Insurers may set off previously reimbursed medical expenses against future claims arising from the same injuries.

JUDGMENT

This appeal is filed by the appellant/3^rd respondent insurance company in O.P (MV) No.166 of 2012 on the file of the Motor Accidents Claims Tribunal, Perumbavoor, mainly challenging the compensation awarded under the head medical expenses. The respondent herein is the claimant before the tribunal.

2. According to the claimant, on 23.09.2011 at about

07.30 pm, while the claimant was riding a motorcycle bearing reg. No. KL-17/A-5114, a car bearing registration No.KL-01/N- 7383, driven by the 1^st respondent in a rash and negligent manner, hit against the motorcycle. As a result of the accident, he sustained serious injuries. The claimant approached the tribunal claiming compensation of ₹7,88,000/-

limited to ₹7,00,000/-.

3. The first respondent/driver and the second respondent/owner of the offending vehicle remained ex-parte before the tribunal. The 3^rd respondent/insurer filed a written statement admitting the policy but disputing the quantum of compensation claimed. Before the tribunal, Exts.A1 to A16 and Exts.B1 were marked. The tribunal, after analysing the pleadings and materials on record, awarded a sum of ₹2,64,750/- with interest at the rate of 9% per annum as compensation under various heads against the 3^rd respondent/insurer. Challenging the award passed by the tribunal, the insurance company has come up in appeal.

4. Heard the learned standing counsel for the appellant/insurance company and the learned counsel appearing for the respondent/claimant.

5. The learned standing counsel for the Insurance Company submitted that, as seen from the award, the claim for ₹1,00,000/- towards medical expenses had already been paid by the Oriental Insurance Company, as reflected in Ext. A9, and that the tribunal committed an error in again awarding an amount of ₹1,00,000/- towards medical reimbursement, which was already received by the claimant. On a perusal of the award, it is seen that in paragraph 8, the tribunal has considered in detail the claim of ₹1,00,000/- towards medical reimbursement in respect of the treatment undergone by the claimant at the Specialist Hospital, Kochi. Ext. A9 is a certificate issued by the Additional Manager of the Oriental Insurance Company Ltd., Muvattupuzha Branch, wherein it is stated that an amount of ₹1,00,000/- was settled upon submission of various bills issued by the Specialist Hospital.

6. This Court, in National Insurance Company Ltd.

v. Akbar Badsha [2015 (5) KHC 327] , held that “the Insurance Company is entitled to set off the amount paid towards medical bills in respect of the same injuries under a Mediclaim policy, except to the extent of the premium paid under the Mediclaim policy.” Hence, I find that the appellant is entitled to succeed in this appeal, since the amount of ₹1,00,000/- was already reimbursed to the claimant, by the Oriental Insurance Company. Accordingly, I find that the amount awarded under the head of medical expenses is liable to be deleted. Accordingly, the award is modified as follows:

Accordingly, the appeal is allowed, and the respondent/claimant will be entitled only for a total compensation of ₹1,64,750/- (Rupees One lakh sixty four thousand and seven hundred and fifty only) after deducting ₹1,00,000/- awarded towards medical expenses, from the impugned award, with interest @ 9% per annum from the date of the petition till realisation and proportionate costs. The appellant insurer shall deposit the said amount together with interest and costs within a period of two months from the date of receipt of a certified copy of this judgment. The claimant shall furnish copies of the PAN Card, ADHAAR Card and bank details before the appellant insurer within a period of one month so as to enable the insurance company to make the deposit as ordered above. In case of failure to furnish details as above, it shall be open for th