Dear All,
This is regarding a case at our site as one of our employees had gone through an operation, and he is not on the payroll of the company. At the time of his operation, he was told that his employer would reimburse all amounts as he was covered under mediclaim. However, his hospital was not on the panel list, so he paid all from his pocket. Now, after two months, he has come to know that all his bills are still lying at his employer's site.
In his conversation with his employer, they keep telling him that his bills are in the process. Now, he is considering taking legal action against his employer as he is a good friend of mine. Therefore, I request all of you to please provide your valuable suggestions on what he can do in this case.
Awaiting your reply.
From India, Ludhiana
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4This is regarding a case at our site as one of our employees had gone through an operation, and he is not on the payroll of the company. At the time of his operation, he was told that his employer would reimburse all amounts as he was covered under mediclaim. However, his hospital was not on the panel list, so he paid all from his pocket. Now, after two months, he has come to know that all his bills are still lying at his employer's site.
In his conversation with his employer, they keep telling him that his bills are in the process. Now, he is considering taking legal action against his employer as he is a good friend of mine. Therefore, I request all of you to please provide your valuable suggestions on what he can do in this case.
Awaiting your reply.
From India, Ludhiana
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Hi Shivraj,
First of all, let us know whether the mediclaim covers the particular operation that was done to your friend or not (either the operation comes under the coverage of the mediclaim policy or it is not covered). You have two options:
1) If the operation is not covered under the mediclaim policy, then even if your friend opts for legal proceedings, it will be useless. (Because the mediclaim policy itself has predefined standards about the inclusions & exclusions of coverage).
2) If the operation is covered, even though the name of the hospital is not mentioned in the panel list, it is the insurance company's responsibility to reimburse the cash subject to the coverage amount. If the insurance company is least bothered in this regard, you can suggest to your friend to pursue legal proceedings.
Correct me if I'm wrong.
From India, Hyderabad
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First of all, let us know whether the mediclaim covers the particular operation that was done to your friend or not (either the operation comes under the coverage of the mediclaim policy or it is not covered). You have two options:
1) If the operation is not covered under the mediclaim policy, then even if your friend opts for legal proceedings, it will be useless. (Because the mediclaim policy itself has predefined standards about the inclusions & exclusions of coverage).
2) If the operation is covered, even though the name of the hospital is not mentioned in the panel list, it is the insurance company's responsibility to reimburse the cash subject to the coverage amount. If the insurance company is least bothered in this regard, you can suggest to your friend to pursue legal proceedings.
Correct me if I'm wrong.
From India, Hyderabad
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Hi Shivu,
Why does your friend want to go the legal way? Why not follow up with the company for payment of his bills? Going legal can be considered, but what is the evidence that the bills are still in the office and have not yet been sent to the insurance people? The company can deny having anything or destroy them; that can happen. Also, in order to recover the amount, you will lose much more money if you choose the legal way. Wait for some more time, follow up with them aggressively, and I'm sure you can get things done politely rather than filing a lawsuit.
Regards,
Archna
From India, Delhi
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Why does your friend want to go the legal way? Why not follow up with the company for payment of his bills? Going legal can be considered, but what is the evidence that the bills are still in the office and have not yet been sent to the insurance people? The company can deny having anything or destroy them; that can happen. Also, in order to recover the amount, you will lose much more money if you choose the legal way. Wait for some more time, follow up with them aggressively, and I'm sure you can get things done politely rather than filing a lawsuit.
Regards,
Archna
From India, Delhi
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First thing is on what basis he wants to go legal. It is a clear case of a snail's pace of administrative process. He needs to find out the reasons for the delay, whether it is from administration, accounts, or policy matters. Based on that, he needs to send a communication to the respective departments regarding his claim. If there is any provision to escalate the matter to the Managing Director, that holds good.
This issue is a total internal matter. As you mentioned that he is not on the payroll, then how is payment being done? Under whom is he working? How is attendance recorded? Please ensure that any employee working for you should either be on your payroll or contractor rolls, so there will not be many legal complications.
Regarding the operation, if the injury occurred while at work, then it is management's responsibility to take care of his total medical expenses, whether he is a contract/casual/regular employee, unless he is not covered under ESIC or workmen's compensation policy.
Regards,
G.B. Mahendra Kumar
Fortune Hub - One Stop Solution for the Total HR Domain
From India, Bangalore
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This issue is a total internal matter. As you mentioned that he is not on the payroll, then how is payment being done? Under whom is he working? How is attendance recorded? Please ensure that any employee working for you should either be on your payroll or contractor rolls, so there will not be many legal complications.
Regarding the operation, if the injury occurred while at work, then it is management's responsibility to take care of his total medical expenses, whether he is a contract/casual/regular employee, unless he is not covered under ESIC or workmen's compensation policy.
Regards,
G.B. Mahendra Kumar
Fortune Hub - One Stop Solution for the Total HR Domain
From India, Bangalore
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Hi Friends, One quick question, can the mediclaim be processed even if the employee is not on the pay roll? Regards CS Mukesh Tank
From India, Mumbai
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From India, Mumbai
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Hy, the condition / situation which you have mentioned above discussion it clearly state that he can use legal option by way of Vicarious Liability under the Law of Tort.
From India, Pune
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From India, Pune
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Dear All Thanks for your help. As per my concern i am agree with Archana, my friend should go and talk to seniors and escalate the matter. Once again thanks to all for your contribution.
From India, Ludhiana
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From India, Ludhiana
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Dear All,
Before actually considering legal actions, please read the first statement:
"This is regarding a case at our site as one of our employees had gone through an operation and he is not on the payroll of the company."
First of all, we need to be clear when a person is not on the payroll - is he a direct employee, an employee on voucher payment, or an employee from the contractor side? Secondly, are the mediclaim/ESI benefits extended to the employee? If the employer has extended one of the benefits, the employer can be questioned for reimbursement of expenses. If the employee is not given any benefits and if it is only out of Employee Relations that the employer has agreed to reimbursement, we need to sort it out with the employer.
I think we need to work on the above two cases and see what best can be done.
Regards,
Kumar
From India, Hyderabad
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Before actually considering legal actions, please read the first statement:
"This is regarding a case at our site as one of our employees had gone through an operation and he is not on the payroll of the company."
First of all, we need to be clear when a person is not on the payroll - is he a direct employee, an employee on voucher payment, or an employee from the contractor side? Secondly, are the mediclaim/ESI benefits extended to the employee? If the employer has extended one of the benefits, the employer can be questioned for reimbursement of expenses. If the employee is not given any benefits and if it is only out of Employee Relations that the employer has agreed to reimbursement, we need to sort it out with the employer.
I think we need to work on the above two cases and see what best can be done.
Regards,
Kumar
From India, Hyderabad
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