ESIC circular FileNo. G-19011/1/2026-MSU · 24 Jul 2026
Official title
Delegation of Power of Condonation of Delay in Submission of Medical Reimbursement Claims (MRCs) to the Medical Commissioner (Zonal) — Grounds and Conditions to be Considered — Constitution of Committee by Field Offices
Official record
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Check the official recordThe Employees' State Insurance Corporation has delegated the authority to condone delays in submitting Medical Reimbursement Claims (MRCs) beyond the one-year limit to the Medical Commissioner (Zonal). This delegation is strictly limited to the condonation of delay; financial powers regarding claim admissibility and payment remain governed by existing Delegation of Powers. Field offices must constitute a committee to evaluate delayed claims based on specific grounds, such as force majeure, prolonged ICU confinement, or unconsciousness of the Insured Person. The committee must examine each case using a prescribed proforma and forward its recommendations, including supporting documentation and financial details, to the Medical Commissioner (Zonal) for a final decision.
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FileNo. G-19011/1/2026-MSU Date: 24-07-2026
कायालय ापन Office Memorandum
Subject: Delegation of Power of Condonation of Delay in Submission of Medical Reimbursement Claims (MRCs) to the Medical Commissioner (Zonal) — Grounds and Conditions to be Considered — Constitution of Committee by Field Offices.
यह सूिचत कया जाता है क िनधारत एक वष क समय-सीमा के उपरांत तुत कए गए िचक"सा ितपूित दाव$ (Medical Reimbursement Claims - MRCs) के संबंध म& 'वलंब क (मा (Condonation of Delay) करने क श', स(म ािधकार+ क वीकृित से, िचक"सा आयु (आंचिलक ) को "यायो/जत क गई है।
It is informed that, in respect of Medical Reimbursement Claims (MRCs) submitted after the prescribed one-year time limit, the power of condonation of such delay has, with the approval of the Competent Authority, been delegated to the Medical Commissioner (Zonal).
यह "यायोजन केवल 'वलंब क (मा तक ह+ सीिमत रहेगा। दावे क वीकृ"यता (Admissibility) एवं भुगतान से संबंिधत 'व3ीय श'*याँ वतमान श'*य$ के "यायोजन (Delegation of Powers - DoP) के चिलत ावधान$ के अनुसार ह+ संचािलत होती रह&गी।
This delegation is restricted to condonation of delay only. The financial powers relating to admissibility and payment of the claim shall continue to be governed by the extant Delegation of Powers (DoP).
While examining requests for condonation of delay, the following grounds and conditions shall be taken into consideration:-
(a) Force Majeure and natural disasters; (b) Prolonged duly justified ICU confinement of the IP — where the IP was in ICU, on a ventilator, or otherwise medically incapacitated, and the family was entirely preoccupied with the IP's survival; (c) Unconscious IP — where the IP was unconscious and no family member had knowledge of the ESI coverage; (d) Any other case warranting such consideration, arising out of circumstances that genuinely caused the delay.
These grounds shall be considered only under exceptional circumstances and shall not be a routine provision.
Field offices (MS/DMD/DMN/RO) on submission of MRC by IPs & dependents shall constitute a Committee at their respective unit level to examine cases of delayed MRCs and forward its recommendations to the Medical Commissioner (Zonal).
The Committee shall comprise of the following:
(i) Medical Superintendent/Officer-in-Charge — Chairman; (ii) Dy. Medical Superintendent/Senior Specialist — Member; (iii) Representative of Accounts/Finance — Member; (iv) In-charge of the concerned Benefit/MRC Branch — Member-Secretary.
The Committee shall examine each case as per the proforma at Annexure 'A' (enclosed) and forward the complete record — reason for delay, documentary evidence, final diagnosis, treatment given, claim amount, admissible amount, and its clear recommendations — to the Medical Commissioner (Zonal) for decision.
इस कायालय ापन म& िनहत िनद7श त"काल भाव से लागू ह$गे।
The directions contained in this Office Memorandum shall come into force with immediate effect.
यह स(म ािधकार+ के अनुमोदन से जार+ कया जाता है।
This issues with the approval of the Competent Authority.
Enclosed: - Annexure ‘A’
Assistant Director (MSU)
Copy to:
Annexure -A
| S.No. | Particulars |
|---|---|
| 1 | Reason of delayed submission |
| 2 | Documentary evidence of delayed submission |
| 3 | Final Diagnosis |
| 4 | Management/ Treatment given |
| 5 | Claim Amount |
| 6 | Admissible Amount |
| 7 | Recommendations of the Committee |
