Navigating ESIC for a Major Surgery After a Road Accident: Is It Still Possible?

While going to the office, I met with an accident. I didn't claim earlier and have been receiving treatment in a private hospital. Now, my injury is 3 months old, and I have to undergo a major operation. Is it possible under ESIC? If yes, then how?

You must go to the nearest ESI Hospital for further treatment. From there, they could send you for specialty treatment if required. Otherwise, you could submit your medical bills to your ESI local office for reimbursement. Since you're covered under the ESI Scheme, you need to take leave through ESI only for all benefits.

The ESI scheme provides full coverage even while commuting to your workplace or returning home. However, the accident report must be filed within the specified time limit, which may now be quite late or delayed. Even if the accident occurred outside the establishment or factory due to unawareness, you can submit the accident report through your employer. This can be accepted by the local office with the approval of the concerned regional office. In such cases, your benefit rates for absence will be increased from general sickness to employment injury.

The second option is to attend the ESIC dispensary and get yourself referred to a designated hospital, where you will receive reimbursement of medical bills and wages at ordinary sickness benefits rates.

Regards,
P.K. Sharma