Workplace Injury Dilemma: Should the Company Cover Private Hospital Costs?

Good Morning, I have noticed an issue in a company where I have been placed for internship training. There was a woman who got injured in the restroom of the company premises. She was then taken to the ESI hospital for treatment and later went home to rest. However, after some time, she experienced pain in the injury, so her husband took her to another private hospital without informing the company's Safety Officer.

Statement 1: Her husband spent Rs. 5000 in the private hospital.

Statement 2: Her husband wants to claim the amount from the company.

The problem arises as the HR manager refuses to pay the amount because the victim and her husband did not provide any prior information before seeking treatment at the private hospital.

Question: Should the company pay the amount or not?

Accident Report and ESI Benefits

Did the officer concerned file/submit an accident report in Form 12 (online)?

If yes, then she will get accident benefits from the ESI Corporation and not from the employer. If, during the leave period, she developed any pain related to the accident/injury, she should have consulted the Medical Officer of the ESIC first and gotten referred to a private hospital by the Medical Officer. She is not supposed to go to the hospital of her choice directly.

Reimbursement Claim Rejection

Therefore, the HR manager is right in rejecting the claim for reimbursement of the amount spent by her in the private hospital. Even if the injured person or her spouse had informed the company officer that she is being taken to a private hospital for treatment, the reimbursement should not be approved. This is because the employer has been paying a contribution (at a rate of 3.25% of the salary paid), absolving his liability towards all possible risks, including death.