Group Health Insurance Claim Question : Business Standard India

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Question:

I was deputed to a joint venture (JV) by my parent company. It was the practice at the parent company that medical expenses of employees were directly reimbursed by the employer. But in the JV company, they took a group mediclaim policy instead of reimbursement of medical expenses. After the completion of my stint with the JV, the parent company called me back. I am still in service. I had to undergo treatment immediately after I left the JV company. Since the group insurance policy was in force, I utilised it and the insurance company settled the claim, too, after due verification.

The insurer sent the cheque to the JV company for onward payment to me. On receiving it, the JV company sent me a letter, questioning my right to group mediclaim when I am not in service with them. I replied that I am still in the service of the company, the JV is still in force and if it intended to not continue the facility for me, why had it not deleted my name?

Meanwhile, the JV tried to return the cheque to the insurance company, which says it is a valid claim, duly discharged. To make any claims from the parent company, I would need original bills, which are with the insurer. What is the way out for me?

Answer:

Under a group insurance policy, a claim can be rejected only if there is a clause that the employee has to be in service for lodging a claim. In most policies, the claim gets paid even if the person is no longer working with the company. Hence, the option now available is to request the JV company to pay the proceeds of the claim to you for the expenses incurred by you. Or, you can request it to return the claim cheque to the insurer and then they should obtain the original bills and receipts from the insurer to enable you to claim from your parent company.

Source: http://www.business-standard.com/india/news/insurance-kamesh-goyal/376133/

 

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