yogapaartiban (CONSULTANT) 03 September 2015

Mediclaim - hr negligence - tort

PLEASE PROVIDE POSSIBLE STEPS THAT COULD BE FOLLOWED ON THE BELOW ISSUE:- My client, Mr.X was working in IT Company (Y) met with an accident on Dec1st 2013. Since then, Mr.X was on Loss of Pay till March 29th 2015. Mr.X have resigned his job on March 29th 2015 as Company(Y) couldn't extend his leave period. Before he had sent his resignation letter, he requested to get his corporate Health Insurance Policy to be converted to individual one( retail policy) so that he could continue the same post separation from company(Y) and his HR had assured of it. He received the resignation acceptance letter on April 1st 2015 with some attachments in which he found that the corporate insurance would be terminated on the last working day of the employee. He had been following up with his HR on this since then and HR was positive on this. He tried contacting with the insurer, New India Assurance company and all of a sudden he got to know that this would be possible only if it was done before processing his resignation. Also, a couple of members from NIA told him that there would be a grace period of 30 days in which a lapsed policy could be revived. He sent a mail to corporate team of his company on April 20th but they had responded lately i.e., on May 8th by which nothing could be done to continue the policy. Actually the thing is his HR doesn't know the terms of the insurance and HR had processed the resignation before processing the insurance continuation request. And the team, had not responded to his request in the grace period of his policy. So in either way, the mistake is with the company(Y). Now Mr.X have to bear the medical expenses for his condition till 4 years as no new personal policy would cover the preexisting condition. There is no way that he could get the Health insurance policy now. He was expecting to file a case against company(Y) for its tort of negligence and claim a compensation for this. I checked with this person and he has all emails from company(Y), emails of formal conversation with HR, letters from Company(Y) like resignation letter, pf etc, even voice conversations with HR. My suggestion would be to send notice to Company(Y) stating to solve issue through out of court settlement by the employee board in specific time duration, failing which the issue could be taken to court. I still didn’t make any progress in this case. The company involved in the above issue is one of the leading IT giants like Infosys/IBM. All that my client need now as you may understand is the compensation for the loss incurred to him by the corporate negligence. Also the person is in need of an early remedy. I need to take a decision based on your suggestions in this case. Therefore I welcome your suggestions greatly. THANKS IN ADVANCE

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2 Replies

Kumar Doab (FIN) 12 September 2015

Has the company shown the premia for Insurance Provided by Employer in Gross Salary/CTC?

Has the company adjusted the premia for entire period including during LOP in FnF statement?

Does he have a copy of Master Policy issued by NIA?

Has the NIA comments of NIA been in writing or minuted by him to HR/employer? Would NIA confirm the comments in writing or even thru RTI?

Is there any evidence of 'Leave can not be extended any more' and resignation was demanded? OR resignation was extarcted under coercion,influence, by force, intimidation? In such case it is unfiar and illegal and offence. It can be termed deemed termination. Forced Resignation/termiantion during sickness is a bad order.

Relate everything and check if he has the staus of consumer with compnay since premia is adjusted from his monthly/annual pay package? If yes DCDRF can be one of the options.

Here other options are:

---if the employee is covered by the def. of 'Employee' as in (Name of the state) Shops and Commercial Establishments Act, that was enacted to govern the service conditions of 'Employees' working in such establishments. This act of many states does not discriminate between ‘Workman’ and ‘Non Workman’......................and provides for insurance to employees, also. Inspector appointed under : (Name of the state) Shops and Commercial Establishments Act, can be approached.

---if the employee is covered by the def. of 'Workman' as in ID Act he can approach IT/ITeS Employees/Trade Unions and also highest officials of Dept. of Labor,o/o Labor commissioner...................

yogapaartiban (CONSULTANT) 18 September 2015

Thanks a lot. Sorry for my delayed reply. For more clear reference I checked conversation emails between employee - Insurance, which made clear he is not entitled to continue the same medical insurance after termination of service from Corporate, with medication in continuiation. Since policy convertion made possible only if person on relieving deemed healthy. Your information is more helpful. Thanks again.