Hello,
One of my friends was working with an organization as a junior officer. Her organization had taken out a mediclaim policy for all employees, including a premium for loading delivery cases. When my friend was hospitalized, she informed her employer over the phone. After being discharged and returning home post-delivery, the HR personnel of her organization asked her to submit all medical bills within 7 days from the date of discharge, which my friend complied with. Later on, the HR personnel realized that they had not provided the 'FORM' required for the claim submission. They then sent the FORM, which my friend received after the seven-day deadline had passed. Despite being confined to bed, my friend somehow managed to complete the formalities, including obtaining the doctor's signature, and sent the documents through a courier to her organization. The HR personnel then submitted all the papers to the insurance company. However, the insurance company is now stating that the reimbursement of medical bills will be rejected due to the delayed submission. My friend's argument is that since all medical bills (excluding the FORM) were submitted on time, the HR should have forwarded them to the insurance company promptly to avoid any delays. It was the fault of the HR personnel for not sending the FORM on time. As her medical bills have not been approved by the insurance company yet, my friend is questioning if she can take legal action against her organization in light of the situation. If so, where should she approach? Would the Consumer Court deal with such matters? I would appreciate urgent advice on this matter.
Regards.
From India, Mumbai
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15One of my friends was working with an organization as a junior officer. Her organization had taken out a mediclaim policy for all employees, including a premium for loading delivery cases. When my friend was hospitalized, she informed her employer over the phone. After being discharged and returning home post-delivery, the HR personnel of her organization asked her to submit all medical bills within 7 days from the date of discharge, which my friend complied with. Later on, the HR personnel realized that they had not provided the 'FORM' required for the claim submission. They then sent the FORM, which my friend received after the seven-day deadline had passed. Despite being confined to bed, my friend somehow managed to complete the formalities, including obtaining the doctor's signature, and sent the documents through a courier to her organization. The HR personnel then submitted all the papers to the insurance company. However, the insurance company is now stating that the reimbursement of medical bills will be rejected due to the delayed submission. My friend's argument is that since all medical bills (excluding the FORM) were submitted on time, the HR should have forwarded them to the insurance company promptly to avoid any delays. It was the fault of the HR personnel for not sending the FORM on time. As her medical bills have not been approved by the insurance company yet, my friend is questioning if she can take legal action against her organization in light of the situation. If so, where should she approach? Would the Consumer Court deal with such matters? I would appreciate urgent advice on this matter.
Regards.
From India, Mumbai
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Employee Responsibility in Mediclaim Policy
My friend's company advised in writing that it was the responsibility of an employee to directly deal with the insurance company in this case. The company is not responsible.
My query is that when an employee joins any organization, they are bound to take the mediclaim approved by the organization. When an employee leaves the organization, the mediclaim policy automatically lapses. So, how is an employee responsible for directly dealing with the insurance company when the company was making payments of the premium to the insurance company?
Kindly guide me in the matter as I am thinking of advising my friend to file a court case against the company.
From India, Mumbai
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My friend's company advised in writing that it was the responsibility of an employee to directly deal with the insurance company in this case. The company is not responsible.
My query is that when an employee joins any organization, they are bound to take the mediclaim approved by the organization. When an employee leaves the organization, the mediclaim policy automatically lapses. So, how is an employee responsible for directly dealing with the insurance company when the company was making payments of the premium to the insurance company?
Kindly guide me in the matter as I am thinking of advising my friend to file a court case against the company.
From India, Mumbai
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