The Employees’ State Insurance Corporation (ESIC) on November 5th 2024 issued a new circular aimed at streamlining the submission process for cash benefit claims (such as Sickness Benefits and others) and Maternity Benefit Claims by Insured Persons (IPs). The circular emphasizes the use of the IP Portal for online claim submissions and the elimination of physical documentation wherever possible.
Background
Earlier circulars, dated 22nd September 2022 and 2nd May 2023, informed all stakeholders about the deployment of online modules for submitting maternity benefits and cash benefits claims. These instructions were intended to eliminate offline or physical submission processes and encourage the use of digital channels for a smoother and faster claims process. The initiative was reiterated by the Director General (DG) during various zonal meetings, highlighting the importance of this shift toward e Governance.
Recent Observations
The review of the period from April 2024 to August 2024 has revealed a significant discrepancy: a large number of claims are still being created by Branch Offices, rather than directly by the Insured Persons through the IP Portal. Attached Excel sheets and summary reports provide clear evidence of this issue. Additionally, Branch Office Managers have been observed asking for physical copies of Regulations Certificates and other documents, even in cases where claims were submitted online. This practice is seen as counterproductive to the goal of promoting a fully online claims system.
Key Points in the Circular:
- Online Submission of Claims:
- The ESIC encourages Insured Persons (IPs) to file their maternity benefits and sickness benefits (SB) claims directly through the IP Portal, bypassing the need for physical submissions at Branch Offices.
- Elimination of Physical Copies:
- Branch Office Managers are instructed not to demand physical copies of Regulations Certificates or any other documents if they have already been submitted through the online portal at the time of claim creation.
- In exceptional cases where verification is required, Branch Offices may contact the relevant dispensaries or hospitals directly, either through email or other digital modes, instead of requesting hard copies.
- Focus on e Governance:
- The Director General has emphasized that the non-compliance of these instructions will be taken seriously, as the ongoing physical document submissions undermine the objective of eGovernance and create unnecessary delays in processing claims.
- Action for Branch Offices:
- All Branch Office Managers are directed to facilitate IPs in filing claims online and ensure that offline submissions are eliminated as much as possible.
- Claims payments should not be delayed due to the requirement for hard copies of certificates already submitted online.
What This Means for Insured Persons (IPs):
- Efficient Processing: IPs can now submit their claims online via the IP Portal, without the need to physically visit a Branch Office. This will help speed up the claims process.
- No Physical Documentation Needed: If you’ve already submitted documents online, there should be no need for you to resubmit physical copies.
- Faster Verification: In case of any discrepancies or doubts, the ESIC has instructed Branch Offices to verify documents electronically or through direct contact with dispensaries and hospitals, rather than relying on physical paperwork.
Conclusion:
The ESIC’s efforts to streamline the claims process through online submissions are in line with the broader goal of digitalization and improving service delivery for insured individuals. The move is designed to reduce delays, enhance transparency, and eliminate unnecessary paperwork. IPs are encouraged to take full advantage of the IP Portal to submit their claims, and Branch Offices are urged to support this shift towards an efficient, paperless system.
