Claims Submission Process

The insured person (IP) should gather and arrange the following

1. 1 IPD/OPD bills and discharge summary
2. 2 Dispensary referral slip (if applicable)
3. 3 E-Pehchan Patra (ESIC identity card)
4. 4 Vouchers, cash memos, and receipts
5. 5 Date-wise expenditure list
6. 6 Praman Patra (signed by employer) from local ESIC office
7. 7 Joining letter with designation
8. 8 Declaration Patra confirming this is the first-time claim
9. 9 For family claims: Ashrit Praman Patra (dependency certificate)

1. 1 Submit all documents at the ESI Dispensary
   • ○ Vetan Praman Patra (signed by ESI Directorate)
   • ○ Joining letter + designation
   • ○ ESIC Direction / Sampurna Vivran
   • ○ Declaration if claiming treatment for the first time
   • ○ For dependents, dependents pramaan patra
   • ○ Temporary ID card with IP’s photo (signed by the employer)
2. 2 Dispensary staff verify each document and ensure completeness.
3. 3 Only after verification, the file is forwarded to the Medical Officer.

1. 1 The Medical Officer checks the authenticity of the claim and supporting papers.
2. 2 If the treatment was an emergency, the doctor issues an Emergency Certificate validating this.
3. 3 The exact amount spent is verified against bills and vouchers.

1. 1 If the insured person received treatment outside Uttar Pradesh, approval from the CMO of that state is required.
2. 2 The CMO confirms treatment legitimacy and expenditure before forwarding the claim.

1. 1 The Branch Officer reviews, signs, and forwards the verified claim to the higher authorities.

The claim is reviewed at multiple levels

1. 1 ESIS Directorate (for policy and compliance check)
2. 2 Regional Office (RO) – initiates the release of payment
3. 3 State Medical Commissioner (SMC) – final review and approval
4. 4 Accounts Section – processes and disburses payment to the beneficiary

Once approved, the payment is transferred to the insured person’s registered bank account.