Dear All,
This is regarding a case at our site as one of our employee had gone through an operation and he is not on the payroll of the company.
As the time of his operation he was told that his employer will reimburese all amount as he was covered under mediclaim but his hospital was not in panel list and he piad all fom his pocket but after two months now he comes to know that his all bills are lying at his employer site.
But his converstion with his employer they all were telling him that his bills are in to process.
Now he is thinking to take an legal action against his employer.
As he is a good friend of mine.
So you all are requested to pls give your valuable suggetios.
what he can do in this case.
Awaiting for your relpy.
From India, Ludhiana
4This is regarding a case at our site as one of our employee had gone through an operation and he is not on the payroll of the company.
As the time of his operation he was told that his employer will reimburese all amount as he was covered under mediclaim but his hospital was not in panel list and he piad all fom his pocket but after two months now he comes to know that his all bills are lying at his employer site.
But his converstion with his employer they all were telling him that his bills are in to process.
Now he is thinking to take an legal action against his employer.
As he is a good friend of mine.
So you all are requested to pls give your valuable suggetios.
what he can do in this case.
Awaiting for your relpy.
From India, Ludhiana
Hi Shivraj,
First of all let we know whether the mediclaim covers the particular operation that was done to your friend or not ( either the operation comes under coverage of mediclaim policy or it is not covered ). You have to options:
1) If the operation is not covered under mediclaim policy then even if your friend opts legal proceding it will be useless. (Because the mediclaim policy itself have the predefined standards about the inclusions & exclusion of coverage)
2) If the operation is covered, even though the name of hospital is not mention in panel list its the Insurance company responsibility to re-imburse the cash subjected to amount coverage. If the insurance company is least bothered in this regard you can suggest your friend for legal proceedings.
Correct me if i'm wrong
From India, Hyderabad
First of all let we know whether the mediclaim covers the particular operation that was done to your friend or not ( either the operation comes under coverage of mediclaim policy or it is not covered ). You have to options:
1) If the operation is not covered under mediclaim policy then even if your friend opts legal proceding it will be useless. (Because the mediclaim policy itself have the predefined standards about the inclusions & exclusion of coverage)
2) If the operation is covered, even though the name of hospital is not mention in panel list its the Insurance company responsibility to re-imburse the cash subjected to amount coverage. If the insurance company is least bothered in this regard you can suggest your friend for legal proceedings.
Correct me if i'm wrong
From India, Hyderabad
Hi Shivu,
WHy does your friend want to go 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 not yet sent to the insurance people. The company can deny having anything or destroy them, that can happen.
Also in order to take back the amount you will loose 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 the things done politely rather than filing a suit.
Regards,
Archna
From India, Delhi
WHy does your friend want to go 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 not yet sent to the insurance people. The company can deny having anything or destroy them, that can happen.
Also in order to take back the amount you will loose 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 the things done politely rather than filing a suit.
Regards,
Archna
From India, Delhi
First thing is on what basis he want to go legal. it is a clear case of a snail pace of admin process. he need to find out the reasons for the delay, whether it is from admin,accounts or policy matter. based on that, he need to send a communication to the respective departments regarding his claim and if there is any provision to escalate the matter to MD, that holds good.
This issue is a total internal matter and as you mentioned that he is not in payroll, then how is payment is been done and under whom he is working , how is attendance is recorded and please make sure that,any employee works for you either he should be in your rolls or contractor rolls, so there will not be much legal complication.
Regarding the operation, if the injury is caused while at work, then it is management 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 compensation policy.
Regards,
G.B. Mahendra Kumar
Fortune Hub - One Stop Solution for Total HR Domain
From India, Bangalore
This issue is a total internal matter and as you mentioned that he is not in payroll, then how is payment is been done and under whom he is working , how is attendance is recorded and please make sure that,any employee works for you either he should be in your rolls or contractor rolls, so there will not be much legal complication.
Regarding the operation, if the injury is caused while at work, then it is management 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 compensation policy.
Regards,
G.B. Mahendra Kumar
Fortune Hub - One Stop Solution for Total HR Domain
From India, Bangalore
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
From India, Mumbai
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
From India, Pune
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
From India, Ludhiana
Dear All
Before actually thinking on the legal actions, Please read the first statement
"This is regarding a case at our site as one of our employee 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 payroll - is he a direct employee or an employee on voucher payment or employee from contractor side
Secondly, are the mediclaim / ESI benefits are 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 benefit and if it is only out of the Employee Relations that the employer has agreed for reimbursement, we need to sort it out with the employer.
Think we need to work on the above two cases and see what best can be done
Regards
Kumar
From India, Hyderabad
Before actually thinking on the legal actions, Please read the first statement
"This is regarding a case at our site as one of our employee 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 payroll - is he a direct employee or an employee on voucher payment or employee from contractor side
Secondly, are the mediclaim / ESI benefits are 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 benefit and if it is only out of the Employee Relations that the employer has agreed for reimbursement, we need to sort it out with the employer.
Think we need to work on the above two cases and see what best can be done
Regards
Kumar
From India, Hyderabad
Community Support and Knowledge-base on business, career and organisational prospects and issues - Register and Log In to CiteHR and post your query, download formats and be part of a fostered community of professionals.