After prolonged battle, ESIC clears Rs 4.60 lakh

“The insured worker had undergone treatment at Eden Critical Care Hospital, Chandigarh, an ESIC-empanelled facility, where he was charged Rs 4.60 lakh. When reimbursement was delayed, he approached me for help,” Singh said.

“To resolve the grievance, I took up the matter with the Regional Office, ESIC. After prolonged pursuit, ESIC agreed to release the full reimbursement,” he added.

He stated that Rs 1,86,545 was first credited to the worker’s bank account, followed by two cheques for Rs 1,36,727 and Rs 1,36,728, thereby settling the entire amount as full and final payment.

Pointing to systemic gaps, Singh said that ESI Hospital, Mohali, lacks facilities for surgery and super-specialty treatment. Consequently, patients are referred to Civil Hospital, Mohali; GMSH, Sector 16; GMCH, Sector 32; and PGI, Sector 12, Chandigarh, where no cashless treatment agreements exist with ESIC.

“This forces insured workers to pay huge sums upfront despite being covered under the ESI scheme,” he said.

He clarified that he provides legal assistance to ESI-insured workers free of cost, with the objective of ensuring timely and complete medical benefits.

Background of the case

Jashanpreet Khan (IP No. 1214693790), an employee of M/s Kosmo Auto Mobiles, Mohali, suffered an employment-related injury and was admitted to Eden Critical Care Hospital from November 5 to November 15, 2025.

Despite being eligible for cashless treatment, the hospital allegedly raised a bill of Rs 5,50,396, later offering a discount of Rs 96,396, and obtained an undertaking that the amount would be paid upfront and later claimed from ESIC allegedly in violation of the MoU with ESIC.

A complaint was submitted on November 14, 2025, to the Regional Director and Senior Medical Officer (SMO), ESIC, who reportedly directed the hospital to refund the amount. However, the hospital allegedly failed to comply.

Initially, ESIC released only Rs 1,86,545 on December 20, 2025, prompting further representations. Following continued intervention, the entire reimbursement was finally released, bringing relief to the insured worker and underscoring the need for stricter enforcement of cashless treatment norms under the ESI scheme.