC, New Delhi, after visiting the assigned local office of ESIC for your claim, serve them a lawyer's notice or take action from your end. File a suit for the recovery of money with the Consumer Court in your area of residence, as it falls under the consumer act. Additionally, you can file the suit with the related Labor Court. You can approach the Labor Office in the area where you are working.

Best regards, [Your Name]

I believe there may be reasons for not attending to the patient in an emergency by the ESIC Hospital. Boss 2966, in his remarks above, has rightly raised some doubts on the issue.

However, all ESIC/ESIS hospitals work under the guidance and control of the Medical Commissioner, ESIC, Headquarters, New Delhi. You can find his email on the ESIC website and request proper and immediate action in the matter if you were eligible for medical treatment. If no satisfactory reply is received, you can further make a representation to the Director General, ESIC, Headquarters, New Delhi.

Regards

First of all, I am thankful to BOSS2966, Mr. Sibal, Mr. Madanagopalaswamy, and Mr. Mehta for your valuable opinions. I agree with BOSS2966; it's really short of information. I will clarify your queries as follows:

1. Yes, he (IP) is fully eligible for receiving super-specialty facilities from ESIC, and he has a valid ESIC Pehchan Card for himself and his family.

2. Actually, she is pregnant, and a serious problem occurred at night. Therefore, there was no time to wait for daytime.

3. The attending doctor mentioned that there were no sufficient provisions for treating her, and for better treatment to save the lives of the mother and baby, it was necessary to admit her to a private nursing home. He also suggested the name of a nearby nursing home. He did not even check or provide any first aid to her but simply prescribed some medicine and advised him (IP) to take her back.

4. At that moment, he was not in a mental state to inquire about the claiming procedure. He was just confused and immediately took her to the nearby nursing home as suggested by the doctor.

5. His mistake was that he did not inform about that incident.

I hope this clarifies the situation. Once again, thanks to all for providing such helpful advice.

Now, instruct him to ask in the designated ESI Office about the procedure for reimbursement of medical expenditure for his spouse. They will provide the format. In that, he will have to get it filled out by the private hospital authorities along with the original discharge summary, original cash payment bills, prescriptions, original lab test reports, etc., to the ESI Office. You will receive reimbursement as per the rates fixed with the hospitals. It will be approximately 50 to 60%.

Dear member,

It is a very unfortunate state of affairs at the ESIC Hospital as described by you. If you wish, you can report the matter to the ESIC Headquarters Medical Commissioner, as well as the Director-General of ESIC, regarding the treatment conditions at the said hospital. You can request immediate remedial measures so that no other insured person, insured woman, or their family members have to endure such harassment and mental stress.

With best wishes.

In the future, to have a hassle-free treatment from the specialty hospitals, you can book a prior appointment through [ESIC Hospitals & Dispensaries](http://www.esichospitals.gov.in/).

Since you posted the matter on Cite HR, it is understood that you are a literate person who knows what you are writing. Therefore, I didn't feel it was right to teach you the clerical procedure. I informed you to contact the local office of ESIC where the IP is attached. Now that you have been guided and you understand the system, kindly bear in mind that in any emergencies, the ESIC hospitals are always open 24x7 all over India. Any Insured Person (IP) or his/her family members who are enrolled for treatment can easily get admitted or receive medicines as deemed appropriate by the attending Doctor. There is no need to go to private nursing homes; one can even go to government hospitals in case of emergencies, as these are equally admissible in ESIC claims.

Although it may not be fitting to mention here, sometimes attending Doctors have close relationships with nursing homes. There is no need to write elaborately; anyone can understand such occurrences by referring to reports in daily newspapers.

Regards