Termination of workman - employee submitted duplicate bill to medical insurance company - CiteHR
Umakanthan53
Labour Law & Hr Consultant
Prins Kumar Sahay
Technician And Union Member

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In my company lot of employee submitted duplicate bill to medical insurance company which is a corporate medical company.
Now insurance company pressurised us to terminate all those employee, because they conduct a fraud with insurance company.
What is termination rule and can we terminate an employee on these basis.
Please mentioned in detail

Dear friend,
In the realm of employment, misconduct refers to any of the acts or omissions of employees during the course of their employment as set out or enumerated in the service regulations. Punishment ranging from minor to major such as censure to dismissal is the consequence of any misconduct depending on its gravity is the consequence after duly following a set of disciplinary action in tune with the Principles of Natural Justice.
Therefore, it is very important that the misconduct should have been committed by the employee within the zone of his employment. As man being a social animal, it is impossible to predict his behavior or conduct all the time in all the situations. Hence the employer cannot be a moral policeman of the conduct of his employees outside the employment zone. However, it is an accepted legal dictum that If the employee indulges himself elsewhere in any act prohibited in law and gets sentenced to any severe punishment like imprisonment, of course, the employer can terminate his services. But, it is consequential only after a trial and conviction by a competent Court of Law in this regard and not on the mere request of a third party like an Insurer.

Sir
Medical insurance is a group policy which company has been provided to all employee.
Means that company is direct buyer of this corporate policy and provide to the employee,in this policy workers are submitted duplicate bills to the insurance company

Dear Prins,
From your reply I understand that the premia to this Group Health Insurance Policy has been paid by the employer as a welfare measure.
As it is, it is the contention of the Insurance Company that some of the insured persons/employees submitted false claims with bogus bills. If so, the first step that could be taken by the insurer in this regard would be rejection of such false claims and cancellation of the insurance cover to such persons. Whether it was done by the insurer directly under intimation to the employer or through the employer? That apart it is, in my opinion, a contentious and complicated issue as the alleged false claims would have been made only on the basis of prescriptions by doctors and cash bills issued by medical shops. Is it the contention of the insurer whether the prescriptions of the doctors are wrong or the bills were bogus or both? If so, how the insurer came to the conclusion - based on their own doctors' opinions or on the basis of any investigation conducted by them? Whether the copies of such documents were attached to the letter asking the management to summarily terminate their services?
If the employer starts acting on the request of the insurer, certainly it would be a cumbersome disciplinary process as the first issue would be establishing the fact that the claims were false and the second and the foremost would be that as it is a dispute between the insurer and the insured and the employer is no where connected except remitting the premia for the claimants as a welfare measure either on his own or as per the terms of any collective bargaining agreement between the employer and the employees. Is the management ready to engage itself in such a laborious exercise simply at the request of the insurer?
Of course, the management has every right to call for the explanations of such employees as the premia was paid by them on their behalf. If the employees unequivocally admit that they did so, it is my personal opinion that at the most the management can forthwith stop this concession to such employees only for their misuse of the concession.

Sir i am working in a MNC company.
There is a health policy provided by company as groups health policy as many companies provide to his employee.
In 2011 in submit a claim to helth insurance company by some fraud document and calim has been settle and health which amount i claimed has been deposited in my account.after some day i submitted one other claim but this time insurance company take some doubt and make a enquiry by third party.in inquiry the found that document submitted by me in both claim is duplicate than that third party member called me and tell me all about enquiry and ask me withdrawn my current claim and recovery of first claim.
I will agree with one condition that they will not disclose my name with company and that third person has been ready.
I will gave him the cheque of amount who i received my first claim and that person send me a email with menson that they will never approach me and my cheque submitted to insurance company and amount has been deducted from my account.
After this all thing happened i will forget thease all thing and continue working till now in this period company has revised my policy every year and i will also do claim for my baby and that claim has approved,so confirm that the matters happen in 2011 had been end,
But in 2019 my company is going to close so company is trying to put some pressure on employee by different types to take VSS/VRS scheme that decalerd by company.
In this situation company ask for list of employee who hass been done any fraud with insurance company,and there is my name in the list.company is now putting pressure on me that take VSS/VRS eales i will terminate you.
My question is that
1)after 8 year is there any reason for fraud case.
2)That time insurance company settle that matter with recovery his amount ,than there is any reason for case.
3)Is company authorize to terminate any employee for submitted duplicate document in insurance company

Sir first i saying thank you very mutch.
I am sending my situation please guide me-
In 2011 in submit a claim to helth insurance company by some fraud document and calim has been settle and health which amount i claimed has been deposited in my account.after some day i submitted one other claim but this time insurance company take some doubt and make a enquiry by third party.in inquiry the found that document submitted by me in both claim is duplicate than that third party member called me and tell me all about enquiry and ask me withdrawn my current claim and recovery of first claim.
I will agree with one condition that they will not disclose my name with company and that third person has been ready.
I will gave him the cheque of amount who i received my first claim and that person send me a email with menson that they will never approach me and my cheque submitted to insurance company and amount has been deducted from my account.
After this all thing happened i will forget thease all thing and continue working till now in this period company has revised my policy every year and i will also do claim for my baby and that claim has approved,so confirm that the matters happen in 2011 had been end,
But in 2019 my company is going to close so company is trying to put some pressure on employee by different types to take VSS/VRS scheme that decalerd by company.
In this situation company ask for list of employee who hass been done any fraud with insurance company,and there is my name in the list.company is now putting pressure on me that take VSS/VRS eales i will terminate you.
My question is that
1)after 8 year is there any reason for fraud case.
2)That time insurance company settle that matter with recovery his amount ,than there is any reason for case.
3)Is company authorize to terminate any employee for submitted duplicate document in insurance company or only can stop medical policy.
I totally agree that i will submitted fraud bill and description also,
In this case what can i do .
Is i accept the VSS/VRS or opposed for VSS and challenge his termination in court

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