How Can I Persuade My Former Employer to Release My Pending Mediclaim Payment?

Hi Aruna, I am writing this query to seek expert advice from professionals.

I am an ex-employee of a real estate company and had served almost 3.5 years in the HR Department. During my tenure, I raised a mediclaim for my father, which was successfully processed, amounting to INR 1 Lac in the company's account.

On 15th April 2019, my employer abruptly asked me to resign. At the time of my exit, I was assured by the company that I would receive my mediclaim along with my full and final settlement. However, despite continuous follow-up, I only received my full and final settlement (excluding the mediclaim) in June 2019. When I inquired about the pending mediclaim, the HR informed me that I would receive it shortly. To protect my rights, I mentioned in the F&F Settlement receipt that my mediclaim was still pending.

Now, my employer is refusing to disburse the mediclaim amount and is pressuring me to sign a fresh copy of the F&F Settlement sheet stating that there are no dues pending from the employer's side. I have declined to sign the new copy and have initiated formal email reminders.

I seek advice on how to approach the MD or top-level management to ensure I receive my rightful mediclaim. It is worth noting that the top management and MD are reluctant to pay the insurance amount.

Please advise on the best course of action.

Thank you, Aruna

Hi Aruna, this situation needs to be handled subtly. My point of view is that this amount cannot be demanded as a matter of right like salary. Mediclaim is a voluntary benefit offered by the employer and not a statutory benefit like Gratuity or PF. It is not part of your salary. However, you can request them through email to release the payment. You have not briefed why your employer forced you to submit a resignation. When your exit is not smooth, the probability of your request for the mediclaim amount getting approved is remote.

Hi, Aruna.

If you have contributed to the Mediclaim premium (Employee 50% + company 50% pattern as followed in some companies), then you will have the rights for the claim. Otherwise, there will be no validity.

The facts stated suggest that the action of the employer is unethical; you are entitled to the amount of mediclaim. The company cannot appropriate the same, whatever the context.

If your mediclaim insurance premium is part of your salary or shown in your CTC, you are legally entitled to receive the mediclaim reimbursement amount.

If you have incurred hospitalization expenses for your father's hospitalization and submitted them to the insurance company through your employer for reimbursement, you are eligible for the approved amount.

You may write to the insurance company through which your company policy is operational, stating that the approved mediclaim amount has not been reimbursed to you for your father's hospitalization claim.

You have the full right to register your complaint with the Insurance Regulatory Development Authority (IRDA), providing full details of your case history. You will receive your claim without any delay.

Lastly, if nothing materializes, you can write to the insurance company stating that you are not interested in the reimbursement of your father's hospitalization claim. Therefore, return all your claim papers and let the insurance company retrieve the claim amount from your ex-employer.

Regards, Suresh

Hi,

In my view, you should get the amount from the company, and if required, you must take the legal route. The money is not a claim made by the company but a mediclaim reimbursement of an employee. The company has no authority to appropriate money that does not belong to them. If the company is adamant about not passing on what has been reimbursed to you through them, I strongly urge you to consult a lawyer.

Best wishes

Hi, thank you for sharing the suggestions. I wrote a mail reminder again to the MD, but there has been no response from his side either. Currently, no one from the HR department is taking my calls or even responding to my reminder emails.

I had a conversation with the insurance company, and they mentioned that I need to speak to the employer directly. It is concerning that even though the mediclaim was not part of my salary, the amount does not belong to the company either. Obtaining reimbursement from the insurance company has been a significant struggle, and despite my efforts, my ex-employer seems indifferent to the situation.

I am in desperate need of help. Please suggest what the next course of action should be. Should I consider sending them a legal notice?

Please advise.

Thank you, Aruna

Aruna,

I had suggested writing a letter to the insurance company and the Insurance Regulatory Development Authority (IRDA) instead of talking to the insurance company. They will reply to you officially. Also, make sure to mark a copy to your ex-employer.

Regards,
Sna