IN THE HIGH COURT OF JUDICATURE AT MADRAS

DATED: 06.10.2015

CORAM

THE HON'BLE MR. JUSTICE S.MANIKUMAR

and

THE HON'BLE MR. JUSTICE M. VENUGOPAL

C.M.A. No.2232 of 2015

M.P.No.1 of 2015

Royal Sundaram Alliance Insurance Co. Ltd.,

“Sundaram Towers”,

Nos.45 & 46, Whites Road,

Chennai-14.

.. Appellant

vs

1.M.Satya Rao

2.M.Purushotham

.. Respondents

Appeal against the fair and decretal order dated 27.01.2015 passed

in M.C.O.P.No.5401 of 2011, on the file of the Motor Accidents Claims

Tribunal (V Court of Small Causes), Chennai.

For Appellant

.. Mr.N.Vijayaraghavan

For Respondents.. Mr.V.Mohan Choudary

JUDGMENT

(Judgment of the Court was delivered by S.MANIKUMAR, J.)

The only question, called upon by Royal Sundaram Alliance

Insurance Company Ltd., appellant herein, in this appeal is, whether

the first

respondent/injured is entitled to seek for medical

reimbursement of Rs.8,72,120/-, spent by his son, employee of HPCL,

from the tortfeasor and consequently the appellant insurer, when the

son of the first respondent is said to have availed the medical

benefit from his employer HPCL. Medical expenditure incurred by the

injured has been paid by the employer of his son, under medi-claim, a

social security policy, available to the employee.

https://hcservices.ecourts.gov.in/hcservices/

2. There is no dispute that the first respondent/claimant had

incurred a sum of Rs.8,72,120/-. The insurer had investigated and

verified that a sum of Rs.7,94,866.95 ps. had already been paid by

HPCL. Therefore, the appellant insurer had contended that the actual

balance/medical expenses to be paid by the company is Rs.43,334/-

only.

3. Upon perusal of Ex.R-1 series, letter dated 30.07.2013 and

Inpatient Bill Summary, spoken to by R.W.l, witness examined on behalf

of the company, the Claims Tribunal has noticed that a sum of

Rs.7,94,866.95 ps., has already been paid by HPCL and the balance

amount of Rs.43,334/- was paid by the injured.

4. Before the Claims Tribunal, the appellant insurer has contended

that the claim for medical expenses is not like LIC, where premium is

paid by the insured, and on maturity, the sum assured under the policy

is repaid with dividend to the assured, or in the case of death prior

to maturity, paid to the legal representatives of the assured; and

whereas, medi-claim or medical expenses, are reimbursed to the

surviving injured and to the legal representatives of the deceased, in

case of death. The appellant insurer has also contended, that the life

insurance policy is by a contract of insurance repayable, in case of

survival or death and that in case of mediclaim policy, reimbursement

is made by the insurer. Reimbursement of medical expenditure can be

sought for, against the insurer of mediclaim policy, for the actual

expenditure incurred, and if the said insurer reimburses the expenses

incurred by the insured or the legal representatives of the deceased,

then, the surviving victim or the legal representatives cannot seek

for reimbursement of the very same expenditure from the tortfeasor or

the insurer of the offending vehicle, as it would amount to double

payment under the head 'medical expenditure'. It is also the

contention of the appellant, that all the payments received by the

claimant, only by reason of the accident, shall have to be deducted

from the compensation received.

5. However, by placing reliance on the decision in the case of

Helen C.Robello v. Maharashtra State Road Transport Corporation

Limited, 1999 ACJ 10 (SC), considered in United India Insurance

Company Limited v. Patricia Jean Mahajan and Others, 2002 ACJ 1441,

and a decision of a learned single Judge in National Insurance Company

Limited v. C.Ramesh Babu and another, 2014 ACJ 1674, and taking note

of the fact that an appeal preferred by the insurance company therein,

against the abovesaid decision has been dismissed by the Hon'ble Apex

Cou