Entered Agreements With Doctors, Institutes To Give Medical Benefits To Insured Workers In Vadodara: ESI Corporation To Gujarat High Court
Lovina B Thakkar
19 Dec 2024 9:30 AM IST
While hearing a PIL for providing medical benefits to insured persons under the Employees' State Insurance Act including establishment of dispensaries in Vadodara immediately till adequate medical facilities are provided, the Gujarat High Court said that the ESI Corporation was examining the necessity and responsibility of reorganizing/relocating dispensaries.
Taking note of the steps stated to be taken the Corporation, the court also noted that the the corporation's affidavit demonstrated that it has entered into agreements with medical institutions, doctors to give medical benefits to insured persons and their families through the available medical infrastructure in the district.
The PIL was filed by a social worker, working for the cause of the workers covered by the Employees' State Insurance Act which raised concerns regarding improper healthcare services for insured people and implementation of Section 56 of the ESI Act that ensures medical benefits to the people under the insurance concerns on labour related issues.
A division bench of Chief Justice Sunita Agarwal and Justice Pranav Trivedi perused through the provisions of the ESI Act including Sections from 56 to 59 and 59A that mandates the corporation and state government to provide medical benefits to insured persons and their families, establish and maintain dispensaries and hospital and tie-up with local medical institutions and private bodies to provide the medical care and services.
The provisions further states that the insured has rights to sickness, maternity and disablement benefits. However, they can use only the medical services from the facilities assigned to them, and cannot claim reimbursement for treatment outside the prescribed services.
The bench in its order noted, “From the reading of the above provisions, it is more than evident that providing the medical benefits under the ESI Act to the insured persons and their families (where such medical benefits is extended to his family) is the conjoint duty of the ESI Corporation as well as the State Government.”
Furthermore, The Court noted that corporation can tie-up with the local and private medical bodies to provide healthcare to the insured people and their family. It noted that as per the affidavit submitted by the Corporation, it stated that it is making effort for providing 100 bed hospital in the newly implemented area of Vadodara District and as per the statement made in the affidavit filed on behalf of the Corporation, the said project is at the last stage and negotiations are on the verge of completion.
"The material brought on record along with the affidavit of ESI Corporation also demonstrates that it has entered into agreements with medical institutions, doctors for providing medical benefits to the insured persons and their families through the available medical infrastructure in the district," the court noted.
The petitioner had contended that the ESI dispensaries should be within the reach of insured people i.e., 8 kms if the insured people exceed 3000. The petitioner had contended that if the insured population has a potential of 3000 then a dispensary is necessary pre-requisite.
However, the court noted, there was no answer to the Corporation's stand that it is making efforts to provide adequate medical facilities to the insured persons and their families through various means, i.e. by opening dispensaries, commissioning for 100 bed hospital, Super Speciality Hospital in the area and signing Memorandum of Understanding with the available hospitals/ institutions/dispensaries in the area.
"There is no reply to the affidavit filed on behalf of respondent no. 4. All communications placed in the writ petition are directed to only one contention that the ESI is Page mandated to open dispensaries within a radius of 8 kms of the population of insured persons where the population is approximately 3000 or more," it noted.
The Court further observed that ESI Corporation has formed a committee on "Reorganization of ESI dispensaries" for the regional area by the Regional Officer, Ahmedabad vide order and the committee meetings are being held in the State Regional office of Vadodara jurisdiction.
The minutes of the meetings were taken into record that stated 20 dispensaries are running in Vadodara and 8 additional dispensaries are further proposed to be opened.
It bench thus said, “As per the above noted facts, it is evident that the Committee constituted by the Regional Office, Ahmedabad is evaluating the data and examining the necessity and responsibility of re-organizing/relocation of the dispensaries which are either already functioning (full time/part time) or approved by the competent authority or pending for approval. We, therefore, direct that it is open for the petitioner to make a representation to the competent authority, namely the Regional Director, ESI Corporation, Ahmedabad, namely respondent no. 3 herein, raising the grievances made in the present petition along with the copy of this order. In case the petitioner makes such a representation, the grievances raised by the petitioner shall be placed before the aforesaid Committee for re-organization of ESIS dispensaries, which shall duly consider the same and also invite the petitioner in the meetings for deliberations and suggestions.”
The Court then ordered that the committee will be “free to take decisions independently” and to consider the issues raised by the petitioner regarding the establishment/reorganisation or relocation of ESI dispensaries within jurisdiction. It thus disposed of the writ petition.
The writ petition raised the concern regarding improper healthcare services for insured people and implementation of Section 56 of the ESI Act that ensures medical benefits to the people under the insurance. The petitioner points out that the ESI Corporation is supposed to set up dispensaries within 8 km of any area with an approximate population of around 3,000 insured people. Furthermore, the ESI should come up with alternative options such as either entering into an agreement with some local hospitals or setting up an "Insured Medical Practitioner" (IMP) system.
The petitioner then contended the urgency to establish dispensaries for specialized treatments. Furthermore, the petitioner stated that in spite of repeated requests and ESI Corporation meetings, nothing has been done in respect of opening dispensaries and hospitals that were expected for the entire District of Vadodara. As per the ESI, the insured workers and families are entitled to medical treatment and care including illness and surgery. These medical benefits are carried out at ESI dispensaries, hospitals and diagnostic centres.
The RTI application filed in 2023 further revealed that there are only 11 dispensaries which are not well-equipped and is insufficient to serve the large number of insured workers about 4,47,000 under the scheme.
The respondent-ESI Corporation filed a reply stating The ESI scheme covers more than 442 districts, where medical care is provided through multiple facilities including 1,502 dispensaries, 1,003 hospitals and clinics, among other units. The scheme benefits more than 17 lakh workers and 65 lakh family members in Gujarat. The ESI is also collaborating with the State Government for establishing a 100-bed hospital in Savli-Manjusar for Vadodara. The corporation also runs 12 dispensaries in Vadodara and has tie-ups with private hospitals for specialized treatment.
Further, it stated ESI Corporation is working on new facilities in Vadodara for better access to healthcare in the final stages. Also, workers can enrol via online platforms, streamlining the process. The ESI Corporation re-emphasises that it is offering free medical benefits to insured workers along with their family, especially those who cannot afford any expensive medical care.
