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SUPREME COURT OF INDIA
B.V. Nagarathna and Ujjal Bhuyan, JJ.
Hem Raj – Appellant
Versus
The New India Assurance Co. Ltd. – Respondent
Civil Appeal No. 4642 of 2023 (@SLP(C) No. 3623 of 2021)
Decided on : 25-07-2023
Consumer Protection Act, 1986 – Section 23 [Consumer Protection Act, 2019 – Section 67] – Insurance – Fatal motor accident – Indemnification of medical expenses – NCDRC, on the basis of submission of Counsel for insurer, disallowed disbursement of medical bills on the premise that there was no evidence on record and that appellant herein had not contested Order of District Forum before State Commission – Stand of insurer in this case is not fair and just – Portion of Order of NCDRC disallowing indemnification of amount spent towards medical expenses by appellant-insured set aside – Respondent-insurance company to pay amount of Rs.4,09,000/- with 7% interest and a nominal cost of Rs.30,000/- payable to appellant. (Paras 14, 15 and 16)
Facts of the case:
Instant appeal has been filed by the insured seeking indemnification of total amount of INR 10,36,500/- from the respondent-insurance company, being aggrieved by the Order passed by National Consumer Disputes Redressal Commission.
Findings of Court:
Submissions made on behalf of insurance company before NCDRC are contrary to evidence on record as a result of which appellant herein has been not only deprived of amount spent by him towards medical expenses owing to injuries sustained by injured Ram Parshad Tharu in accident in respect of which there is a third-party insurance coverage, but also has been constrained to approach this Court.
Result : Appeal allowed
JUDGMENT
Nagarathna, J.
Leave granted.
2. This appeal has been filed by the insured seeking indemnification of the total amount of INR 10,36,500/- from the respondent-insurance company, being aggrieved by the Order passed by the National Consumer Disputes Redressal Commission (NCDRC for short).
3. Briefly stated the facts are that the appellant is the owner of a Mahindra Pick-up Vehicle bearing registration no. PB-19H-2461 which is used by him for his personal use. That the appellant had purchased an insurance policy No.36060231130100003910 by paying the premium on the policy to the respondent-insurer covering the territory of India initially and later Nepal also. The period of the policy was from 21.03.2014 to 20.03.2015. On 11.09.2014, the vehicle was driven by Amritpal alongwith other people who visited Nepal to attend a satsang. Just prior to entry into Nepal i.e., before crossing the border, the appellant had got extended the insurance policy in the territory of Nepal. On 11.09.2014 at 10.00 am, at Gorhi Chowk, Ward No.4, Gram Vikas Samiti, District Bardia Belva (Nepal), the vehicle met with an accident. FIR No. 21 dated 14.09.2014 was duly registered in this regard. In this accident, Smt. Santliya Tharu, wife of Ram Parshad Tharu, resident of Ward no.7, Gram Vikas Samiti, District Banke Titeeherea (Nepal) died and Ram Parshad Tharu was injured. He was referred to Charak Hospital and Research Centre, Lucknow (India) for medical treatment. According to the appellant, the medical expenses of Rs.4,09,000/-(Nepalese Rupee) were borne by him. This fact is admitted in the document dated 01.11.2014 executed 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/- (Nepalese Rupee) was paid by him owing to the death of Smt. Santliya Tharu through Rajinder Kumar, representative of the appellant and Rs.24,000/- (Nepalese Rupee) was received by Bhagat Bahadur Tharu towards the fare of vehicles used for transporting the dead body and other funeral rituals of Smt. Santliya Tharu. According to the appellant, a sum of Rs.5,24,000/- (Nepalese Rupee) (INR 3,27,500/-) was paid to Jeet Bahadur Tharu, the only son of Ram Parshad Tharu and Smt. Santliya Tharu and Bhagat Bahadur Tharu on a claim for death as well as vehicle charges and expenses for funeral rituals of Smt. Santliya Tharu. Medical expenses totalling to Rs. 6,54,000/- (Nepalese Rupee) , equal to Rs 4,09,000/- (Indian Rupee) were also incurred for the treatment of the injured Ram Prashad Tharu. Moreover, on 01.11.2014, there was a consensus 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 the appellant through his representative Sukhdeep Singh to Jeet Bahadur Tharu as full and final settlement of all claims. Thus, according to the appellant, Rs.16,58,400/- (Nepalese Rupee) equal to Rs.10,36,500/- (Indian Rupee) was expended with compensation on account of the death of Smt. Santliya Tharu being Rs.5,24,000/-(Nepalese Rupee) equal to Rs.3,27,500/- (Indian Rupee) + hospital expenses towards the treatment of Ram Prashad Tharu being Rs 6,54,000/- (Nepalese Rupee), equal to Rs.4,09,000/- (Indian Rupee) + the full and final settlement amount being Rs.4,80,000/- (Nepalese Rupee) equal to Rs. 3,00,000/- (Indian Rupee).
5. The components of the claim, excluding interest and costs, made by the Appellant before the District Forum can be summarised in the tabular form, as under:
| Claim Component | Nepalese Rupee (NPR) | Indian Rupee (INR) |
| Death Claim | Rs.5,24,000/- | Rs.3,27,500/- |
| Hospital | Rs.6,54,000/- | Rs.4,09,000/- |
| Final Settlement | Rs.4,80,000/- | Rs.3,00,000/- |
| Total as per claim | Rs.16,58,400/- | Rs.10 |
SupremeToday
Insurance claim cannot be disallowed by going against evidence on record.
(1) Ex-gratia is an act of gratis and has no connection with liability, payable as a legal duty.(2) Scope and ambit of Revisional Jurisdiction is very limited.
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