Employees can initiate a claim under the Employees’ State Insurance (ESI) scheme for medical expenses by following a set process. Here are the general steps for initiating a claim for medical expenses under ESI:

Step 1: Seek Medical Treatment

1. Visit an ESI Dispensary or Hospital:
   • In case of illness or injury, the employee should seek medical treatment from a designated ESI dispensary or hospital. ESI dispensaries and hospitals provide medical services to insured persons and their dependents.

Step 2: Obtain Necessary Medical Documents

1. Obtain a Medical Certificate:
   • The treating doctor at the ESI dispensary or hospital will issue a medical certificate, which includes details about the illness, recommended treatment, and the period of incapacitation.
2. Prescriptions and Bills:
   • If prescribed medicines or additional treatments are required, the employee should obtain prescriptions and bills for medicines, tests, or other medical services.

Step 3: Fill Out the Claim Form

1. Obtain the Relevant Claim Form:
   • Based on the type of medical claim (e.g., sickness benefit), the employee should obtain the corresponding ESI claim form from the ESI dispensary or download it from the official ESI portal.
2. Fill Out the Form:
   • Complete the claim form accurately. Provide personal details, details of the illness or injury, and attach the medical certificate issued by the ESI dispensary or hospital.

Step 4: Submit the Claim Form

1. Submit the Claim Form:
   • Submit the filled-out claim form along with the required supporting documents (medical certificate, prescriptions, bills, etc.) to the ESI dispensary where the employee received medical treatment.

Step 5: Track the Claim Status

1. Check Claim Status:
   • Claimants can track the status of their ESI claim through the official ESI portal or by contacting the local ESI office. Many ESI offices have online portals where claimants can check the progress of their claims using unique identification numbers.

Step 6: Receive Reimbursement

1. Reimbursement Process:
   • Upon approval of the claim, the employee may receive reimbursement for medical expenses directly into their bank account. The reimbursement may cover the cost of medicines, tests, and other related medical expenses.

Important Tips:

• It’s crucial to initiate the claim process promptly after seeking medical treatment.
• Claimants should provide accurate and complete information on the claim form to avoid delays in processing.
• Employers often assist employees in the claim initiation process, so employees may consult with their HR department for guidance.

It’s important to note that the steps and requirements may be subject to updates, and individuals are encouraged to refer to the latest guidelines provided by the Employees’ State Insurance Corporation (ESIC).