Cholamandalam Ms. General Insurance Co. Ltd. v. A. Saravanan
2012-03-16
R.SUBBIAH
body2012
DigiLaw.ai
JUDGMENT : R. Subbiah, J. Challenging the award dated 8.9.2010 passed by the Motor Accidents Claims Tribunal (Chief Judicial Magistrate Court), Karur, in M.C. O.P. No. 52 of 2009, Cholamandalam MS General Insurance Co. Ltd. has filed the present appeal. At the outset, the learned counsel for the appellant insurance company fairly submitted that the present appeal is filed questioning a sum of Rs. 2,88,100 awarded by the Tribunal towards the medical expenses incurred by the injured. 2. According to the respondent No. 1-claimant, he made a claim for a sum of Rs. 7,00,000 as compensation for the injuries sustained by him in the accident that had occurred on 29.11.2008 involving the vehicle insured with the appellant insurance company. The Tribunal, after analysing the entire evidence, has passed an award for a sum of Rs. 3,83,100 consisting of the sum of Rs. 2,88,100 towards the medical expenses incurred by the victim. 3. With regard to the medical expenses awarded to the victim, it is the case of the appellant insurance company that a sum of Rs. 2,00,000 has already been reimbursed to the claimant by Star Health Insurance Company under the mediclaim policy and, as such, the claimant is not entitled to claim the same once again from the appellant insurance company. Therefore, respondent No. 1 is not entitled for the amount which was reimbursed by Star Health Insurance Company. The learned counsel further submitted that in the claim petition, the respondent No. 1 had claimed a sum of Rs. 2,50,000 towards medical treatment; and he has also produced documentary evidence before the Tribunal, marked as Exhs. P9 to P13 and P17, to show that he had spent a sum of Rs. 2,88,100 towards medical treatment. But before the Tribunal, the appellant insurance company had taken a stand that the amount of Rs. 2,00,000 spent for medical expenses was reimbursed by Star Health Insurance Company under mediclaim policy and, therefore, he is not entitled for the entire expenses incurred towards medical treatment. But the Tribunal without assigning any valid reason has awarded the entire sum of Rs. 2,88,100 towards medical treatment. Therefore, the said amount awarded under the medical treatment is liable to be deducted from the award amount. In support of his contentions, learned counsel relied on the judgments in Mrs. Helen C. Rebello and Others Vs. Maharashtra State Road Transport Corpn.
2,88,100 towards medical treatment. Therefore, the said amount awarded under the medical treatment is liable to be deducted from the award amount. In support of his contentions, learned counsel relied on the judgments in Mrs. Helen C. Rebello and Others Vs. Maharashtra State Road Transport Corpn. and Another, (1999) 1 SCC 90 , and United India Insurance Co. Ltd. Vs. Patricia Jean Mahajan and Others Etc. Etc., (2002) 6 SCC 281 , 4. Per contra, the learned counsel for the respondent No. 1-claimant submitted that the amount reimbursed by Star Health Insurance Company cannot be deducted while awarding the compensation because the amount was paid by Star Health Insurance Company under the contract of insurance, for which he has paid the premium. In support of this contention, the learned counsel relied on the decisions in Mrs. Helen C. Rebello and Others Vs. Maharashtra State Road Transport Corpn. and Another, (supra) and Vrajesh Navnitlal Desai Vs. K. Bagyam and Another, (supra) 5. In view of the submissions made by the learned counsel appearing on either side, the question that has arisen for consideration in this appeal is, whether the amount awarded by the Tribunal towards medical expenses incurred by the respondent No. 1, having been reimbursed by Star Health Insurance Company under a mediclaim policy, is liable to be deducted? 6. On a perusal of the award, I find that the Manager of Star Health Insurance Company, PW 4, has stated in his evidence that Rs. 2,00,000 had been paid to Kovai Medical Centre Hospital towards the medical expenses incurred by the injured since the victim, being a government employee, was covered by Star Health Insurance Company. It is the contention of the respondent No. 1-claimant that the amount reimbursed by Star Health Insurance Company cannot be deducted from the award amount because the reimbursement was under the contract of insurance, for which premium was paid. 7. At this stage, it would be appropriate to refer to the decision relied on by the respondent No. 1, namely Mrs. Helen C. Rebello and Others Vs. Maharashtra State Road Transport Corpn. and Another, (supra) On going through the said judgment, I find that in that case, life insurance policy was taken.
7. At this stage, it would be appropriate to refer to the decision relied on by the respondent No. 1, namely Mrs. Helen C. Rebello and Others Vs. Maharashtra State Road Transport Corpn. and Another, (supra) On going through the said judgment, I find that in that case, life insurance policy was taken. So far as the life insurance policy is concerned, the amount could be received either by the insured after the maturity or by his heirs after his death, which may be accidental or otherwise, on account of the contract, for which the insured contributed in the form of premium. But, in the instant case, it is only a mediclaim policy, which is valid for a particular period and on expiry of period, automatically the policy lapses and any amount received out of such insurance is liable to be deducted. Further, the said policy covers only for a specific purpose, namely, reimbursing the amount spent by the victim towards his medical treatment. Once the amount is reimbursed, the claimant is not entitled to get the same under the name of compensation because it would amount to double compensation. In this regard, a reference could be placed in the judgment relied upon by the learned counsel for the appellant in Helen C. Rebello's case (supra) and the relevant para is extracted hereunder: (35) Thus, it would not include that which claimant receives on account of other forms of death, which he would have received even apart from accidental death. Thus, such pecuniary advantage would have no correlation to the accidental death for which compensation is computed. Any amount received or receivable not only on account of the accidental death but that would have come to the claimant even otherwise, could not be construed to be the 'pecuniary advantage', liable for deduction. However, where the employer insures his employee, as against injury or death arising out of an accident, any amount received (sic) out of such insurance on the happening of such incidence may be an amount liable for deduction. However, our legislature has taken note of such contingency, through the proviso of section 95. Under it, the liability of the insurer is excluded in respect of injury or death, arising out of (sic and) in the course of employment of an employee. 8. In United India Insurance Co. Ltd. Vs. Patricia Jean Mahajan and Others Etc.
However, our legislature has taken note of such contingency, through the proviso of section 95. Under it, the liability of the insurer is excluded in respect of injury or death, arising out of (sic and) in the course of employment of an employee. 8. In United India Insurance Co. Ltd. Vs. Patricia Jean Mahajan and Others Etc. Etc., (supra), the Hon'ble Apex Court has held as follows: (24)...it is clear that the deductions are admissible from the amount of compensation in case the claimant receives the benefit as a consequence of injuries sustained, which otherwise he would not have been entitled to. It does not cover cases where the payment received is not dependent upon an injury sustained on meeting with an accident.... The principle enunciated in the said decision is a fitting answer to the issue involved in this appeal that in case the claimant receives the benefit as a consequence of injuries sustained, then he is not entitled for the same as compensation once again. But it does not cover the cases where the amount of payment received is not dependent upon the injury sustained on meeting with the accident. Therefore, in my considered opinion, the case relied on by the learned counsel for the respondent No. 1, which was rendered based on the LIC policy, cannot be made applicable to the facts of the present case. So far as LIC policy is concerned, the policyholder is entitled for the payment of entire premium on maturity or the heirs are entitled for the payment in the event of his death. The payment under the life insurance policy does not depend upon the injury sustained in meeting with the accident. On the other hand, as far as the mediclaim policy is concerned, the amount is payable to the claimant when he sustains injuries in an accident. Hence, the compensation for the injuries sustained by him under the head 'medical treatment' cannot be granted. Therefore, I am of the opinion that since the sum of Rs. 2,00,000 has already been paid by Star Health Insurance Company, the respondent No. 1 is entitled only for the balance amount of Rs. 88,100 out of Rs. 2,88,100 spent by him. Hence, the sum of Rs. 2,88,100 awarded by the Tribunal under the head 'medical expenses' is reduced to Rs. 88,100. Consequently, the total amount of Rs. 3,83,100 is hereby reduced to Rs. 1,83,100.
88,100 out of Rs. 2,88,100 spent by him. Hence, the sum of Rs. 2,88,100 awarded by the Tribunal under the head 'medical expenses' is reduced to Rs. 88,100. Consequently, the total amount of Rs. 3,83,100 is hereby reduced to Rs. 1,83,100. Except this, the award passed by the Tribunal is confirmed in all other aspects. For the reasons stated above, the civil miscellaneous appeal is allowed and the appellant insurance company is directed to deposit the modified amount of Rs. 1,83,100 with 7.5 per cent interest from the date of claim petition till the date of realization, after deducting the amount already deposited, before the Tribunal within a period of six weeks from the date of receipt of a copy of this judgment and on such deposit being made, respondent No. 1-claimant is permitted to withdraw the same. No costs. Connected M.Ps. are closed.