[Padmini Veeranki]

Just to add

In simple steps first check answers to the below questions,

How was the GMC enrollment done, I am sure the employee would have been communicated about the coverage and limit before issuing the card. Which itself is evidence that the employee is aware of band movement ( out of ESI Bracket).

Check whether the hospitalization was in ESI network hospitals. Then,

Check why the employee didn’t flash an ESI card for hospitalization if he/she was not aware of the Band movement (this will give you the answer if the person is playing games).

Second, In case the hospitalization in ESI based hospital you Check when the ESI was terminated, in most cases the ESI is active for 6 months even though payment has not been made. so if not terminated and the card is active, you can ask the employee to give his ESI card for a record to the hospital.

Having said the above, You can resort to legal action or involve a labor expert to resolve this, which again involves consultant fees and legal fees. If the difference amount is not huge, take it as a special case and clear the same from management on a compassionate basis.

Hope this helps. In case you need to discuss this in length I am available please drop me a note at veeranki10@gmail.com