Streamlining ESIC Claims Process: A Guide for Insured Persons

The Employees’ State Insurance Corporation (ESIC) has issued a new circular aimed at enhancing the submission process for cash benefit claims, including Sickness Benefits and Maternity Benefit Claims, for Insured Persons (IPs). This initiative emphasizes the importance of utilizing the IP Portal for online claim submissions and aims to eliminate physical documentation wherever possible.

Background

The ESIC has been working towards digitalization and improving service delivery for insured individuals. Earlier circulars, dated September 22, 2022, and May 2, 2023, informed stakeholders about the deployment of online modules for submitting maternity and cash benefit claims.

Recent Observations

A review conducted between April 2024 and August 2024 revealed a concerning trend: a significant number of claims are still being created by Branch Offices instead of directly by Insured Persons through the IP Portal. Reports indicate that Branch Office Managers have been requesting physical copies of Regulations Certificates and other documents, even when claims were submitted online.

Key Points in the Circular

Online Submission of Claims

The ESIC encourages Insured Persons to file their maternity and sickness benefit claims directly through the IP Portal, eliminating the need for physical submissions at Branch Offices.

Elimination of Physical Copies

Branch Office Managers are instructed not to demand physical copies of Regulations Certificates or any other documents if they have already been submitted online at the time of claim creation. In exceptional cases requiring verification, Branch Offices may contact relevant dispensaries or hospitals directly through email or other digital means.

Focus on e-Governance

The Director General has emphasized that non-compliance with these instructions will be taken seriously, as ongoing physical document submissions undermine the objectives of e-Governance and create unnecessary delays in processing claims.

Action for Branch Offices

All Branch Office Managers are directed to facilitate IPs in filing claims online and to ensure that offline submissions are minimized. Claims payments should not be delayed due to the absence of hard copies of certificates already submitted online.

What This Means for Insured Persons (IPs)

Efficient Processing

IPs can now submit their claims online via the IP Portal, eliminating the need for physical visits to Branch Offices. This change is expected to significantly speed up the claims process.

No Physical Documentation Needed

If you have already submitted documents online, there is no need to resubmit physical copies, streamlining the process further.

Faster Verification

In cases of discrepancies or doubts, the ESIC has instructed Branch Offices to verify documents electronically or through direct contact with dispensaries and hospitals, rather than relying on physical paperwork.

Conclusion

The ESIC’s efforts to streamline the claims process through online submissions align with the broader goal of digitalization and improving service delivery for insured individuals. This initiative is designed to reduce delays, enhance transparency, and eliminate unnecessary paperwork. Insured Persons are encouraged to take full advantage of the IP Portal for their claims, while Branch Offices are urged to support this transition towards an efficient, paperless system.

Additional Resources

For further details, you can refer to the official circular: ESIC Circular (November 5, 2024) and the claims process: ESIC Claims Process.