Amounts received under a Mediclaim policy are not deductible from motor accident compensation awarded by a tribunal as contractual and statutory entitlements arise from distinct sources and cannot be equated as double recovery.

JUDGMENT :

SANJAY KAROL J.

Leave Granted.

THE APPEAL

2. ‘A’ met with an accident. They filed a claim before the jurisdictional Tribunal i.e., Motor Accidents Claims Tribunal¹[MACT] seeking compensation in which inter alia, loss of income, future prospects, special diet, transportation and medical expenses have been claimed for. Simultaneously, claims set out with insurance under the claim of medical insurance for the very same medical expenses are allowed and money received. Is it legally permissible for the MACT to account for such amounts received, and as such deduct the same or not, is the question involved herein.

3. A Bench of three Judges of the High Court of Judicature at Bombay in deciding a conflict between judgments of the said Court, namely The New India Assurance v. Dineshchandra Shantilal Shah and Ors , (2013) 09 BOM CK 0240 (First Appeal No.657 of 2013), on the one hand, and Vrajesh Navnitlal Desai v. K. Bagyam and Anr. , 2005 SCC OnLine Bom 156, Royal Sundaram Alliance Insurance Co. Ltd., Kolkata v. Ajit Chandrakant Rakvi and Anr. , 2019 SCC OnLine Bom 496, on the other, in terms of the impugned judgment, held that the amount received by a claimant by way of his own Mediclaim, is not deductible when such a claimant is before the jurisdictional MACT seeking compensation for injuries he has suffered as a result of an accident. New India Assurance Co. Ltd., is aggrieved and questions the correctness of such a finding before us, in this appeal.

3.1 We are, therefore, to decide the question of law as to whether the amount of money received as Mediclaim, in terms of a ediclaim policy, is deductible from an award passed by a Claims Tribunal or not. The factual matrix in which this question arises does not have a bearing on the conclusion of this question of law, and hence, is not relevant for the present determination.

ARGUMENTS OF THE PARTIES

4. We heard the learned Counsel for the parties.

4.1 Learned Counsel for the appellant submitted:

4.1.1 It is an admitted position that the respondent-insured has already been reimbursed for medical expenses through a Mediclaim policy. Once such reimbursement has taken place, the loss under that specific head is neutralized and so, awarding the same amount again under the head of medical expenses would go beyond restitution and lead to or result in a duplication of benefit. The appellant-insurer has submitted this position to be inconsistent with the principle of just compensation.

4.1.2 This position, it is argued, has found support in the decision of this Court in Reliance General Insurance Co. Ltd. v. Shashi Sharma, (2016) 9 SCC 627, where the Court emphasised that double benefits should not be granted while computing compensation in reference to a claim petition arising out of a motor vehicle accident. In that case, amounts received by the claimants by way of ex gratia financial assistance have been held liable for deduction from compensation awarded under a corresponding head. The underlying rationale was that overlapping benefits under the same head distort the concept of just compensation.

4.1.3 The appellant-insurer also dealt with the judgment in Helen C. Rebello v. Maharashtra SRTC, (1999) 1 SCC 90, which held that benefits such as life insurance, provident fund and pension, are not deductible since they accrue independently of the accident and would be payable in any event. However, the