The Employees’ State Insurance (ESI) scheme is a social security program run by the Employees’ State Insurance Corporation (ESIC), under the Ministry of Labour and Employment, Government of India. It provides health insurance, medical care, and cash benefits to employees earning ₹21,000 or less per month (₹25,000 for people with disabilities). Both the employee and employer contribute to the ESI fund every month. If you are an insured person under this scheme, you are entitled to various benefits like medical care, sickness benefit, maternity benefit, disablement benefit, and more.
In this article, we will explain how to claim ESI amount under different benefit categories, the process to follow, required documents, and other important information in simple language.
Types of Benefits under ESI
Before understanding how to claim the ESI amount, it is important to know what types of benefits are available under the scheme:
- Medical Benefit- Full medical care is provided to the insured person and their dependents from the very first day of ESI registration.
- Sickness Benefit- Cash compensation at the rate of 70% of wages is paid during certified sickness for a maximum of 91 days in a year.
- Maternity Benefit- Paid to insured women for confinement (pregnancy), miscarriage, or sickness arising out of pregnancy.
- Disablement Benefit- Paid to employees who suffer temporary or permanent disablement due to employment injury or occupational disease.
- Dependent’s Benefit- If an insured person dies due to employment injury, his dependents are entitled to receive monthly payments.
- Funeral Expenses- A lump sum amount is given to cover the funeral expenses of the deceased insured person.
- Rehabilitation and Vocational Training- For injured or disabled workers, training and rehabilitation support are also provided…!
General Steps to Claim ESI Amount
The procedure for claiming ESI benefits may vary depending on the type of benefit. Below are the general steps:
1. Claiming Medical Benefit
No cash claim is involved here. Medical services are available at ESI hospitals and dispensaries.
Steps:
- Visit the nearest ESI dispensary or hospital.
- Show your ESI card, temporary ID, or biometric Pehchan card.
- Consult a doctor and receive treatment free of cost.
Documents Required:
- ESI card
- Aadhaar card
- Employer’s referral letter (if required)
2. Claiming Sickness Benefit
This is a cash benefit provided to employees during periods of sickness when they are unable to attend work.
Eligibility:
- Must have contributed for at least 78 days in the contribution period.
Steps:
- Visit an ESI hospital and get a medical certificate (Form 8).
- Submit Form 9 (claim for sickness benefit) to your employer.
- The employer will forward it to the ESI Branch Office.
- After verification, the ESI amount is directly transferred to your bank account.
Documents Required:
- Medical certificate (Form 8)
- Sickness claim form (Form 9)
- ESI card and bank account details
3. Claiming Maternity Benefit
This benefit is available to insured women for up to 26 weeks of maternity leave.
Steps:
- Visit the ESI dispensary and get the maternity certificate.
- Submit Maternity Claim Form (Form 19) and Confinement Certificate (Form 23) to the employer.
- The employer will forward the claim to the ESI Branch Office.
- After approval, the payment is made in instalments or a lump sum.
Documents Required:
- Maternity certificate
- Maternity claim form
- Aadhaar card
- Bank account details
4. Claiming Temporary Disablement Benefit
If an employee is injured during work and is unable to work temporarily.
Steps:
- Report the injury to the employer immediately.
- Visit the ESI dispensary and get an accident report.
- Submit Form 10 (Accident Report) and Form 14 (Accident Injury Benefit Claim).
- The employer must send a report to the ESI branch within 24 hours.
- After approval, payment is made.
Documents Required:
- Accident report
- Injury benefit claim form
- Employer report
- Medical certificates
5. Claiming Permanent Disability Benefit
This is a monthly pension paid in case of permanent disability due to employment injury.
Steps:
- Visit the ESI hospital for a medical board evaluation.
- Based on disability percentage, ESIC calculates the monthly amount.
- Submit the claim form and required supporting documents to the ESIC branch office.
Documents Required:
- Disability certificate
- Claim form
- Medical board report
- Bank details
6. Claiming a Dependent’s Benefit
If the insured person dies due to an employment injury, dependents like spouse, children, or parents can claim a monthly pension.
Steps:
- Family members must inform the employer and the ESI branch office.
- Submit death certificate, accident report, and dependency proof.
- Fill and submit the Dependent’s Benefit Claim Form (Form 15).
Documents Required:
- Death certificate
- Dependents’ ID proof
- Claim form
- Bank account details
7. Claiming Funeral Expenses
A one-time payment (currently up to ₹15,000) is made for funeral expenses.
Steps:
- The nearest relative or person who incurred the funeral expenses can apply.
- Submit a simple application to the ESI branch along with the death certificate.
Documents Required:
- Death certificate
- Proof of relationship
- Bank details
Online ESI Claim Process (Where Available)
Some ESI claims can also be submitted online via the ESIC portal. Here’s how:
- Visit esic.in.
- Login using employer credentials (for employer-submitted claims).
- Fill in the respective forms.
- Upload scanned documents.
- Submit and track the status online.
For direct employee communication, visiting the nearest ESI branch or dispensary is advisable for guidance.
Things to Keep in Mind
- Always inform your employer about the incident (injury/sickness/death) at the earliest.
- Keep copies of all medical certificates and reports.
- Claims must be submitted within the specified time limit to avoid rejection.
- Make sure your Aadhar, bank details, and ESI card are linked and updated.
- For any disputes, you can approach the local ESI branch office or call the ESIC toll-free number 1800-11-2526.
Common Reasons for Claim Rejection
- Incomplete or incorrect documents.
- There is a delay in the submission of the claim.
- Not meeting eligibility criteria (like minimum contribution days).
- Medical treatment taken outside ESI network without referral (unless emergency).
Conclusion
Claiming ESI benefits may seem like a complicated process at first, but with the right information and documents, it becomes much easier. Always coordinate with your employer, ESI branch office, and hospitals for smooth processing. These benefits are your right as an insured person under the scheme, and they are meant to support you during times of need, like sickness, maternity, disability, or death in the family. Keeping proper records and being aware of your entitlements can help you claim the ESI amount without much hassle.
If you need help, the nearest ESI branch office is the best place to start, or you can visit the official ESIC website.
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