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How to claim
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Any person who makes a false statement or representation for the purpose of obtaining benefit whether for himself or for some other person renders himself liable to prosecution. 

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Form for reimbursement of medical expenses
Option form for registering members of the family for availing medical benefit from ESI Dispensary situated from other state.
ESI Act & Rules

Related Sections 

Section 2(6-A)
Section 46(1)(d)
Section 55
Section 55-A
Rule 58
  Insured Person
  Employment injury

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