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2019 DIGILAW 236 (HP)

Kulwant Kumar Sharma v. New India Assurance Company Ltd.

2019-03-07

AJAY MOHAN GOEL, SURYA KANT

body2019
JUDGMENT : SURYA KANT, J. 1. This Letters Patent Appeal is directed against order dated December 19, 2017, whereby the learned Single Judge dismissed the appellant's writ petition and upheld the order passed by the Insurance Ombudsman dated 17.03.2016, rejecting the appellant's claim for medical reimbursement of a sum of Rs. 15,287/-. 2. The appellant was an employee of 2nd respondent. The Employer had insured all its employees including the appellant with New India Assurance Company-respondent No. 1. The appellant sought medical reimbursement for Rs. 15,287/- claiming inter alia that he was hospitalized in J.N. Shori Hospital, Pinjore, from 14.09.2006 to 17.09.2006, incurring the aforesaid expenditure for overall treatment. After 2-3 rounds of litigation, the Insurance Ombudsman rejected the appellant's claim on the ground that the record of the Hospital relied upon by him was not genuine; it was fake and fabricated and got prepared in connivance with the Hospital. 3. The order of the Insurance Ombudsman has been upheld by the learned Single Judge, giving rise to this intra-Court Appeal. 4. Certain other developments have also taken place. It is informed by Mr. Rahul Mahajan, learned Counsel for the Management that a domestic inquiry was held against the appellant and two more employees for making false claims on the basis of alleged fake and fabricated record of the private Hospital(s). The charges were proved and they were dismissed from service. The appellant has raised an 'industrial dispute' against the dismissal of his service, which is pending adjudication before the Industrial Tribunal-cum-Labour Court, Shimla. 5. As may be seen, the factual issues which fall for consideration in this appeal or in the Reference pending before the Industrial Tribunal-cum-Labour Court, are overlapping. Any finding given by this Court with regard to the alleged genuineness of the medical reimbursement claim will have a direct bearing on the Reference pending before the Industrial Tribunal-cum-Labour Court. 6. Still further, the question as to whether the claim put forth by the appellant for medical reimbursement was genuine or it was founded upon fake and fabricated bills, is essentially a question of fact. It is also an admitted fact that the Insurance Ombudsman is not a judicially trained mind who could effectively and appropriately appreciate the evidence led by the parties. It is also an admitted fact that the Insurance Ombudsman is not a judicially trained mind who could effectively and appropriately appreciate the evidence led by the parties. In any case, if the findings returned by the Insurance Ombudsman, as upheld by learned Single Judge, are accepted as gospel truth, it will completely seal the fate of the 'industrial dispute' raised by the appellant. To avoid such a serious consequence, we are of the view that let the question as to whether the appellant's claim for medical reimbursement was genuine or fake, be adjudicated independently by the Industrial Tribunal-cum-Labour Court on the basis of evidence to be led by the parties, without being influenced by the findings returned by the Insurance Ombudsman. With a view to give free hand to the Industrial Tribunal to adjudicate the aforesaid issue, we deem it appropriate to allow this appeal in part and set aside the order of learned Single Judge dated 19.12.2017. Ordered accordingly. 7. It is made clear that we have not expressed any view on merits of the claim and counter claim and the parties shall be at liberty to raise all the issues in the pending Reference before the Industrial Tribunal. To avoid multiplicity of litigation, the Reference pending before the Industrial Tribunal-cum-Labour Court, shall be deemed to have been modified to the extent that the learned Tribunal shall also formulate a question as to "whether the claim for medical reimbursement put forth by the appellant was genuine or fake?" and the said question too shall be decided while deciding the main Reference. The appeal stands disposed of in the aforesaid terms, so also pending miscellaneous application(s), if any.