HEM RAJ versus NEW INDIA ASSURANCE CO. LTD on 25 July 2023

[2023] 9 S.C.R. 1187 : 2023 INSC 644

HEM RAJ

A

v.

THE NEW INDIA ASSURANCE CO. LTD.

(Civil Appeal No. 4642 of 2023)

B

JULY 25, 2023

[B. V. NAGARATHNA AND UJJAL BHUYAN, JJ.]

Consumer Protection – Appellant-insured is the owner of thevehicle covered by an insurance policy issued by respondent-insurer– Vehicle met with an accident – Medical expenses were borne byCthe appellant in the treatment of the injuries sustained by the injured– Indemnification of – Held: Evidence in the form of Exhibits C-19to C-28 issued by the Hospital were on record, as per which theappellant had incurred expenditure in the medical treatment of theinjured – The insurance company did not dispute these documents,instead, the contention of the insurer before the NCDRC was thatDthere is no evidence on record to show that the payment was made –The stand of the insurer in this case is not fair and just – Appellantwas not only deprived of the amount spent by him towards medicalexpenses owing to the injuries sustained by the injured in theaccident in respect of which there is a third-party insuranceEcoverage, but has also been constrained to approach this Court –The portion of the order of the NCDRC disallowing indemnificationof the amount spent towards medical expenses by the appellant, setaside – Respondent to pay Rs.4,09,000/- in terms of the Exhibitswith interest at the rate of 7% p.a from the date of filing of thecomplaint before the District Forum till its realization – Cost ofFRs.30,000/- be paid to the appellant – Insurance.

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CIVIL APPELLATE JURISDICTION : Civil Appeal No.4642of 2023.

From the Judgment and Order dated 25.07.2019 of the NationalConsumer Disputes Redressal Commission, New Delhi in RP No.2363of 2017.

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Ritesh Khatri, Adv. for the Appellant.

Rameshwar Prasad Goyal, J. P. N. Shahi, Advs. for theRespondent.

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AThe Judgment of the Court was delivered by NAGARATHNA, J.

Leave granted.

2. This appeal has been filed by the insured seeking indemnificationBof the total amount of INR 10,36,500/- from the respondent-insurancecompany, being aggrieved by the Order passed by the National ConsumerDisputes Redressal Commission (‘NCDRC’ for short).

3. Briefly stated the facts are that the appellant is the owner of aMahindra Pick-up Vehicle bearing registration no. PB-19H-2461 whichCis used by him for his personal use. That the appellant had purchased aninsurance policy No.36060231130100003910 by paying the premium onthe policy to the respondent-insurer covering the territory of India initiallyand later Nepal also. The period of the policy was from 21.03.2014 to20.03.2015. On 11.09.2014, the vehicle was driven by Amritpal alongwithother people who visited Nepal to attend a satsang. Just prior to entryDinto Nepal i.e., before crossing the border, the appellant had got extendedthe insurance policy in the territory of Nepal. On 11.09.2014 at 10.00am, at Gorhi Chowk, Ward No.4, Gram Vikas Samiti, District BardiaBelva (Nepal), the vehicle met with an accident. FIR No. 21 dated14.09.2014 was duly registered in this regard. In this accident, Smt.ESantliya Tharu, wife of Ram Parshad Tharu, resident of Ward no.7,Gram Vikas Samiti, District Banke Titeeherea (Nepal) died and RamParshad Tharu was injured. He was referred to Charak Hospital andResearch Centre, Lucknow (India) for medical treatment. According tothe appellant, the medical expenses of Rs.4,09,000/- (Nepalese Rupee)were borne by him. This fact is admitted in the document dated 01.11.2014Fexecuted in the office of District Incharge, Crime Investigation Branch,Home Ministry, Government of Nepal, duly signed by Jeet Bahadur Tharu,son of Ram Parshad Tharu.

4. According to the appellant, a sum of Rs.5,00,000/- (NepaleseRupee) was paid by him owing to the death of Smt. Santliya TharuGthrough Rajinder Kumar, representative of the appellant and Rs.24,000/- (Nepalese Rupee) was received by Bhagat Bahadur Tharu towardsthe fare of vehicles used for transporting the dead body and other funeralrituals of Smt. Santliya Tharu. According to the appellant, a sum ofRs.5,24,000/- (Nepalese Rupee) (INR 3,27,500/-) was paid to JeetBahadur Tharu, the only son of Ram Parshad Tharu and Smt. SantliyaH

Tharu and Bhagat Bahadur Tharu on a claim for death as well as vehiclecharges and expenses for funeral rituals of Smt. Santliya Tharu. Medicalexpenses totalling to Rs. 6,54,000/- (Nepalese Rupee), equal toRs 4,09,000/- (Indian Rupee) were also incurred for the treatment of theinjured Ram Prashad Tharu. Moreover, on 01.11.2014, there was aconsensus arrived at between the parties and an amount of Rs.4,80,000/- (Nepalese Rupee) being Rs.3,00,000/- (Indian Rupee) was paid by theappellant through his representative Sukhdeep Singh to Jeet BahadurTharu as full and final settlement of all claims. Thus, according to theappellant, Rs.16,58,400/- (Nepalese Rupee) equal to Rs.10,36,500/-(Indian Rupee) was expended with compensation on account of thedeath of Smt. Santliya Tharu being Rs.5,24,000/- (Nepalese Rupee) equalto Rs.3,27,500/- (Indian Rupee) + hospital expenses towards the treatmentof Ram Prashad Tharu being Rs 6,54,000/- (Nepalese Rupee), equal toRs.4,09,000/- (Indian Rupee) + the full and final settlement amount beingRs.4,80,000/- (Nepalese Rupee) equal to Rs. 3,00,000/- (Indian Rupee).

5. The components of the claim, excluding interest and costs, madeby the Appellant before the District Forum can be summarised in thetabular form, as under:

6. The appellant, thereafter, submitted the original documents tothe respondent-insurer seeking indemnity/reimbursement but therespondent-insurer refused to pay the said amount. Contending that therehad been deficiency in service by the respondent-insurance company,the appellant filed a complaint before the District Consumer DisputesRedressal Forum, Tehsil Complex, Mansa (“District Forum”) seekingreimbursement of Rs.10,36,500/- (INR) along with interest @ 18 % perannum as compensation, Rs.50,000/- for mental agony and Rs.20,000/-as litigation expenses.

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A7. On receipt of notice from the District Forum, the respondentsherein appeared and filed their version and sought for certain documentswhile admitting that the appellant is the owner of the vehicle which wascovered by an insurance policy issued by them but denying the otherdetails of payments made by the appellant herein. Both the parties let intheir evidence in the matter as well as filed their written arguments.B

On consideration of the same, the District Forum held in favourof the appellant herein, directed the respondent herein to settle the claimas per the terms and conditions incorporated in the insurance policy andto release only the payments which are legally found payable to theappellant in terms of the insurance policy. Further, cost and compensationCof Rs.10,000/- was awarded to the appellant herein.

8. Being aggrieved by the Order of District Forum, the respondent-insurer preferred First Appeal No. 839 of 2016 before the State ConsumerDisputes Redressal Commission, Punjab Sector 37-A, Dakshin Marg,Chandigarh (“State Commission”). The State Commission did not findDany merit in the appeal and dismissed the same. The State Commissionobserved that the respondent-insurance company had deposited an amountof Rs.25,000/- before the State Commission at the time of filing theappeal and had further deposited a sum of Rs.5,75,000/- in compliancewith an Order of the Commission and directed that the same shall beEreleased to the appellant herein within a period of forty-five days of thesaid judgment.

9. Being aggrieved by the Order of the State Commission, therespondent-insurer preferred Revision Petition No.2363 of 2017 beforethe NCDRC. The NCDRC held that a sum of Rs.3,27,500/- was paidFby the appellant to the son of the deceased Smt. Santliya Tharu. That asum of Rs.6,27,500/- apart from Rs.10,000/- towards cost, is payable tothe appellant herein. Accordingly, the Revision Petition was disposed of.As against the said Order, there is no appeal filed by the insurancecompany. However, the insured-appellant herein has sought for thepayment of Rs.6,54,000/- (Nepalese Rupee) towards the medicalGexpenses for the treatment of Ram Prashad Tharu. The NCDRC hasobserved that there is no evidence on record to show that the saidpayment was made by the appellant herein. In this regard, an applicationhas been filed by the appellant herein seeking to bring on record threedocuments being medical bill receipt dated 16.09.2014, 17.09.2014 andHdetailed inventory i.e., statement of expenditure provided by the hospital from 27.09.2014 to 01.11.2014 as Annexure P-9, in order to establishthat a sum of Rs.4,39,318.99/- was paid by the appellant herein to CharakHospital and Research Centre, Lucknow towards the treatment of RamPrashad Tharu who had sustained injuries in the accident.

10. We have heard learned counsel for the appellant and learnedcounsel for the respondent-insurer and perused the material on record.

11. The main grievance of the appellant pertains to thereimbursement of the medical expenses incurred by him towards themedical treatment of Ram Prashad Tharu at Charak Hospital andResearch Centre, Lucknow. In that regard, appellant’s counsel drewour attention to the Orders passed by the District Forum, State Forum aswell as the NCDRC and contended that the evidence regarding thereimbursement of medical expenses was on record in the form of Exhibits- C19 to C28 which are medical bills on account of the medical treatmentgiven to Ram Prashad Tharu. The District Forum categorically directedthat the opposite party i.e., respondent-insurer herein had to settle theclaim as per the terms and conditions incorporated in the insurance policyand to release the payment which was legally payable to the appellantherein and to indemnify as per the insurance policy. However, the insurerhas failed to do so. In fact, the observations of the State Forum are to asimilar effect i.e. to release the amount found admissible, to the extentof the insured’s entitlement after the expiry of forty five days.

12. However, the learned counsel for the insurer submitted beforethe NCDRC that there was “no evidence on record” to show that thepayment was made. Therefore, on the said submission, the amount ofRs.6,54,000/- (Nepalese Rupee) towards medical bills has not beenordered to be disbursed to the appellant, hence, the appellant has filedthis appeal by way of special leave petition.

13. In this regard, our attention was also drawn to the copies ofthe said Exhibits by way of filing an application for filing additionaldocuments. Learned counsel for the respondent-insurer did not disputethe fact that the evidence in the form of Exhibits C-19 to C-28 were onrecord. We have perused the said Exhibits (Annexure P9 to P28) whichhave been issued by Charak Hospital and Research Centre, as per whichappellant had incurred expenditure of Rs.6,54,000/- (Nepalese Rupee)equivalent to Rs.4,09,000/- (Indian Rupee) in the medical treatment ofRam Prashad Tharu. Learned counsel for the insurance company has AB

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Anot disputed these documents, instead, the contention of the insurer beforethe NCDRC was that “there is no evidence on record” to show that thepayment was made. This is not a correct submission or statement madeon behalf of the insurer.

14. NCDRC has also noted that since the appellant herein did notBassail the Order of the District Forum regarding disallowing of the saidamount, the same had been disallowed. We do not think that is a correctreading of the Order of the District Forum inasmuch as the DistrictForum had specifically referred to medical bills at Exhibits C-19 to C-28and had directed the insurance company to release the amount foundadmissible to the complainant-appellant. The appellant herein wasCnaturally under the impression that the amounts covered under the medicalbills would also be payable. Even, the State Commission had stated tothe same effect that the claims as per the terms and conditionsincorporated in the insurance policy had to be released if found admissibleand to the extent of entitlement of the insured.D

However, the NCDRC, on the basis of the submission of thelearned counsel for the insurer, disallowed the disbursement of the medicalbills on the premise that there was no evidence on record and that theappellant herein had not contested the Order of the District Forum beforethe State Commission. As a consequence, the appellant had to approachEthis Court for seeking reimbursement of the medical bills paid by theappellant for the treatment of Ram Prasad Tharu.

15. We observe that the submissions made on behalf of theinsurance company before the NCDRC are contrary to the evidence onrecord as a result of which the appellant herein has been not only deprivedFof the aforesaid amount spent by him towards medical expenses owingto the injuries sustained by the injured Ram Parshad Tharu in the accidentin respect of which there is a third-party insurance coverage, but alsohas been constrained to approach this Court. We find that the stand ofthe insurer in this case is not fair and just.

G16. In view of the aforesaid discussion, we allow this appeal andset aside that portion of the Order of the NCDRC disallowingindemnification of the amount spent towards medical expenses by theappellant-insured. We direct the respondent-insurance company to paythe amount, Rs.4,09,000/- (Indian Rupee) in terms of Exhibits P-9 to P-28 with interest at the rate of 7% per annum from the date of filing ofH

HEM RAJ v. THE NEW INDIA ASSURANCE CO. LTD.[B. V. NAGARATHNA J.]

the complaint before the District Forum till its realisation. We also imposea nominal cost of Rs.30,000/- payable to the appellant herein. Theaforesaid amounts shall be disbursed to the appellant within a period ofone month from today.

Divya Pandey(Assisted by : Roopanshi Virang, LCRA)

Appeal allowed.

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