How the ESIC Claim Process Works for Employees

The ESIC claim process runs on one form per benefit. You hand it in at your branch office, the local arm of the Employees’ State Insurance Corporation. With it goes the certificate that proves the claim.

The form decides everything after it. Form 9 for sickness, Form 19 for maternity, Form 15 for a death caused at work, Form 22 for funeral expenses.

The part people lose money on is timing. A medical certificate that sits in a drawer for a week costs real days of benefit.

This page covers what you can claim and which form each one needs. It also covers how quickly ESIC must settle it, and what to do about medical bills you paid yourself.

What the ESIC Claim Process Covers

This section covers what is actually claimable: cash for the events that stop you working, each at its own rate, with treatment running alongside.

Most people know ESIC as a hospital card. The cash side is the part that gets left on the table, by staff who were never told it was there.

What has happened	What ESIC pays	For how long
You are ill and certified unfit	70% of wages	Up to 91 days in a year
A long-term illness on the approved list	80% of wages	Up to two years
You were hurt at work	90% of wages	As long as the disability lasts
The injury left lasting damage	90% of wages, cut to match how much earning power was lost	Monthly, for life
You are pregnant	Full wages	26 weeks
An insured worker died of a work injury	90% of wages to the dependants	Monthly, for as long as each dependant qualifies
An insured worker died, any cause	₹15,000 towards the funeral	One payment

ESIC publishes these rates with the conditions attached to each, and the conditions are where the differences sit. Funeral expenses, for one, are payable from day one of insurable employment with no waiting period.

There is one more, for unemployment. An insured person out of work can claim unemployment relief at 50% of wages, for up to 90 days, once in a lifetime.

It becomes payable 30 days after the job ends, and needs a year of insurable employment behind it.

That scheme runs for a set period at a time, and the period gets extended. Ask your branch office whether it is currently open before you count on it.

Who Can Claim, and What It Takes

This section covers the contribution test. Sickness asks for 78 paid days, maternity for 70, unemployment relief for a year on the books, and an injury at work for nothing at all.

Cover from day one is wider than it first looks. It reaches the pension paid to dependants after a fatal injury, and the funeral payment is free of the test as well.

Everything else is earned by days paid in, and the days are counted inside a contribution period. That is one of the two halves ESIC splits the year into, April to September and October to March.

Three tests use those halves:

1. Sickness needs 78 days of contribution in the relevant contribution period.
2. Maternity needs 70 days, across the one or two contribution periods immediately before.
3. Unemployment relief needs a year of insurable employment, and 78 days in the completed contribution period before the job ended.

What you are paid is worked out on the standard benefit rate, not on your last payslip. ESIC defines that rate as the total wages paid in the contribution period, divided by the days those wages covered.

The ESIC Claim Process, Step by Step

This section walks the sequence, from the event to the money. Each benefit uses its own form, and the ESI (General) Regulations, 1950 set both the form and the deadline.

1. Report it, the same day where you can. For an accident, the employee tells the employer as soon as practicable, by word or in writing. Somebody else may give that notice on their behalf, which matters when the worker is in no state to give it.
2. Make the employer file Form 12. A fabrication unit whose welder falls has to send the accident report immediately if the injury is serious, and within 48 hours otherwise.
3. Get the certificate from an ESIC doctor. Sickness and temporary disablement both run on medical certificates issued by an Insurance Medical Officer, not by a doctor of your choosing.
4. Get it in within three days of the date on it. This is the step that costs people money, and it is worth its own explanation below.
5. Fill the form for that benefit. The table below maps each one. Getting it wrong is survivable: the regulations let ESIC treat a claim made on the wrong approved form as though it were on the right one.
6. Take it to the branch office. Claims go to the branch office in writing, by post or by hand.
7. Wait out the statutory clock. Sickness is seven days, maternity fourteen, funeral expenses fifteen, disablement a month and a first dependants’ payment three months. A payment that misses its limit is reported to the regional office rather than quietly dropped.

Which Form, and Who Signs It Off

What you are claiming	Form	Who certifies eligibility
Sickness, or disablement while it is temporary	Form 9	Branch office
Maternity	Form 19, with the Form 18 certificate	Branch office
Funeral expenses	Form 22	Branch office
Permanent disablement	Form 14	Regional office
Dependants’ benefit, first claim	Form 15	Regional office
Dependants’ benefit, later payments	Form 16	Regional office

Read that last column carefully. It names who signs the claim off, not where you post it. Every claim in the table goes to the branch office.

What changes is who signs it off. The branch office settles sickness, maternity, temporary disablement and funeral expenses itself.

Permanent disablement and dependants’ benefit go up to the regional office, which is why those two take longer to pay.

The Three-Day Certificate Rule

A medical certificate has to reach the branch office within three days of the date it was issued.

Miss it, and the benefit only starts running three days before the day you actually hand the certificate in. Everything earlier is gone.

On a second or later certificate for the same illness, that window is fourteen days rather than three.

The certificate is not the claim. It is the evidence, and evidence goes stale on a schedule.

If Maternity Is the Claim

Maternity runs on two certificates and two separate clocks.

The expected-confinement certificate is issued in the last 50 days before the due date, and not before that. The confinement certificate goes in within 30 days of the birth itself.

How to Claim ESIC Medical Expenses

This section covers money you have already spent, which follows a different route from every other claim on this page.

ESIC normally gives treatment rather than money. Where that was not possible, reimbursement is allowed in eleven listed situations.

They include an emergency admission elsewhere, a medicine the dispensary did not have, and an ambulance that was not available.

It goes to the ESI Scheme office run by your state government, not to your branch office.

The claim has to carry the actual receipts and vouchers. Your branch office can point you to the right address.

You have one year from spending the money. That is generous against the three-day certificate rule, and it is still missed, because a pharmacy bill is not something most people think to file.

ESIC Death Claim Amount, and Who Gets It

This section covers what is payable when an insured worker dies, which splits into two separate claims.

Where the death came from an injury at work, the dependants’ benefit is a monthly pension, divided among the dependants in set shares. The rate is 90% of wages, and there is no contribution condition to satisfy.

The funeral payment is separate and much simpler. ₹15,000 goes to whoever actually bore the cost, and it is payable on any death in insurable employment, not only a death at work.

Who is claiming	How long it runs
The widow	For life, or until she remarries
A son	Until he turns 25
An unmarried daughter	Until she turns 25, or marries, whichever is first
A child who is infirm	For as long as the infirmity lasts

Three months is the longest of the payment deadlines. A family with no income coming in should file the Form 15 claim immediately rather than waiting for the paperwork to feel complete.

Where the ESIC Claim Process Goes Wrong

The failures repeat, and they usually start on the employer’s side of the desk.

Type of business	What goes wrong
Manufacturing unit	The accident report is filed late, so the injury is argued about instead of paid
Retail chain	Staff are never told the cash benefits exist, so only the hospital card is used
Hospital or diagnostic lab	Contribution gaps in the record, so the 78-day test fails on paper
School or coaching institute	Part-time staff assumed to be outside the scheme, so no claim is ever made
Hotel or restaurant group	Certificates collected at the outlet and sent on weekly, past the three-day window

Read down that second column and the pattern is the same each time. What fails is the paperwork or the awareness, not the entitlement.

Attendo (formerly Petpooja Payroll) is a complete workforce management system for every kind of business, running attendance, shifts, leaves, approvals, payroll and statutory compliance in one place.

The contribution record is built from the attendance to salary workflow every month. So the paid days behind a claim are already counted when somebody asks for them.

Your ESIC Claim Process Checklist

Run any claim past six questions before it leaves your hands.

1. Does this benefit need contribution days, and are they in the record?
2. Is the certificate from an Insurance Medical Officer rather than a private doctor?
3. Is the certificate still inside its three-day window?
4. Is it the right form for this benefit, and is it signed?
5. Is this one the regional office has to certify, so it will take longer?
6. For a bill you paid yourself, are the receipts still together and inside the year?

Keep the worker’s insurance number, which is their ESIC number, and the e-Pehchan identity card somewhere the family can reach them. Our guide to finding an ESIC number covers how to trace one that has gone missing.

Getting Your ESIC Claim Paid

The scheme is procedural, and the procedure runs on dates.

The contribution days behind a claim are settled long before anybody falls ill. Whether the paper arrives on time is the part still in your hands.

So the useful habit is small. When something happens, get the certificate that week, keep the paper together, and get it to the branch office while the three days are still running.

For the other statutory claim your staff will ask about, see our guide to EPF (Employees’ Provident Fund) forms.

Frequently Asked Questions