Employee State Insurance Corporation (ESIC) - ESIC Grievance Redressal

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Written by Dr. Sameer Sippy | Medically Reviewed by The Medindia Medical Review Team  on Sep 28, 2014
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ESIC Grievance Redressal

This ESIC scheme, being a multi-disciplinary, service intensive, social security programme for workers, an estimated 3.5 lakhs of beneficiaries visit the service outlets at the grassroots level daily either for treatment purposes or for availing cash benefits. In such a highly interactive and dynamic system, there is ample scope for any unlawful, inadvertent or wilful harassment being caused to the beneficiaries of this scheme.

Hence, to overcome such incidents, ESIC Corporation has set up an elaborate system for speedy redressal of public grievances and complaints at various levels as follows:

  • Branch Office Level
    • Manager, In charge of Branch Office
  • Dispensary Level
    • IMO In charge.
  • Hospital Level
    • Medical Superintendent/Deputy Medical Superintendent
  • Regional Level
    • Public Grievance Officer
    • Regional Director ESIC

e) Director Public Grievances, ESI Corporation, Kotla Road, New Delhi-110002. Tel No.: (011) 23239424/23234092

The ESIC has taken various remedial measures for ensuring timely redressal of grievances to the beneficiaries of this scheme. In accordance with Regulation 10 and 10A of ESI (General) Regulations 1950, Local Committees and Regional Board representing employers, employees and Scheme administrators have been constituted under ESIC Scheme. All the units/offices of the ESI Corporation dealing with the public grievances have been given specific instructions to register complaints from varied sources viz. Insured Persons/Employers/VIPs/Associations of Employees and Employers/News items and Complaint-Boxes that are provided at the Branch Offices/Regional Offices. Based on the classification of the nature of complaints received, a registration number should be allotted to each case. On conducting proper enquiries of such grievances, the cases are settled promptly. In case of rejection of any complaint/grievances, the complainant is informed regarding the reasons of rejection of such petitions.

Subsequently, the ESI Corporation has taken the policy decision to set up an independent cell to deal with the public grievances exclusively at Regional levels across India with effect from April 1999.

Accordingly, special cells to deal with the public grievances as well as to promote the public relations have been set up at Regional Offices across India. This is done with for the purpose of monitoring the redressal of grievances of the beneficiaries and dependants attached to this ESIC Scheme. The complaints of the beneficiaries including the Employers and representatives of Associations/Labour leaders are given due attention and weightage so as to settle claims and other grievances on priority basis. Besides, 'SHIKAYAT ADALAT' has specially been constituted to deal with the public grievances.

A facilitation center has been opened at Sub Regional Offices across India allowing insured person, employers etc. to lodge their complaints/grievances freely without any fear and interact with the ESIC.

The Complaints are duly attended to and wherever essential, detailed investigations are conducted so that such Complaints are redressed in a prompt and judicious manner and recurrence of such grievances are nipped in the bud.

Medical Appeal Tribunals

The State Government constitutes Medical Appeal Tribunal for the purpose of Section 54 A of ESI Act and Rule 20 A of ESIC (Central) Rules 1950 and regulation 76 of the ESI (General) regulations, 1950.

The Medical Appeal Tribunal consists of a Judicial Officer appointed by the State Government of status not higher than judge of the Employee Insurance Courts. He/She will be assisted by one or more senior State Medical Service Experts drawn from the panel from the respective branch of medicine to which the case pertains. This Tribunal also includes officials nominated by the State Government of recognized trade unions for this purpose.

Procedure of Medical Appeal Tribunal

An insured person or ESI Corporation, whosoever, is dissatisfied with the decision of the Medical Board may appeal to the Medical Appeal Tribunal on Form B.I.5 within 3 months of being informed of the decision., If it is satisfied that the Appellant had sufficient and valid reasons for not submitting the application with the prescribed time as specified by ESIC, then the Tribunal even after the stipulated period of three months may entertain an application.

The Tribunal has the powers to confirm, reverse or vary with the decision of the Medical Board in part or in whole.

Employees' Insurance (EI) Courts

Under Section 74 of the ESIC Act, the State Government shall constitute an EI (Employees' Insurance) Court for local areas by notification in the Official Gazette. Any person who is or has been a judicial officer or is a legal practitioner of five years' standing shall be qualified to be a Judge of the Employees' Insurance Court. Under Section 54A(2) of the Act, the Employees' Insurance (EI) Court can decide to appeal against the decision of Medical Board/Medical Appeal Tribunal, in case of any shortfalls.

(b) The insured person or the Corporation can file an Appeal under Section 54A of the Act and Rule 20B of ESI (Central) Rules, 1950 to the Employees' Insurance (EI) Court by presenting an application within three months of the date of communication of the decision of the Medical Board/Special Medical Board or to the Medical Appeal Tribunal to the insured person or the ESI Corporation as the case may be.

The Employees' Insurance (EI) Court may entertain application after the stipulated period of three months, if it is satisfied that the applicant had sufficient and valid reasons for not presenting the application within the said period.

The Rules made by the State government in respect of form and procedures to be followed in presenting an application to Employees' Insurance (EI) Court shall be applicable to the applications presented for the above purpose.

An appeal can be made against the decision of an Employees' Insurance (EI) Court can be transferred to the High Court, if a substantial question of interpretation of law is involved under Section 82 of the Act and period of limitation for an appeal shall be sixty days.

Reference:

  1. Employee's State Insurance Corporation - esic.nic.in

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Hello I would like to know that when esic insured women can claim her cash benefits. As the expected date of the delivery is first week of April'18. I also visited the local esic office but they said they will claim after rejoining the organisation\. Is that true. Why I cannot get the cash benefits during my pregnancy. Kindly reply asap

Guest

Hi All, The esi card in the name of spouse, is her mother in law can be covered under the esic scheme

Dear Sir,

Kindly inform me the details of ESI schemes for dental treatments and also the available dental hospitals in Kerala.

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