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kumar rahul   26 September 2016

Mediclaim rejected, hr fault

I joined the x company on 12th April 2016. My family was covered under  corporate mediclaim provided by medi assist india. on 8th May 2016  my son was hospitlised for 9 days. I paid all the bills and  submitted all the documents for mediclaim.

My claim was rejected  as company did not applied for my medical insurence  on joining.

Following message received from insurer-- 

"Please find the below claim is  Out Of Scope,

Beneficiary cover from : 20 june 16, Date of Admission: 08 may 2016."

My contract and  company HR manual clearly states that  my family is covered under mediclaim from date of joining.

Both my employer and  insurance company not ready to entertain any request.

Please advise  how can i proceed further  to claim the amount.





 9 Replies

adv.bharat @ PUNE (Lawyer)     26 September 2016

Rahulji u need to give legal notice to boty party for not giving you your claim despite of legal status.

If u like my suggestion then give THANK on my profile.

Rama chary Rachakonda (Secunderabad/Highcourt practice watsapp no.9989324294 )     26 September 2016

Get the response from your management for your mediclaim rejection & file a case in consumer forum for mediclaim
1 Like

Amit Mahajan (RH-Legal)     26 September 2016

Dear Rahul,

Since you are currently associated with the employer, thus right way would be that you should take up the matter through your seniors and get the HR personal answerable, you would be able to drive out compensation from your employer. By providing him Legal Notice, you may suffer resistence in job. You have to find out the correct reason for such error. 


Amit Mahajan


1 Like

Nitish Banka (lawyer)     26 September 2016

file a case in labour court against the employer by issuing a legal notice.

Warm Regards,

Adv. Nitish Banka


1 Like

Kumar Doab (FIN)     26 September 2016

Don't remain entangled with HR.

Escalate to good offices of appointing authority,MD under proper acknowledgment.

Has the company included premia in CTC?

Are you entitled to be covered by ESIC?

You seem to have a good case.

1 Like



Confrontation with the management at the very begining of career is not advisable for your future growth with them. So think twice on legal remedies. Take up the case with the Grievance mechanism if existing or approach through union if any and ensure amicable resolution.

Kumar Doab (FIN)     27 September 2016

If it is error by HR then it will fall back on HR.

Since HR executes inner wills/wishes of employer so employer may also give some room to HR.

Recourse that you want is not in interest of HR hence they are all trying to subdue you.


Procceed methodically: Write, of course, under proper acknowledgment, to HR, then escalate to god offices.

Of course you can proceed thru; Unions, Greivance redressal Commitee,Works Commitee, your own counsel specializing in Labor/service matters.

Ms.Usha Kapoor (CEO)     30 September 2016

Carry you r Grievance with the top brass an dsee that it isi settled amicably. Approach employee grievance cell. Also mobilise trade unionmembers to support your claim.Whether CTC includes mediclaim premia also? Get acknowledgment from  Top Brass , Union members etc. If you appreciate ths reply please click the thank you button on this forum.

Rama chary Rachakonda (Secunderabad/Highcourt practice watsapp no.9989324294 )     17 October 2016

The claim is payable, when treatment is from a registered hospital or nursing home. However, in case of non registered hospital or nursing home the treatment can be covered under the policy subject to hospital/nursing home conforming to the following guidelines:

  • The hospital/nursing home should have 15 in-patient beds
  • It should have qualified nursing staff round the clock
  • Qualified doctors round the clock
  • Fully equipped operation theatre

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