Wrongfully claiming mediclaim

honest jai12 (Querist) 21 December 2013 This query is : Resolved
Hi,
I work for a private company which provides group mediclaim through a third party administrator(TPA). I claimed small mediclaim amounts for my divorced wife after divorce. This cashless claim also got passed since her name was not removed from the group mediclaim policy. This happened a year back. I was also married second time at that point in time. Second wifes name was not included in the group mediclaim.

Now I wish to payoff the claimed amount to the insurance company or third party adminsitrator(TPA) in order to have a clean slate. The TPA, insrance company or the company for which I work has not identified or approached me with this error.

Could you please guide me on how this can be done? What could be the penalty?

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Devajyoti Barman (Expert) 22 December 2013
You better just replace the name of your new wife with your ex.

honest jai12 (Querist) 22 December 2013
I an ready to pay back the amount claimed. I dont want problems if my company or insurance company comes to know about it?
Will the insurance company or TPA take legal action even if I am ready to pay back the amount? or they will accept the wrongfully claimed amount and close the matter.

Devajyoti Barman (Expert) 22 December 2013
No, they are unlikely to intiate any legal action for this petty issue.

T. Kalaiselvan, Advocate (Expert) 22 December 2013
As suggested, just go for the change in the spouse name. If a detailed letter explaining the circumstance under which you wrongly claimed insurance amount on the name of your wife and that you apologize yourself for the wrong claim and that you are returning the wrongly claimed amount will be a self explanation of your deed which may be pardoned and the money returned may be accepted by the insurance company as a gesture of acknowledgment, so do what ever you feel right.

honest jai12 (Querist) 22 December 2013
Thanks for the reply. I can return the claimed amount.
However, the company involved is a government run mediclaim company. Hence my concern is without understanding the practical angle, the insurance company may follow the process of taking legal action. Is this concern correct? Will a government run company pardon without initiating legal action ? What has been the experience of other policy holders who may have wrongfully made claim.

T. Kalaiselvan, Advocate (Expert) 22 December 2013
A government run company is also doing a business in this field so they may accept your magnanimity and may not go ahead with any other adverse action against you, as advised enclose a detailed explanation explaining the circumstance under which the claim was made erroneously by oversight.