Dear All,
One of our Employee who is registered under ESI, is suffering from heart problem. In an emergency case he visited an Hospital (The Hospital has contract with the Esi). The Hospital was not agreed to take the case as their long payment is due with Esi. The Hospital said they will take the case only if the employee will do the Cash Payment but the hospital, and promised that they will help to claim from the Esi . Now all the payment has been made and all also the information was made to the Esi , they also said that they will made the payment.
Now we have completed all the paper for the claim , but the Esi is saying that they cannot accepted the Papers as claim amount is too big (say around 3.5 Lakh) . My question is even after following Esi instruction can Esi reject the Claim on the ground that Claim is too high? Then what's the need to contribute to Esi?
Thanks
Abhishek Das
From India, Kashipur
3One of our Employee who is registered under ESI, is suffering from heart problem. In an emergency case he visited an Hospital (The Hospital has contract with the Esi). The Hospital was not agreed to take the case as their long payment is due with Esi. The Hospital said they will take the case only if the employee will do the Cash Payment but the hospital, and promised that they will help to claim from the Esi . Now all the payment has been made and all also the information was made to the Esi , they also said that they will made the payment.
Now we have completed all the paper for the claim , but the Esi is saying that they cannot accepted the Papers as claim amount is too big (say around 3.5 Lakh) . My question is even after following Esi instruction can Esi reject the Claim on the ground that Claim is too high? Then what's the need to contribute to Esi?
Thanks
Abhishek Das
From India, Kashipur
1. Sir, ESI has its own instructions and procedure as well as rate-contracts with the tie-up hospitals. Therefore, the bill which the insured person has submitted is to be examined by the competent authorities keeping in view its procedure, rates and instructions.
2. Since the employee has submitted his claim ( as mentioned by you in the thread), it is better if the matter is regularly pursued with the authorities with whom the bill is pending.
3. In case of rejection or any part-rejection of the claim, the claimant can appeal to higher authorities including to Hqrs. Office of ESIC at New Delhi. If considered suitable the affected employee/insured person can also file a case for claim under section 75 in E.I.Court of the competent jurisdiction.
From India, Noida
2. Since the employee has submitted his claim ( as mentioned by you in the thread), it is better if the matter is regularly pursued with the authorities with whom the bill is pending.
3. In case of rejection or any part-rejection of the claim, the claimant can appeal to higher authorities including to Hqrs. Office of ESIC at New Delhi. If considered suitable the affected employee/insured person can also file a case for claim under section 75 in E.I.Court of the competent jurisdiction.
From India, Noida
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