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EMPLOYEE GUIDE - HOW TO CLAIM BENEFITS

Sickness Benefit Claims

An Insured Person intending to claim Sickness Benefit has to submit a claim for benefit in one of the forms 12,13 or 14 appropriate to the circumstances of the case to the concerned ESIC Branch Office. A claim for Sickness Benefit can be made only on the basis of medical certificates issued by the doctors appointed for this purpose under the Scheme.

However, the Corporation may accept any other evidence of sickness or temporary disablement if in its opinion the circumstances of any particular case so justify. The certificates issued by the Insurance Medical Officers are the first, the intermediate, the special intermediate and the final certificates. The claim form for benefit is printed just below each certificate.

An insured person may, if they so desire, deposit the certificates in the box, if any, provided for the purpose at the dispensary or at the Branch Office to which they are attached; they may send them by post or may present them at the Branch Office in person, or may deliver the same at the Branch Office through their agent or messenger.

Since cash Benefits can be paid only through the bank account of the Insured Person, the details of the bank account - with a copy of the first page of the bank passbook as proof- should be submitted to the Branch Office along with the certificates. The bank details of Insured Persons should be submitted online also by the employers.

Dependant Benefit Claims

A claim for Dependants Benefit may be submitted to the concerned Branch Office by each dependant or jointly by all or by some of the dependants in Form 18. Also the claim may be made by the legal representative of a beneficiary or in case of a minor, by their guardian. It must be attested by any of the competent authorities mentioned on the form and be supported by documents for evidence.