2-Re-SO-2489(E) dated 4th June, 2025(Guidelines)-1

Road Accident Victim Scheme, 2025: Guidelines

Background

The Ministry of Road Transport and Highways initiated the "Road Accident Victims Scheme, 2025" per Section 162 of the Motor Vehicles Act, 1988 (MV Act), for providing immediate cashless treatment to victims of road accidents involving motor vehicles of any category.
Section 164B of the MV Act allows for the establishment of a Motor Vehicle Accident Fund (Fund) to manage victim treatment as per the scheme.
The fund will operate through two accounts: 1) for insured vehicles, and 2) for uninsured vehicles/hit and run motor accidents.
These guidelines are a result of the scheme prepared by the Central Government under Section 162 of the Act.
Steps to be taken are presented briefly for stakeholders and attached as Standard Operating Procedures (SOP).
Roles and responsibilities of involved stakeholders are also appended.

Eligibility Criteria

Any individual who is a victim of a road accident caused by a motor vehicle (road accident) and sustains injuries requiring hospital admission is eligible for cashless treatment under this scheme, as per these guidelines. The definition of motor vehicle is as per Section 2, sub-section (28) of the MV Act, 1988.
Road accident victims are entitled to cashless treatment for a specified period within the scheme.
Benefits under this scheme are prioritized over any other benefit scheme for medical treatment by the Central Government, State Government or Union Territory Administration for the same purpose.
Victims admitted to the hospital for the first time more than 24 hours after the accident are not eligible under this scheme.

Empaneled Hospitals

Treatment will be provided through empaneled hospitals under this scheme, including those empaneled under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) that align with the National Health Authority (NHA) guidelines.
Hospitals not under AB PM-JAY will be empaneled per the guidelines and process issued by the NHA.
Hospitals not yet empaneled may provide treatment for stabilization of road accident victims after registering in the NHA’s Transaction Management System (TMS) via their Health Facility Registry (HFR) ID.
Empaneled hospitals must adhere to NHA guidelines on patient admission, pre-authorization, claim settlement, hospitalization, and medical treatment of road accident victims.

Technology-Based Implementation

The scheme will be implemented through electronic links between victim details, empaneled hospital information, treatment specifics, and standardized treatment package costs, ensuring timely payment and maintaining a complete digital record of treatment.
The NHA’s TMS portal and the Ministry of Road Transport and Highways’ electronic Detailed Accident Report (e-DAR) application will be integrated through Application Programming Interfaces (APIs), allowing seamless data transfer for scheme management and operation.
The unique identifier of the accident victim in e-DAR, i.e., e-DAR Victim ID, will be mapped with the patient's unique identifier in TMS (TMS Patient Registration ID), which will be linked to the empaneled hospital ID (see Figure 1) ensuring road accident victims can avail treatment.

Transferring the Victim to the Hospital

A road accident victim can be transferred to either the nearest empaneled hospital (see Figure 2 in Appendix) or any other hospital for treatment. If taken to a non-empaneled hospital, that hospital is responsible for providing stabilization treatment and arranging ambulance services to transfer the victim to the nearest empaneled hospital. Stabilization treatment criteria and acceptable costs will be defined by the NHA.
An IT application will be developed to help locate the nearest empaneled hospital for the scheme's purposes.
A road accident victim can be brought to the hospital with or without police assistance. The latter cases include:
- Victim arriving at the empaneled hospital independently.
- Victim brought by the hospital or a third-party ambulance service.
- Victim brought by the owner, driver, or passenger of the motor vehicle involved in the road accident.
- Victim brought by family members or acquaintances.
- Victim brought by a Good Samaritan.
- Victim referred by an official or employee of the road ownership or road maintenance agency, or emergency services.
- Victim brought by any other means.
Any person can dial the Emergency Response Support System (ERSS) / 112 helpline to report a road accident (see Figure 3 in Appendix). The responder at 112 will obtain initial details about the location of the road accident, its nature, the potential number of victims, and the need for an ambulance. The responder will provide the caller with details of the nearest empaneled hospital and also forward the details to the police station with jurisdiction over the accident site. The responder will transfer the request for an ambulance to 108 or any other state helpline managing the ambulance service ecosystem, along with the details provided by the caller.
States/Union Territories will ensure the identification, mapping, and strengthening of the ambulance ecosystem and ensure integration with 112 services, if not already done, to ensure a rapid response of ambulance services for road accident victims.
The cost of transportation using ambulance services from the accident site to the empaneled hospital or referral by another hospital into an empaneled hospital will be payable as per the standard package approved by the NHA.
If an empaneled hospital refuses to admit a victim for treatment, it can be reported to the district Grievance Redressal Officer as per the grievance redressal mechanism detailed in paragraph 13 of these guidelines.

Details of the Accident and the Victim

Upon receiving information about a road accident involving a motor vehicle, the nearest available police officer will reach the accident site as soon as possible and, where possible, obtain details through 112 or other technical platforms, and take action to transfer the victim to the nearest empaneled hospital if necessary.
The police officer will fill initial details about the road accident on the e-DAR application to create an e-DAR Victim ID. This created e-DAR Victim ID will then be used for mapping with the Treatment ID created on TMS by the concerned hospital.
If the victim reaches the hospital without police assistance, the empaneled hospital will create a Treatment ID on TMS. The ID created on TMS will be sent electronically to the district police via the API interface between TMS and e-DAR. An alert will also be sent to the District Collector with jurisdiction over the accident site and the hospital where the victim is admitted for information purposes.
If, in the opinion of the District Police Officer, the specific location of the accident falls under the jurisdiction of another district police, the information about the accident will be transferred on e-DAR to the concerned district within 3 hours of receiving the request from TMS, after which the transfer facility will become inactive. An alert will also be sent to the District Collector of such new district for information purposes. However, the facility to transfer the information about the accident to any other district will not be available.
If it is prima facie established that the victim is a victim of a road accident, the police officer of the jurisdictional police station will collect initial details about the road accident and prepare an e-DAR Victim ID along with the FIR number (if available) on e-DAR based on the accident site. This should not be ensured in more than 24 hours from the time of receipt of the TMS ID. The police officer will be required to provide only initial details related to the creation of the ID of the victim on e-DAR within this period and other details can be uploaded later. The e-DAR Victim ID (ID) so created on e-DAR will then be tagged with the Patient Registration ID prepared on TMS.
During this period of 24 hours, stabilization treatment by the hospital shall continue and the hospital shall be eligible to receive payment for the cashless treatment under this scheme. After the period of 24 hours, the TMS ID will expire and the victim will be disengaged from the scheme.
During this period of 24 hours, when police response has not been received and if the hospital administrator feels that the condition of the victim is critical and his life may be lost by further waiting for police response by only doing stabilization treatment, the same may be marked on TMS. Thereupon, all the treatment packages under the scheme shall be unlocked even before the police response is received on e-DAR, subject to the scheme coverage of maximum upto Rs. 1.5 Lakh per victim for a maximum period of 7 days from the date of accident.
If police response is not received within 24 hours of receipt of the TMS ID, the TMS ID will expire and the victim will be disengaged from the scheme, except for the specific conditions mentioned in para 6.7 above wherein a further period of 24 hours shall be provided for police response which is an extended period and in this period an alert shall be sent by e-DAR to the State/UT Director General of Police or the State Nodal Police Officer, not below the rank of Additional DGP, to get response from the concerned subordinate police officer within an extended period of 24 hours. After the extended period of 24 hours further to 24 hours under specific conditions mentioned in para 6.7, the TMS ID will expire and the victim will be disengaged from the scheme.
The police officer will identify the details of the victim and upload it on e-DAR. The police officer will also endeavor to identify the family members of the victim and inform them after obtaining the personal details of the victim.

Treatment of Victims

All empaneled hospitals under this scheme, including AB PM-JAY hospitals, are expected to provide treatment to eligible victims as per the treatment packages specified by NHA for the purposes of this scheme.
The treatment will start as soon as the victim is brought to the hospital and pre-authorization for the package will start. Treatment under the scheme will involve a two-stage process. The victim will be registered as soon as he reaches the hospital. At the time of registration, NHA’s biometric authentication policy with respect to AB PM-JAY will be applicable, except in cases where biometric authentication is not possible based on the victim's condition. Exemption from biometric authentication will be as per the norms specified by NHA in this regard and shall be available on the portal.
The Pre-authorization request from the hospital will be raised as per NHA’s standard procedure. However, notwithstanding the Pre-authorization request, treatment will be started immediately by the empaneled hospital.
If a victim is brought to the hospital by the local police and the e-DAR Victim ID is generated, the empaneled hospital will provide treatment as per the treatment package up to a maximum of Rs 1.5 lakh per victim for a maximum period of 7 days from the date of the accident.
Wherever possible, the empaneled hospital may collect information from the victim, including the identity and details of the family members to be notified. A treatment (patient) ID will be created on TMS by the empaneled hospital which will be mapped with the e-DAR Victim ID provided by the police officer.
If the victim reaches the hospital without police assistance, a treatment (patient) ID will be created on TMS and sent to the jurisdictional district police for initial confirmation of the victim being a road accident victim. In such a case, the hospital will only be eligible to receive payment for the treatment package for the purpose of stabilization.
However, during this period of 24 hours at any point in time and as per specific conditions mentioned in para 6.7, all treatment packages under this scheme shall be unlocked on e-DAR, even before the police response is received, subject to the scheme coverage of maximum upto Rs. 1.5 Lakh per victim for a maximum period of 7 days from the date of accident. In such a case, the hospital shall be entitled to receive payment for the actual treatment packages utilized in the period of 24 hours or police response, whichever is earlier, irrespective of the response given by the police authorities (accepted, rejected or timed out) under coverage under this scheme.
Once police confirmation is received within the stipulated period of 24 hours, the empaneled hospital will continue treatment from the treatment package up to a maximum of Rs 1.5 lakh per victim for a maximum period of 7 days from the date of the accident.
If the police confirms that the patient is not a victim of a road accident caused by the use of a motor vehicle or no confirmation is received within the period of 24 hours, the victim shall be disengaged from the treatment cover under this scheme.
If a victim goes to a hospital that is not an empaneled hospital under the scheme, the victim may be referred to the nearest empaneled hospital or may be advised to continue treatment in the hospital at his/her own expense. Payment to such hospitals providing stabilization treatment shall be considered as per the specifications and packages for stabilization developed by NHA in this regard.
During the course of treatment, if the empaneled hospital believes that it does not have the required expertise to continue the treatment, the hospital may transfer the victim to another hospital through the referral system in TMS. However, the coverage under the scheme, i.e., up to Rs 1.5 lakh per victim for a maximum period of 7 days from the date of the accident, shall be understood cumulatively across all hospitals treating the victim.

Discharge on Treatment or Death

In case of successful treatment, the patient will be discharged before the period of 7 days from the date of the road accident. The victim may also be discharged from the scheme when the treatment limit in terms of the coverage amount or coverage period under the scheme is exhausted, whichever is earlier, even if further treatment is being received in the same hospital or the referred hospital and payment for such treatment beyond the coverage amount or coverage period shall not be made from the funds under the scheme.
In the unfortunate event of the death of the victim during the course of treatment under the scheme, the same shall be recorded as ‘Discharge as Dead’ in TMS and payment up to the coverage amount limit or coverage period till the date of death of the victim shall be made to the empaneled hospital under the scheme. However, the cost of any post-mortem procedure shall not be covered under the scheme.
If a victim, who has been given stabilization treatment, wants to be discharged before police response is received on e-DAR, the cost of such stabilization treatment shall only be borne by the victim.

Hospital Claim Settlement

After the victim is discharged from the scheme, the hospital will have to submit the claim for payment to the concerned State Health Agency (SHA) on the NHA portal. All the required documents as prescribed by NHA or SHA must be submitted by the empaneled hospital along with the claim for payment.
If the road accident site and the hospital where the treatment is being provided are in different States/Union Territories, the claim for payment shall be submitted to the SHA of the State/Union Territory in which the treating hospital is located, and such SHA may seek necessary information from the authorities of the district in which the accident occurred.
The concerned SHA will approve the claim for payment in full or partially or reject the claim in full or partially with reasons for rejecting the claim being communicated to the hospital.
The Motor Vehicle Accident Fund Trust, mentioned in the Central Motor Vehicles (Motor Vehicle Accident Fund) Rules, 2022, may determine the drawing limit for the agency designated by the Central Government for making payments to hospitals for the claims approved by the SHA. The limits may be reviewed by the Trust from time to time after assessing the number of cases for that particular State/Union Territory.
In cases where TMS ID expires due to no response being received from the Police authorities, the hospital shall be paid the amount of stabilization treatment under this scheme. However, for cases where TMS ID expires due to no response being received from police authorities for cases declared as life threatening by the hospital administrator, the amount of actual treatment given till an extended period of 48 hours under specific conditions mentioned in para 6.7, shall be paid to the hospital under coverage under this scheme.
During police verification, if it is found that the victim is not a victim of a road accident, the entire cost of treatment will have to be borne by the victim and the hospital will be informed and alerted about the police verification details through the linkage of e-DAR with NHA’S TMS.

Accounting and Utilization of Funds

Settlement of claims approved by the SHA will be made from the relevant account established by the Motor Vehicle Accident Fund Trust.
If it is established through e-DAR linked with the vehicle that the offending motor vehicle in the accident had valid third-party insurance coverage, the hospital's claim payment will be made from the contribution made by general insurance companies to the account of insured vehicles created by the Motor Vehicle Accident Fund Trust. In such a case, after confirming the validity of the third-party insurance policy on the date of the accident, the payment transaction shall be made within a period of 10 days from the SHA approving the claim, failing which the claim shall be deemed to have been approved and payment shall be made to the hospital from the insured vehicle account along with interest at the rate determined by the Central Government.
In all other cases, i.e., where the motor vehicle involved in the accident does not have valid third-party insurance coverage or in the case of hit and run where the motor vehicle cannot be identified or where no response is given on e-DAR by police within the time limit prescribed, the claim for payment shall be settled from the account of uninsured vehicle /hit and run motor accident established from the budgetary outlay released by the Central Government to the Ministry of Road Transport and Highways. In such a case, the payment transaction shall be made within a period of 10 days from the SHA approving the claim with the approval of the District Collector, failing which the claim shall be deemed to be approved and payment shall be made to the hospital from the budgetary fund along with interest at the rate determined by the Central Government and recovery shall be made from the State/UT Government.
The police will confirm the involvement of the motor vehicle on e-DAR and the information on the status of the motor third-party insurance of the motor vehicle involved in the road accident will be given on e-DAR through linkage with the vehicle based on which the relevant account of the fund for payment to the hospital will be identified electronically.
The Motor Vehicle Accident Fund Trust will ensure the availability of sufficient funds in both accounts of the Fund for the settlement of claims within the stipulated time period.

Monitoring of the Scheme at the Grassroots Level

The State Road Safety Council constituted under Section 215 of the Motor Vehicles Act, 1988 will be responsible for monitoring the implementation of the scheme in the concerned State/Union Territory and take such action in relation to any agency of the State Government or Union Territory Administration, as may be necessary, for ensuring that the objectives of the Scheme are fulfilled. The State Road Safety Council may raise any issue before the Subject Selection Committee, where any clarification is required in reference to the guiding principles or applicability of the Scheme.
Overall monitoring and coordination of the implementation of the scheme in the district will be the responsibility of the District Road Safety Committees (DRSC) established under Section 215 of the Motor Vehicles Act, 1988. The DRSC will attempt to improve the coverage of compulsory third-party insurance in cooperation with insurance companies and for this purpose will co-opt a representative of the insurance company designated by the IRDAI as the lead insurer in that state/district.

Assistance in Operations by the District Administration

The District Collector, District Magistrate, or Deputy Commissioner, as the case may be, will ensure proper monitoring for the successful implementation of the Scheme through DRSC and remove any difficulties in the implementation of the Scheme at the district level.
The District Police Chief will ensure that all police officers in the district are trained and sensitized so that the e-DAR Victim ID can be prepared immediately and a police officer goes to the hospital with the victim so that the victim ID on e-DAR can be made available to the empaneled hospital immediately for starting the treatment of the victim. Training on the use of e-DAR and the mobile app for the immediate preparation of e-DAR Victim ID will be arranged by the District Police Chief.
The District Collector, with the assistance of the District Police Chief, may appoint volunteers from the District Red Cross Society or any other voluntary group to assist victims in getting admitted to the empaneled hospital.
The district administration should organize civic awareness campaigns and field officer sensitization sessions so that all stakeholders are well informed about the features of the scheme, eligibility criteria, empaneled hospitals, and related SOPs.
The DRSC will be responsible for sensitizing non-empaneled hospitals regarding the scheme and the stabilization packages that will be given to the victim coming to such non-empaneled hospitals.

Grievance Management

A dedicated Grievance Redressal Officer will be appointed by the District Road Safety Committee to resolve grievances arising from the implementation of the Scheme. The name, designation, and contact details, including the telephone number, of the Grievance Redressal Officer will be recorded on e-DAR by the District Collector.
If the applicant is not satisfied with the resolution of the grievance by the Grievance Redressal Officer or there is a delay in the resolution of the grievance, such grievances will be sent to the concerned District Collector. A specific time limit for the redressal of specific types of grievances at the level of the Grievance Redressal Officer and the District Collector will be published by the State Road Safety Council.
If the applicant is not satisfied with the resolution of the grievance by the District Collector, the appellate authority will be the State Road Safety Council.
Review of grievances related to the Scheme will be included as an agenda item in the periodic meetings of the District Road Safety Committee.
NHA's helpline number (14555) will be made available and widely publicized to address questions, concerns, grievances, etc., of the following categories:
- Grievances of victims related to hospital admission, treatment, etc.
- Grievances of hospitals regarding claim settlement.
- Grievances of SHAs, administrators, etc.

Fraud Control

All fraud-prevention guidelines, measures (flagging), etc., developed by NHA will apply to this scheme.
Anti-fraud flagging will be designed to cover all potential mechanisms of fraud, with special emphasis on detecting fraud in cases involving a large number of victims.

Standard Operating Procedures (SOPs) for various stakeholders

112 Operator

Upon receiving a call from the victim or a Good Samaritan regarding a road accident involving a victim, the operator will ask the caller whether information about the nearest empaneled hospital is required or a request for an ambulance is to be made, or both.
If the caller requests information about the nearest empaneled hospital:
- Details of the road accident and injury will be obtained from the caller, and it will be confirmed whether the location of the accident is the same from where the call is being made.
- Details of the nearest empaneled hospital will be identified along with contact details, and details of its name and location will be provided to the caller.
If the caller requests an ambulance:
- The request may be forwarded to 108 or any other helpline for an ambulance.
- Information on the location of the accident site, the nature of the injury (wound), and the nearest empaneled hospital will also be made available to 108 or the relevant helpline.
The police station under whose jurisdiction the accident site falls will be sent the accident site, details of the victim(s), as well as details of the empaneled hospital where the victim/Good Samaritan has been sent.
Upon completion of the entire incident at 112, a confirmation message will be sent to the caller, which will include details of the police station where the details of the case have been forwarded.

Victim or Victims' Family

The road accident victim or his family may decide either to take the victim to hospital by their own means or report the accident to 112 for further action.
If the victim(s)' family decides to report the accident to the authorities, they can call 112 to report the road accident:
- The victim/victim’s family will have to provide the operator at 112 with initial details about the road accident (victim details along with the location of the accident) and also request an ambulance.
- After the victim is transferred to the empaneled hospital by ambulance, treatment will be done by the hospital.
If the victim/family decides to transfer the victim by their own means:
- The victim/victim’s family will be able to obtain details of the nearest empaneled hospitals either by calling 112 or, wherever possible, through technological platforms.
- Based on the details provided, the victim can then be transferred to the empaneled hospital.
- If the victim is transferred to the hospital that is not empaneled under this scheme, the victim will be given initial stabilization treatment through a module developed by NHA, and then further treatment can be done from empaneled hospitals.
- If an empaneled hospital does not admit the victim, it can be informed to the district Grievance Redressal Officer nominated by DRSC.
- For other hospital and treatment-related grievances, victims can call the Helpline number 14555.

Good Samaritan

Upon seeing the road accident victim, a Good Samaritan will either decide to take the victim to hospital by their own means or report the accident to 112 for further action.
If the Good Samaritan decides to report the accident to the authorities, he will call 112 to report the road accident:
- The Good Samaritan will provide the operator at 112 with initial details about the road accident (victim details along with the location of the accident) and also request an ambulance.
If the Good Samaritan decides to transfer the victim by their own means:
- The Good Samaritan will obtain details of the nearest empaneled hospitals either by calling 112 or, wherever possible, through the technological platforms.
- Based on the details provided, the Good Samaritan will transfer the victim to the empaneled hospital.
- If an empaneled hospital does not admit the victim, it can be informed to the district Grievance Redressal Officer nominated by DRSC.
- For other hospital and treatment-related grievances, victims can call the Helpline number 14555.

Police

Accident Reporting

If the local police receive information about a road accident (either from a Good Samaritan or through 112), the nearest available police officer will try to reach the accident site as soon as possible:
- Details of the nearest empaneled hospitals can be obtained either by calling 112 or from the mobile app or through public platforms.
- Based on the details provided (nature of injury, nearest hospital, etc.), the police officer will transfer the victim to the hospital.
The police officer will fill initial details about the road accident on the e-DAR (eDAR) application to create an e-DAR Victim ID.
Upon reaching the hospital, the e-DAR Victim ID will be made available to the hospital at the time of admitting the victim.

Treatment

Upon receiving a request from the hospital for confirmation of the fact of the road accident, the district police may either accept it, reject it, or send it to another district.
If the police officer believes that the accident site falls under the jurisdiction of another district, such request may be transferred to the concerned district on e-DAR within 3 hours of receiving the request from TMS. After this time period, the transfer facility will become inactive. However, the facility to transfer information about the accident further to any other district will not be available.
While transferring the request, the concerned police officers will be required (through a check box) to certify that the location of the accident does not fall under the jurisdiction of their district.
Once the police officer believes that the accident site falls under their jurisdiction, either directly upon receipt of the TMS request or upon transfer from another district police, the officers of the jurisdictional police station will collect initial details about the road accident incident.
If it is prima facie established that the victim is a victim of a road accident:
- An e-DAR Victim ID will be prepared based on the location of the accident.
- The police officer will be required to provide only initial details on e-DAR related to the creation of the victim ID within this period, and other details can be uploaded or modified later.
- Within 24 hours of receiving the TMS ID, the police officer will approve the TMS request and provide an e-DAR ID for it.
If the police officer feels that the victim is not a victim of a road accident, he will have to reject the TMS request within 24 hours. The patient will be considered discharged from the scheme.
If no response is received within 24 hours, the TMS request will expire.
If a case is considered life-threatening by the empaneled hospital, the police officer will try to respond immediately to the TMS request to continue full treatment for road accident victims.
The police officer will also endeavor to identify the family members of the victim and inform them after obtaining the personal details of the victim.

Hospital

Treatment at Empaneled Hospital

In cases where the road accident victim is taken to the hospital without police assistance:
- Stabilization treatment will be started for the victim. Along with this, the hospital, as far as possible and by ensuring that the victim's treatment is not disrupted, can collect information such as identity details, accident site, vehicle involved in an accident (if any), etc. from the victim.
- The hospital will prepare a Treatment ID (ID) on TMS and send it to the district police via e-DAR. At such times, bio-authentication will be done as per NHA policy.
- If no response is received from the police even within 24 hours of submitting the confirmation request, stabilization treatment will continue until the expiry of the package, but the TMS ID will be closed.
- If confirmation is received from the police that the patient is an actual victim of a road accident, the e-DAR Victim ID will be tagged with the TMS ID. Once such confirmation has been received from the police, pre-verification can be started for the entire treatment package.
- If the request is rejected by the police, i.e., the patient is not an actual victim of a road accident, the patient will be considered discharged from the scheme, and the cost of treatment will be directly recovered by the hospital from the victim.
- In cases where the police confirmation request has expired or the patient dies during treatment, such a victim will be automatically considered discharged from the scheme.
- If a victim, who has been given stabilization treatment, and wants to be discharged before police action is received on the e-DAR, the cost of such stabilization treatment will have to be borne by the victim.
In cases where the road accident victim is taken to the hospital with police assistance:
- The e-DAR Victim ID will be brought on TMS by the hospital to map it with the Treatment ID.
- The hospital will request pre-approval from the full list of packages available under this scheme.
During the course of the treatment, the hospital will have the facility to transfer the victim to another hospital through the referral system in TMS. However, the coverage under the scheme, i.e. one lakh and fifty thousand rupees for a maximum period of 7 days from the date of the accident, will be considered cumulatively in all hospitals for each victim. For such referral cases, the transportation cost of the ambulance will also be reimbursed as per the standard packages of NHA.

Treatment at Non-Empaneled Hospital

If the road accident victim is admitted to a hospital that has not been designated by the State Government or the Union Territory Administration for this scheme, such a hospital can give stabilization treatment to the victim as per the guidelines of the NHA.
Also, the hospital will register itself on the module developed by NHA. Registration on this module will be a prerequisite for the hospital to receive payment for stabilization treatment as per NHA policy. However, registering on this module will not entitle the hospital to become an empaneled hospital under the scheme.
Upon giving stabilization treatment, the hospital may choose either to give the victim full treatment on its premises or transfer the victim to the nearest empaneled hospital.
However, if the hospital proceeds to provide full treatment on its premises itself, the cost of such treatment will be recovered from the victim only.

Post-Treatment

When the treatment limit expires in terms of the coverage amount and coverage period under the scheme, the victim will be considered discharged from the scheme, even if he receives further treatment by other means in the same hospital or the referred hospital(s).
In case of death of the victim during treatment under the scheme, it will be recorded as 'Discharged as dead' in TMS.
After the victim gets discharged from the scheme, the hospital will submit the reimbursement claim to the concerned State Health Agency (SHA) along with such documents as per the current guidelines of the NHA.

District Collector

Treatment

Upon receiving a request for confirmation from TMS, e-DAR will send an SMS alert to the concerned District Collector, informing you that the road accident victim has been admitted to the hospital under the scheme.
Until such time as action is taken by the police, stabilization treatment will be given to the victim.
If the TMS request is approved or rejected by the District Police within the stipulated time limit, a notification will be sent by SMS to the DC by e-DAR. However, no further action will be required to be taken by the DC.
If the TMS request is about to expire, i.e., no action is taken by the District Police up to 3 hours of the prescribed time limit, another notification will be sent by SMS to the DC.
If the TMS request is transferred from the police of another district, a notification will be sent by SMS to the DC.
The DC will then coordinate with the concerned District Police Chief to take timely action on e-DAR.
Thereafter, if the police confirm that the victim is an actual victim of a road accident, the DC will coordinate to get the e-DAR Victim ID prepared and mapped with the TMS ID to continue treatment under the scheme.
If the police subsequently deny that the victim is not an actual victim of a road accident, no further action is required to be taken by the DC under the Scheme. Although, the DC will exercise discretion to coordinate any necessary assistance to the victim through other available means, i.e., State-specific schemes, local funds, etc.

Claim Settlement

The reimbursement request submitted by the hospital will be approved by the concerned SHA.
If it is found that the accident is different from the insured vehicle involving the insured vehicle (not insured, hit and run accident, stabilization treatment in the non-empaneled hospital, expiry due to lack of police response on the TMS request), the request will be sent to the District Collector based on the accident location.
Thereafter, based on the details provided by SHA on TMS, the DC will approve the payment and direct SHA to make payment to the concerned hospital through PFMS

General Insurance Council

Settlement

The hospital will place a request for reimbursement on TMS.
After the reimbursement request is approved by the concerned SHA, if it is found that the violator motor vehicle has valid motor third party insurance, the request will be sent to the General Insurance Council (GIC Council).
The General Insurance Council will be given a time of 10 days from the date of receipt of the claim from SHA to verify the insurance policy of the violating motor vehicle.
If the General Insurance Council finds that the insurance policy is active, it will be marked as 'I' on TMS. In such case, the 'Account for insured vehicles' will be tapped by the General Insurance Council to transfer the approved payment to the hospital.
If the General Insurance Council feels that the reimbursement request cannot be considered for any other reason, it will be marked as 'TBD' in TMS. However, in such a case, the 'Account for insured vehicles' will be used by the GIC Council to transfer the accepted payment to the hospital.
If