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ESI beneficiary alleges injustice: Only Rs 1.86 lakh paid against Rs 5.50 lakh medical bill

An alleged denial of cashless treatment under the ESI scheme in Mohali has surfaced after an empanelled hospital charged an insured worker over Rs 5.5 lakh.

2 min readMohaliDec 24, 2025 10:24 AM IST

The patient’s father submitted a written complaint on November 14, 2025, to the Regional Director, ESIC, and the Senior Medical Officer (SMO), ESIC.

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An alleged case of denial of cashless treatment under the Employees’ State Insurance (ESI) scheme has surfaced in Mohali, raising serious questions over compliance by empanelled hospitals.

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, Chandigarh, an ESIC-empanelled facility, from November 5 to November 15, 2025. As an ESI beneficiary, he was fully entitled to cashless medical treatment under ESIC norms.

However, it is alleged that the hospital charged the patient a medical bill amounting to Rs 5,50,396 and obtained an undertaking during treatment stating that the amount would be paid upfront and later claimed from ESIC. The patient’s father reportedly informed the hospital authorities that his son was an ESI beneficiary eligible for cashless treatment, yet the amount was still recovered — an act alleged to be a direct violation of the Memorandum of Understanding (MoU) signed with ESIC.

Following this, the patient’s father submitted a written complaint on November 14, 2025, to the Regional Director, ESIC, and the Senior Medical Officer (SMO), ESIC. Acting on the complaint, the SMO directed the hospital to refund the amount collected from the insured person. Despite these directions, the hospital allegedly failed to comply and discharged the patient without any refund.
Advocate Jasbir Singh stated that the matter was later taken up again with the Regional Director and SMO, ESIC, who assured that the entire medical bill would be reimbursed. Accordingly, all bills were submitted to the SMO, ESIC office on December 5, 2025.

Shockingly, on December 20, 2025, the insured person received only Rs 1,86,545 against the total bill of Rs 5,50,396, leaving a balance of Rs 3,63,851 unpaid.

The aggrieved party has now urged Regional Director ESIC, Pankaj Vorha, to intervene and direct Eden Critical Care Hospital to immediately refund the pending amount. It has further been demanded that if the hospital fails to comply, the balance should be recovered from the hospital’s security deposit with ESIC and paid to the beneficiary without further delay.

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