Hi,
Please help me. I met with an accident and suffered a knee fracture. I received treatment for my knee from a private hospital last week without referring to ESIC. Is it possible to claim my expenses from ESIC in this case? If yes, what is the complete procedure for this? Please let me know what to do. Please help me.
Thanks,
MUZAMMIL HASSAN
From India, Delhi
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Please help me. I met with an accident and suffered a knee fracture. I received treatment for my knee from a private hospital last week without referring to ESIC. Is it possible to claim my expenses from ESIC in this case? If yes, what is the complete procedure for this? Please let me know what to do. Please help me.
Thanks,
MUZAMMIL HASSAN
From India, Delhi
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You will have to go to your ESIC clinic and submit all medical case papers. Urgent or emergency treatment was necessary due to off hours of ESIC clinic. You can try to convince ESIC authorities. Read Regulation 69 and 96A of ESIC, which deals with accident cases, etc.
From India, Pune
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3180From India, Pune
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Dear,
Nowadays, cashless card facility has made it easy. ESIC hospitals refer patients to private hospitals only when they are unable to provide complete treatment. In this case, they also reimburse the expenses up to the maximum extent. Hence, one needs to visit an ESI hospital first.
In your case, you may try to convince the ESI personnel by showing the last-minute urgency of your case for hospitalization and that there were no ESIC hospitals nearby, etc., if it is true.
From India, Delhi
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Nowadays, cashless card facility has made it easy. ESIC hospitals refer patients to private hospitals only when they are unable to provide complete treatment. In this case, they also reimburse the expenses up to the maximum extent. Hence, one needs to visit an ESI hospital first.
In your case, you may try to convince the ESI personnel by showing the last-minute urgency of your case for hospitalization and that there were no ESIC hospitals nearby, etc., if it is true.
From India, Delhi
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Dear Muzamil,
ESI is for employees’ welfare. You should have intimated your ESI dispensary immediately by your relatives or through your employer. Accident case can be treated as emergency and you have not intimated them.
Collect all your medical case history, expense bill and letter from the hospital where you are treated mentioning that your case was an emergency case/ accident case.
Ask your employer to provide covering letter stating to ESIC that you faced an accident and was unable to intimate in time/ delayed intimation and may be allowed for medical expense reimbursement.
Then deposit it in the ESI dispensary and they will forward it to their ESI hospital. There you need to convince the medical officer/ authorized person.
Once they are convinced they will forward it to regional office and your bills will be reimbursed. It will take around one month time.
Hope you will avail the monetary benefit.
From India, Bhubaneswar
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ESI is for employees’ welfare. You should have intimated your ESI dispensary immediately by your relatives or through your employer. Accident case can be treated as emergency and you have not intimated them.
Collect all your medical case history, expense bill and letter from the hospital where you are treated mentioning that your case was an emergency case/ accident case.
Ask your employer to provide covering letter stating to ESIC that you faced an accident and was unable to intimate in time/ delayed intimation and may be allowed for medical expense reimbursement.
Then deposit it in the ESI dispensary and they will forward it to their ESI hospital. There you need to convince the medical officer/ authorized person.
Once they are convinced they will forward it to regional office and your bills will be reimbursed. It will take around one month time.
Hope you will avail the monetary benefit.
From India, Bhubaneswar
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ESIC Form-Medical Expense Reimbursement.p df
Medical Reimbursement Format.doc