How to Submit ESIC Accident Report in From 12?

ESIC Accident Report in Form 12 is a type of report required to submit at ESIC within 48 hour from the time of happening the accident.

If an employee covered under ESIC whose monthly gross salary is not exceeding INR 21K, met with an accident during the working hour, required to submit accident report to ESIC by the employer immediately.

Employer can submit the ESIC Accident Report in Form 12 online within 48 hour from their employer portal.

In this article, we will discuss the online ESIC Accident Report submission process via employer portal and the claim procedure against the Accident Report that we filled.

Please follow the below flowchart to submit the report online via employer ESIC portal:

  • Go to ESIC official website.
  • Click on Employer Log-In.
  • Log-In using Employer registration code and the password.
  • You will be landed to the Employer Home Page.
  • Click on the Accident Report (Form-12) in left side of the Page showing on the above picture.
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  • In next step, put the Injured employee’s IP number in respective place, select the new report and submit.
  • Accident Report Form will appear where you have to provide the Injured employee’s Occupation and Department under Employee details and click on next.
  • In next page you have to provide the Accident details and following information is required to enter in the report:
    • Work Shift starting date and time.
    • At what time Injured Employee start his work.
    • At what time Accident happen.
    • Exact Place of Accident.
    • Nature of Accident.
    • Location of Injury.
    • Dispensary or Hospital from whom or where the Injured Person Received or is Receiving Treatment.
    • Two witness details like name and address who present at the place where accident happened.
    • Wages and attendance details of the date of accident.
  • After providing the above information click on next.
  • In the next page you have to provide the Accident Cause along with the below details:
    • What the Injured person was doing at the time of accident.
    • Select the appropriate and tick mark.
    • Date of submission of report.
    • Name of the person submitting report.
    • Designation of the person submitting report.
    • Select the Branch office for submitting the ESIC Accident Report.
  • After providing the above information tick on the declaration and submit.

After successful submission of the accident report, you may download the report along with the Acknowledgement copy in PDF format.

You may edit the ESIC Accident Report if you made any mistake by clicking on the Accident Report (Form 12) in the Home Page>Then provide the IP number of the employee whose accident report you want to edit>Then select Edit Report> Then submit.

You may also read: How to apply for Maternity Benefit under ESIC

Claim Procedure against ESIC Accident Report

You may submit the accident report at ESIC branch office along with the below mentioned documents duly attested by Employer:

  • E- Pehchan along with Form 37 of the IP.
  • ESIC Accident Book (Form 11).
  • KYC document proof of the IP like Pan & Aadhaar and Bank account linked with his IP number.
  • Medical documents like reports, scan copy, X-Ray, prescription etc.
  • Witness hand written statement in regional language of the respective state.
  • Any other documents requested by the ESIC authority at the time of submission.

Basically within a week of happening the accident the above documents should reach the respective ESIC branch office for claim processing.

After scrutiny of the documents, benefit will be provided by the ESIC to the Insured Person subject to eligibility.

If you have any query regarding the-is article please do comment below.


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