ESIC Benefits and Claims 2026

Reviewed on 2026-06-20 by Dr. Shrawan Kumar Pathak.

Most insured workers never claim what they have already paid for. The contribution leaves your salary every month, yet the cash benefits sit unused because nobody explains them in plain words. This guide is a checklist. Tick each benefit you may be entitled to, then read the pitfalls so your claim is not the one that gets sent back.

ESI cover is automatic, not optional. You do not “apply” to join. You are in the scheme from your first day at a covered establishment if your gross wages are up to Rs 21,000 a month. For a person with disability, the ceiling is Rs 25,000 a month.

Your share is 0.75% of wages; your employer adds 3.25%. The employer must deposit both by the 15th of the next month. Your medical cover starts from day one of insurable employment, before any contribution has even cleared.

• Gross wages up to Rs 21,000 a month (Rs 25,000 if you have a disability).
• Your workplace is registered under the ESI Act.
• You have an Insurance Number and a Pehchan or e-Pehchan card.
• Your contribution is showing on the IP Portal at esic.gov.in.

Pitfall. A common shock is the family that turns up at a private hospital and is refused reimbursement. ESI medical care has no expenditure ceiling, but only inside the ESI system, ESI hospitals, dispensaries and tie-up hospitals. Use the ESI network unless your branch office has referred you out in writing.

Section 46 of the ESI Act gives six statutory benefits. Here is the working list with the figures confirmed on the ESIC website.

Cash at 70% of your wages while you are certified sick, for up to 91 days in a year. To qualify you must have contributed for at least 78 days in the relevant six-month contribution period. Get a certificate from your ESI doctor, do not self-certify.

For 34 notified long-term or malignant diseases, Extended Sickness Benefit runs at 80% of wages for up to two years, if you have two years of continuous employment and 156 days of contribution. For sterilisation, Enhanced Sickness Benefit pays full wages, 7 days for vasectomy and 14 days for tubectomy.

Full wages for 26 weeks of confinement, extendable by one month on medical advice. You need 70 days of contribution in the two preceding contribution periods. A miscarriage carries 6 weeks; a commissioning or adopting mother gets 12 weeks. Of the 26 weeks, not more than 6 can be taken before the expected delivery date.

For an injury at work, Temporary Disablement Benefit pays 90% of wages from day one, with no minimum contribution needed, for as long as the disability lasts. If a Medical Board certifies a permanent loss of earning capacity, Permanent Disablement Benefit pays 90% of wages as a monthly amount, scaled to that loss.

If an insured worker dies because of a work injury, the family receives Dependants Benefit at 90% of wages as a monthly payment, the widow for life or until remarriage, children up to the prescribed ages. Separately, Funeral Expenses of Rs 15,000 are payable from day one to the dependants or whoever performs the last rites.

Under the Atal Beemit Vyakti Kalyan Yojana, an insured person who becomes unemployed can get cash relief of around 50% of average wages for up to 90 days, once in a lifetime, provided you meet the minimum insurable-employment and contribution conditions. There is also the older Rajiv Gandhi Shramik Kalyan Yojana for those who lose work after a longer period of cover. The rate, the minimum employment period and the contribution threshold for these schemes have changed over time, so verify the current rate, eligibility and dates on https://esic.gov.in/abvky before you rely on them.

If you are weighing this against other retirement money, our guide to a PF withdrawal online explains how those claims work alongside ESI.

1. Log in to the IP Portal at esic.gov.in using your Insurance Number and registered mobile.
2. Open the Claims section and pick the benefit you want, sickness, maternity, disablement or other.
3. Attach the medical certificate from your ESI doctor and your bank account details.
4. For maternity, disablement and dependants claims, also submit the physical form at your ESIC Branch Office with proof.
5. Track the claim status on the portal; the cash is credited straight to your bank account.

Activating your digital identity first makes this far smoother. If your PF and ESI logins are not set up, start with how to activate your UAN, then return to file the ESI claim.

Figure: step-by-step flow. If a step stalls, use the grievance or RTI route shown.

• No contribution history. Cash benefits depend on contribution days. If your employer skipped deposits, the portal shows a gap and the claim fails. Raise it with the branch office in writing.
• Private treatment without referral. Bills from outside the ESI network are usually not reimbursed unless you were referred.
• Late maternity intimation. Submit the maternity claim and certificate on time; do not wait until after delivery to start the paperwork.
• Wrong bank or mobile details. A mismatch between your IP Portal record and your bank stalls the credit. Update both before claiming.
• Self-certified sickness. Only an ESI medical officer's certificate counts for Sickness Benefit, not a private prescription.

If your benefit is delayed or refused without a clear reason, do not give up the money. First raise a grievance through the ESIC grievance link on esic.gov.in or the central public grievance portal at https://pgportal.gov.in. If you still get no answer, ESIC is a public authority under the RTI Act, so file an RTI at https://rtionline.gov.in asking for the status of your claim, the officer handling it and the reason for any rejection. A dated RTI often moves a file that a phone call could not.

For related disputes, see how others have handled an EPF or NPS withdrawal dispute, and if a death claim is involved, our note on family pension after a husband's death covers the parallel pension route.

Any employee earning gross wages up to Rs 21,000 a month at an establishment covered under the ESI Act is automatically insured. The ceiling is Rs 25,000 a month for a person with disability. Cover and medical care begin from your first day of insurable employment.

Sickness Benefit pays 70% of your wages for up to 91 days in a year, provided you contributed for at least 78 days in the relevant six-month contribution period. For 34 notified long-term diseases the Extended Sickness Benefit rate is 80% for up to two years.

Maternity Benefit is 26 weeks of full wages, extendable by one month on medical advice, if you have 70 days of contribution in the two preceding contribution periods. A miscarriage carries 6 weeks and an adopting or commissioning mother gets 12 weeks.

If death is caused by a work injury, the family gets Dependants Benefit at 90% of wages as a monthly payment, with the widow paid for life or until remarriage. A separate Funeral Expenses payment of Rs 15,000 is made from day one of insurable employment.

Log in to the ESIC IP Portal at esic.gov.in, open the Claims section, choose your benefit, and upload the ESI doctor's certificate and bank details. Maternity, disablement and dependants claims also need a physical form submitted at your ESIC Branch Office.

Yes. Under the Atal Beemit Vyakti Kalyan Yojana an insured person can get cash relief of about 50% of average wages for up to 90 days, once in a lifetime, if you meet the current minimum insurable-employment and contribution conditions. Verify the current rate and eligibility window on https://esic.gov.in/abvky.

Raise a grievance on the ESIC portal or at https://pgportal.gov.in. If there is still no resolution, file an RTI at https://rtionline.gov.in asking for your claim status and the reason for rejection, since ESIC is a public authority under the RTI Act.

• https://esic.gov.in/information-benefits
• https://esic.gov.in/benefits
• https://esic.gov.in/Publications/benefits_cc.pdf
• https://esic.gov.in/abvky
• https://pgportal.gov.in
• https://rtionline.gov.in