One of my friends went to a private hospital for medical treatment. Due to some unavoidable situations, she didn't apply for ESIC benefits. Moreover, she was helpless in terms of ESIC guidance. It's been more than 2 years, but can she claim the amount spent on that treatment? I need your support to guide her in claiming the spent amount. The amount spent was nearly 2 lakhs.
From India, Delhi
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1From India, Delhi
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If any employee who is under ESI needs any medical care, the same shall be available from ESI medical dispensaries. If he/she requires super specialty treatment, the ESI medical officer will refer him/her to a private hospital attached to ESIC. In case such hospitals do not have the facility, then they will refer the insured to a hospital where the required treatment can be obtained. This is the process. ESIC cannot admit any hospital bills produced without following these steps.
It is understood that your friend did not go to an ESI hospital but instead went directly to a private hospital. ESIC used to admit such cases, especially in the case of accidents while on duty or when it becomes necessary to be admitted during the night when the dispensary is closed. However, this is provided that immediately after such admission to the private hospital, i.e., at least the next day after admission, an intimation of the admission and reasons behind it are given to the ESI Local/Branch Office. I believe this practice has also been discontinued.
Since your friend has not even informed about the sickness and admission in a private hospital even after being discharged, I don't think ESIC will entertain it. However, you can advise her to visit the ESI Branch office and submit a request.
From India, Kannur
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It is understood that your friend did not go to an ESI hospital but instead went directly to a private hospital. ESIC used to admit such cases, especially in the case of accidents while on duty or when it becomes necessary to be admitted during the night when the dispensary is closed. However, this is provided that immediately after such admission to the private hospital, i.e., at least the next day after admission, an intimation of the admission and reasons behind it are given to the ESI Local/Branch Office. I believe this practice has also been discontinued.
Since your friend has not even informed about the sickness and admission in a private hospital even after being discharged, I don't think ESIC will entertain it. However, you can advise her to visit the ESI Branch office and submit a request.
From India, Kannur
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