ESIC Claim or Medical Benefit Denied: Worker Complaint Guide 2026

You earn under ₹21,000 a month, the payslip shows an ESI deduction every month, and yet the ESI dispensary turned you away saying “card not active”, or the cash sickness benefit has not credited for 47 days, or the maternity payment is stuck because the employer never filed the Form 11. The Employees' State Insurance Corporation (ESIC) is a statutory public authority created by the ESI Act 1948 and it owes every Insured Person (IP) free medical care, cash benefits and dependent benefits as a right, not a favour. This guide gives you the exact 30-minute route to fix a denied claim, the evidence to keep, the official grievance ladder, when to file an RTI to the ESIC Regional Office, and how to push the labour department if your employer is the real problem.

The Employees' State Insurance scheme is funded by employer 3.25% + employee 0.75% of monthly wages and gives every registered worker six benefits as a statutory entitlement: full medical care for self and family, sickness benefit (70% of average daily wage for up to 91 days), maternity benefit (100% wages for 26 weeks), disablement benefit, dependent benefit after fatal injury and funeral expenses of ₹15,000. Denial of any of these is a violation of the ESI Act 1948 and can be challenged.

• Employees' State Insurance Act 1948 is the parent statute. §39 fixes the employer's duty to deposit contributions; §85 makes non-payment a punishable offence (up to 2 years imprisonment + ₹5,000 fine).
• §46 lists the six benefits. §56 guarantees free medical care to the IP and family. §75 gives the ESI Court the power to decide disputes about denied claims.
• ESI (General) Regulations 1950, Reg. 52 to 56, prescribe the claim forms, time limits and the 14-day release window for complete claims.
• The Code on Social Security 2020, Chapter IV, will re-cast ESI once notified, but until then the 1948 Act fully applies.
• In ESIC v Hotel Corporation of India Ltd. (2008) 1 SCC 736, the Supreme Court held that the Corporation cannot deny a benefit on hyper-technical grounds when the IP has substantially complied with the regulations.
• RTI Act 2005, §2(h) covers ESIC as a public authority. You can ask any Regional Office PIO for a copy of your contribution ledger, claim file, medical board minutes or grievance disposal record.
• BNS 2023 §316 (criminal breach of trust by employer) + §318 (cheating) apply where an employer deducts ESI from your salary but never deposits it. The FIR is filed under BNSS 2023, not the old CrPC.

1. Open https://www.esic.gov.in and click Insured Person Login (IP Portal).
2. Enter your 10-digit ESI Insurance Number (printed on the e-Pehchaan card or salary slip) and the OTP sent to your registered mobile.
3. Check three tabs:
   • Personal Details - is your e-Pehchaan card active?
   • Employer Details → Contribution History - is the latest month's contribution deposited? A blank row means the employer skipped it.
   • Entitlement to Benefits - does the portal show Eligible for the benefit you are claiming? If it says Not Eligible - contribution shortfall, that is your root cause.
4. Take a screenshot of every screen. This is your primary evidence.

Map the symptom to the responsible party:

1. Card not active / e-Pehchaan missing - the employer has not uploaded your photo and biometric. Push the employer; escalate to ESIC Branch Office.
2. Contribution missing for one or more months - this is on the employer. File at EPFiGMS-style ESIC grievance + labour department.
3. Hospital or dispensary refused treatment - the ESIC empanelled facility is at fault. Escalate to the Medical Superintendent and Regional Director.
4. Cash benefit (sickness, maternity, dependent) delayed beyond 14 days - ESIC Branch Office is at fault. File CPGRAMS.
5. Claim rejected on technical grounds - ask for written reasons under ESI (General) Regulations 1950 Reg. 53; file appeal before the ESI Court under §75.

1. CPGRAMS - go to https://pgportal.gov.in, register with mobile + email, choose Ministry of Labour and Employment → Employees' State Insurance Corporation (ESIC), write a 200-word complaint with the screenshots attached. You receive a Registration Number instantly. Default disposal window is 30 days.
2. ESIC online grievance - https://www.esic.gov.in/online-grievance-redressal. Same form, narrower routing, faster reply for branch-level issues.
3. Toll-free helplines - 1800-11-2526 (Hindi/English, 24×7) and 14-55 (multi-language, 24×7).
4. Email - [email protected] for headquarters, or your Regional Office email from https://www.esic.gov.in/contact-us.

1. Send a written complaint to your HR or proprietor by email and on paper, asking for a copy of the monthly Return of Contribution (RC) and the Challan number for each month in dispute. Keep proof of delivery.
2. If the employer ignores you for 7 days, file with the Regional Labour Commissioner (Central) at https://clc.gov.in or the State Labour Commissioner if the unit is under state jurisdiction. Use the SAMADHAN portal at https://samadhan-portal.labour.gov.in for online filing.
3. Copy the ESIC Recovery Officer for the region; ESIC has powers under §45-C to §45-I to attach the employer's bank account and recover dues with interest at 12% per annum.

1. Address it to the Public Information Officer, Regional Office, ESIC, [your state]. Find the address at https://www.esic.gov.in/regional-offices.
2. Fee is ₹10 by IPO, court-fee stamp, demand draft or rtionline.gov.in e-payment. BPL applicants pay nothing under §7(5) of the RTI Act.
3. Ask for: (a) certified copy of your contribution ledger, (b) certified copy of the employer's monthly RC for the disputed months, © inspection report of the unit (if any), (d) grievance disposal record with action-taken note, (e) name and designation of the dealing officer.
4. Reply must arrive in 30 days under §7(1). No reply or evasive reply means file a first appeal under §19(1) within 30 days to the First Appellate Authority (usually the Regional Director).

Keep one folder, physical or digital, with these items. Every grievance officer asks for the same set:

• Copy of your e-Pehchaan card (front and back).
• Salary slips for the last 12 months showing ESI deduction.
• Form 11 (employer's declaration), Form 1A (family declaration) if filed.
• Form 9 (sickness), Form 19 (maternity), or Form 16 (dependent benefit) - whichever you are claiming.
• Medical certificate issued in Form 8 or Form 10 by the ESIC dispensary or empanelled hospital.
• Bank passbook front page (the account where benefit must credit).
• Aadhaar + PAN (masked copies).
• Screenshots of IP Portal pages - personal details, contribution history, benefit eligibility.
• Written refusal from the hospital or branch office (if any).
• Employer's reply (or proof that the employer did not reply within 7 days).
• Previous grievance numbers with dates - CPGRAMS, ESIC, labour department.

A neatly indexed bundle gets you a faster reply at every step.

ESIC follows a defined escalation ladder. Do not skip steps; each step gives you a paper trail for the next.

Walk into the ESIC Branch Office stamped on your e-Pehchaan card with your evidence bundle. Meet the Branch Manager or Medical Superintendent (for a hospital issue). Insist on a written Acknowledgement Slip with date and signature. Many issues end here in one visit.

File at https://www.esic.gov.in/online-grievance-redressal and at https://pgportal.gov.in (choose ESIC). Keep both registration numbers. CPGRAMS auto-escalates if no reply in 30 days.

Find your Regional Office at https://www.esic.gov.in/regional-offices. The Regional Director is the senior-most officer for your state. Send a registered letter with all annexures. Mark a copy to the Director General, ESIC, Panchdeep Bhawan, CIG Marg, New Delhi 110002.

• Central sphere (factories registered under the Factories Act, mines, ports, central PSUs) - https://clc.gov.in or SAMADHAN portal.
• State sphere (shops, establishments under state law) - your state's Labour Commissioner portal. Maharashtra uses mahakamgar.maharashtra.gov.in; Delhi uses labour.delhi.gov.in; Tamil Nadu uses labour.tn.gov.in.
• Quote ESI Act §39 + §85 in the complaint.

If money is genuinely due and has been refused, file a Section 75 application in the Employees' Insurance Court for your district. No court fee for the IP. Limitation is 3 years from the date the cause of action arose. The ESI Court can order release of benefit with interest and direct ESIC or the employer to pay.

RTI is the cheapest lever in the chain. Use it when:

• You need proof that your contributions were not deposited - ask for the certified contribution ledger.
• You need a paper trail of an inspection or notice already issued to the employer.
• You want the grievance disposal record for an earlier complaint that died silently.
• You need the name and designation of the officer who took a decision - this is essential before an ESI Court application.

Each RTI costs ₹10 and must be answered in 30 days. ESIC has hundreds of PIOs across Regional Offices, Sub-Regional Offices and hospitals. The right PIO is the one holding the record, not the head office.

To,
The Public Information Officer,
Regional Office,
Employees' State Insurance Corporation,
[Address of Regional Office, City, State, PIN]

Subject: Request for information under §6(1) of the Right to Information Act, 2005,
regarding ESI Insurance Number [10-digit IP number]

Sir / Madam,

Under §6(1) of the RTI Act 2005, I request the following information pertaining to
my ESI account, IP Number [XXXX-XXX-XXXX], employer [Employer name and Code Number]:

1. Certified copy of the monthly Contribution History for the period
   [01-04-2025 to 31-03-2026], indicating wage on which contribution was paid,
   employer's share, employee's share, challan number and date of deposit.

2. Certified copy of the employer's Return of Contribution (RC) filed under
   ESI (General) Regulations 1950, Regulation 26, for the same period.

3. Status of my claim under [Form 9 / Form 19 / Form 16] dated [DD-MM-YYYY],
   acknowledgement number [XXXXXX], along with the reason for delay or rejection,
   if any, as required under Regulation 53.

4. Action-taken note on my online grievance dated [DD-MM-YYYY], registration
   number [XXXXXX], including the name and designation of the dealing officer.

5. Copy of the inspection report, if any, prepared in respect of the employer's
   establishment during 2024-2026, and any recovery proceedings initiated under
   §45-A to §45-I of the ESI Act 1948.

Under §6(3), if any of the above information is held by another public authority
or another PIO, please transfer this application within five days.

Under §7(1), I expect a reply within 30 days. As I am [BPL / not BPL], I
[do not / do] enclose the prescribed fee of ₹10 by [IPO / court-fee stamp / DD],
along with proof of identity.

A reply by post and by email to [your email] is requested.

If the information is denied, the grounds must be cited under §8 or §9 of the Act
and the appellate authority under §19(1) must be indicated.

Yours faithfully,
[Signature]
[Name of applicant]
[IP Number]
[Postal address]
[Mobile and email]
[Date and place]

To,
The Human Resources / Proprietor,
[Employer name and address]
ESI Code Number: [XXXXXXXXXX]

Subject: Non-deposit of ESI contribution and failure to issue e-Pehchaan card

Sir / Madam,

I, [Name], employee ID [XXXX], have been working with [Employer name] since
[DD-MM-YYYY]. ESI is deducted from my salary every month (₹___ in [month/year],
as shown in payslip enclosed).

On checking the ESIC IP Portal on [date], I find that the contribution for the
months of [list months] is not reflected against my ESI Insurance Number
[XXXX-XXX-XXXX]. As a consequence, my [card is not active / sickness benefit /
maternity benefit / dependent benefit] claim has been [rejected / kept pending].

This is in violation of §39 of the ESI Act 1948, which makes it the employer's
duty to deposit both shares of contribution by the 15th of the following month.
§85 makes non-payment a punishable offence.

I request you to:

1. Deposit the pending contributions with interest at 12% per annum under §39(5).
2. Issue or activate my e-Pehchaan card within 7 working days.
3. Provide me with a copy of the Return of Contribution and Challan numbers for
   the disputed months.

If the matter is not resolved within 7 days from the date of this letter, I will
file a complaint with the Regional Office of ESIC, the Regional Labour
Commissioner under SAMADHAN, and seek an FIR under BNS §316 read with §318.

Yours faithfully,
[Signature]
[Name]
[Employee ID]
[Date]

Send this letter by email + Speed Post + WhatsApp to keep three independent delivery proofs. India Post's Speed Post receipt with the tracking ID is the strongest courtroom proof.

• Paying a “facilitator” to activate your card. ESIC services are 100% free. Anyone asking for cash is committing extortion under BNS §308 and cheating under §318.
• Filing a CPGRAMS complaint without the IP Portal screenshots. Without proof of missing contributions, the complaint is closed as “insufficient information”.
• Letting 14 days lapse on a maternity or sickness claim. ESI (General) Regulations 1950, Reg. 52, gives ESIC 14 days; after that, the delay is a clear ground for escalation.
• Skipping the labour department when the employer is the real defaulter. ESIC can recover dues, but only the labour department can prosecute the employer under the Shops and Establishments Act and the Code on Wages 2019.
• Filing in the wrong ESI Court. §75 jurisdiction follows where the cause of action arose - usually the district of the Branch Office, not your home district if different.
• Using a private hospital and claiming reimbursement without prior referral. Only Super-Speciality Treatment and medical emergency allow private treatment with prior approval; routine cases are reimbursed at ESIC rates only.
• Forgetting to update the bank account on the IP Portal. Maternity and dependent benefit credit only to the account on record. Update under IP Portal → Update Personal Details → Bank Details.

Every employee in a notified establishment with 10 or more workers (20 in some states, depending on notification) earning up to ₹21,000 a month (₹25,000 for persons with disability) is covered. Coverage is mandatory the moment the employer is registered, regardless of whether the e-Pehchaan card has been printed. From the date of joining, you are an Insured Person (IP) and your family members are Beneficiaries.

This is wage theft + statutory offence under §85 of the ESI Act 1948. Step 1: write to HR demanding the Challan numbers. Step 2: file at pgportal.gov.in and esic.gov.in/online-grievance-redressal. Step 3: file with the Regional Labour Commissioner at clc.gov.in or samadhan-portal.labour.gov.in. Step 4: an FIR under BNS §316 + §318 at the local police station, citing your payslips as proof of deduction. ESIC's Recovery Officer can attach the employer's bank account under §45-C.

No. Under §56 of the ESI Act, the IP and family have a right to free medical care. If the card is technically inactive because of an employer's lapse, ESIC must still treat you in any medical emergency and recover the cost later from the employer. Insist on the refusal in writing, then phone 1800-11-2526 and email the Medical Superintendent of the empanelled hospital and the Regional Director, ESIC.

No. ESI (General) Regulations 1950, Reg. 52, requires release of a complete claim within 14 days. After 14 days you have a clear ground to escalate. File CPGRAMS quoting “delay beyond Reg. 52”. If the reason is that the employer's contribution is short, follow the employer-complaint route above; the sickness benefit clock does not legally pause for that reason if you have 78 days of contributions in the contribution period.

ESIC covers medically necessary care, not elective procedures. Routine dental treatment, hearing aids, artificial limbs, spectacles at rate slabs and dialysis are covered. IVF is now covered for IPs under the 2023 expansion at empanelled centres. Cosmetic surgery is excluded. Check the latest Medical Benefit Rate List at https://www.esic.gov.in/medical-care.

Under §52 of the ESI Act, if the death is due to employment injury, the widow gets a monthly pension of 90% of the deceased's average daily wage, payable for life, plus ₹15,000 funeral expenses under §46(1)(f). Children get a share until age 25. File Form 16 within 12 months at the Branch Office. If denial happens on the “not in the course of employment” ground, the ESI Court under §75 is your remedy.

Yes, with caveats. ESIC is a public authority under §2(h). You can ask for third-party information only with consent or a clear public interest. For a deceased parent, attach the death certificate and your legal heir certificate with the RTI. PIOs typically release the contribution record to the legal heir in 30 days. The fee is ₹10. The reply must come under §7(1).

No. There is no provision in the ESI Act or the RTI Act for blacklisting a complainant. Any retaliation by a public officer is a violation of the Whistle Blowers Protection Act 2014 and the CVC guidelines. If you face retaliation, file a separate complaint with the Central Vigilance Commission at https://www.cvc.gov.in.

Once notified, the Code re-codifies ESI into Chapter IV and brings gig and platform workers within the ambit through a national social-security fund. Until the government notifies the chapter, the ESI Act 1948 continues to apply in full. Watch the Ministry of Labour and Employment site at https://labour.gov.in for the notification.

Refuse, take the agent's name and a phone photo or call recording, and report at three places: (1) the ESIC Vigilance Officer at [email protected] citing CCS (Conduct) Rules and ESI Act §85; (2) the Central Vigilance Commission at https://www.cvc.gov.in; (3) an FIR at the local police station under BNS §308 (extortion) and §318 (cheating). Card activation is free and is the employer's job, not yours.

Yes, but for limited periods. Medical care continues for the IP and family for two years after the contribution stops, provided you paid contributions for at least 78 days in a contribution period. Sickness benefit runs only during active insurable employment. Atal Beemit Vyakti Kalyan Yojana (ABVKY) pays 50% of average daily wages for 90 days to IPs who lose their job involuntarily; apply at the IP Portal under ABVKY.

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• ESIC main portal: https://www.esic.gov.in
• Insured Person (IP) Portal: https://www.esic.gov.in (login at Insured Person Login)
• Online grievance: https://www.esic.gov.in/online-grievance-redressal
• CPGRAMS: https://pgportal.gov.in (choose ESIC under Ministry of Labour and Employment)
• ESIC toll-free helplines: 1800-11-2526 and 14-55 (24×7, multi-language)
• ESIC email: [email protected]
• Regional Offices directory: https://www.esic.gov.in/regional-offices
• Empanelled hospital and dispensary search: https://www.esic.gov.in/dispensaries-hospitals
• Atal Beemit Vyakti Kalyan Yojana: https://www.esic.gov.in/abvky
• SAMADHAN portal (labour grievance): https://samadhan-portal.labour.gov.in
• Office of the Chief Labour Commissioner (Central): https://clc.gov.in
• Ministry of Labour and Employment: https://labour.gov.in
• RTI online portal: https://rtionline.gov.in
• Central Vigilance Commission: https://www.cvc.gov.in
• Employees' State Insurance Act 1948: https://www.esic.gov.in/attachments/PublicationFile/40050a3a17ad0a4ae6ddcf2e9bcecf9d.pdf
• ESI (General) Regulations 1950: https://www.esic.gov.in/attachments/PublicationFile/9b81fe6c50ba6bba0b2c0e7c93f7f12c.pdf
• Code on Social Security 2020: https://labour.gov.in/sites/default/files/SS_Code_Gazette.pdf
• ESIC v Hotel Corporation of India Ltd. (2008) 1 SCC 736
• Justice K.S. Puttaswamy v Union of India (2017) 10 SCC 1 - dignity floor for welfare entitlements

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• State grievance portals - which one to use
• The citizen RTI playbook
• EPFO claim rejected or pending: UAN, KYC complaint - canonical sibling on the EPFO file side
• Labour Department complaint: employer salary, PF, gratuity - canonical sibling when the employer is the root cause of ESIC short-deposit
• Pension not credited and life certificate complaint - canonical sibling on the post-employment EPS pension flow

1200×630 PNG, flat-vector editorial illustration. Centre: an outline of an Indian factory or shop floor with a worker in plain uniform holding up an e-Pehchaan ESI card; a subtle red exclamation mark hovers over the card. Left: a stylised laptop screen displaying the ESIC IP Portal with a Contribution History table where three rows are highlighted in amber as “Not Deposited”. Right: a stylised hospital reception counter with a small sign “Empanelled ESIC Hospital” and a closed barrier. Background: a soft saffron-to-green gradient with a subtle Ashoka chakra watermark. Bottom strip in deep navy: “ESIC Claim or Medical Benefit Denied - Citizen Guide 2026 - righttoinformation.wiki”. Style: clean, government-portal aesthetic, no real faces, no real names, no real logos other than a tiny “ESIC route only” badge.