Hem Raj vs The New India Assurance Company Ltd.

IN THE SUPREME COURT OF INDIA 2023 INSC 644 CIVIL APPELLATE JURISDICTION

CIVIL APPEAL NO. 4642 OF 2023 (@SLP(C) NO. 3623 OF 2021)

HEM RAJ ….. APPELLANT(S)

VS.

THE NEW INDIA ASSURANCE CO. LTD. …..RESPONDENT(S)

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 Signature Not Verified

of India initially and later Nepal also. The period of the policy was from Digitally signed by RADHA SHARMA Date: 2023.07.25 17:11:59 IST Reason: 2

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, 3

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:

4

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.10,36,500/-

6. The appellant, thereafter, submitted the original documents to the

respondent-insurer seeking indemnity/reimbursement but the

respondent-insurer refused to pay the said amount. Contending that

there had been deficiency in service by the respondent-insurance

company, the appellant filed a complaint before the District Consumer

Disputes Redressal Forum, Tehsil Complex, Mansa (“District Forum”)

seeking reimbursement of Rs.10,36,500/- (INR) along with interest @

18 % per annum as compensation, Rs.50,000/- for mental agony and

Rs.20,000/- as litigation expenses.

7. On receipt of notice from the District Forum, the respondents

herein appeared and filed their version and sought for certain

documents while admitting that the appellant is the owner of the vehicle

which was covered by an insurance policy issued by them but denying

the other details of payments made by the appellant herein. Both the 5

parties let in their evidence in the matter as well as filed their written

arguments.

On consideration of the same, the District Forum held in favour

of the appellant herein, directed the respondent herein to settle the

claim as per the terms and conditions incorporated in the insurance

policy and to release only the payments which are legally found payable

to the appellant in terms of the insurance policy. Further, cost and

compensation of Rs.10,000/- was awarded to the appellant herein.

8. Being aggrieved by the Order of District Forum, the respondent-

insurer preferred First Appeal No.839 of 2016 before the State

Consumer Disputes Redressal Commission, Punjab Sector 37-A,

Dakshin Marg, Chandigarh (“State Commission”). The State

Commission did not find any merit in the appeal and dismissed the

same. The State Commission observed that the respondent-insurance

company had deposited an amount of Rs.25,000/- before the State

Commission at the time of filing the appeal and had further deposited a

sum of Rs.5,75,000/- in compliance with an Order of the Commission

and directed that the same shall be released to the appellant herein

within a period of forty-five days of the said judgment.

9. Being aggrieved by the Order of the State Commission, the

respondent-insurer preferred Revision Petition No.2363 of 2017 before 6

the NCDRC. The NCDRC held that a sum of Rs.3,27,500/- was paid by

the appellant to the son of the deceased Smt. Santliya Tharu. That a

sum of Rs.6,27,500/- apart from Rs.10,000/- towards cost, is payable

to the appellant herein. Accordingly, the Revision Petition was disposed

of. As against the said Order, there is no appeal filed by the insurance

company. However, the insured-appellant herein has sought for the

payment of Rs.6,54,000/- (Nepalese Rupee) towards the medical

expenses for the treatment of Ram Prashad Tharu. The NCDRC has

observed that there is no evidence on record to show that the said

payment was made by the appellant herein. In this regard, an

application has been filed by the appellant herein seeking to bring on

record three documents being medical bill receipt dated 16.09.2014,

17.09.2014 and detailed inventory i.e., statement of expenditure

provided by the hospital from 27.09.2014 to 01.11.2014 as Annexure

P-9, in order to establish that a sum of Rs.4,39,318.99/- was paid by

the appellant herein to Charak Hospital and Research Centre, Lucknow

towards the treatment of Ram Prashad Tharu who had sustained

injuries in the accident.

10. We have heard learned counsel for the appellant and learned

counsel for the respondent-insurer and perused the material on record. 7

11. The main grievance of the appellant pertains to the

reimbursement of the medical expenses incurred by him towards the

medical treatment of Ram Prashad Tharu at Charak Hospital and

Research Centre, Lucknow. In that regard, appellant’s counsel drew our

attention to the Orders passed by the District Forum, State Forum as

well as the NCDRC and contended that the evidence regarding the

reimbursement of medical expenses was on record in the form of

Exhibits - C19 to C28 which are medical bills on account of the medical

treatment given to Ram Prashad Tharu. The District Forum

categorically directed that the opposite party i.e., respondent-insurer

herein had to settle the claim as per the terms and conditions

incorporated in the insurance policy and to release the payment which

was legally payable to the appellant herein and to indemnify as per the

insurance policy. However, the insurer has failed to do so. In fact, the

observations of the State Forum are to a similar effect i.e. to release the

amount found admissible, to the extent of the insured’s entitlement

after the expiry of forty five days.

12. However, the learned counsel for the insurer submitted before the

NCDRC that there was “no evidence on record” to show that the

payment was made. Therefore, on the said submission, the amount of

Rs.6,54,000/- (Nepalese Rupee) towards medical bills has not been 8

ordered to be disbursed to the appellant, hence, the appellant has filed

this appeal by way of special leave petition.

13. In this regard, our attention was also drawn to the copies of the

said Exhibits by way of filing an application for filing additional

documents. Learned counsel for the respondent-insurer did not dispute

the fact that the evidence in the form of Exhibits C-19 to C-28 were on

record. We have perused the said Exhibits (Annexure P9 to P28) which

have been issued by Charak Hospital and Research Centre, as per

which appellant had incurred expenditure of Rs.6,54,000/- (Nepalese

Rupee) equivalent to Rs.4,09,000/- (Indian Rupee) in the medical

treatment of Ram Prashad Tharu. Learned counsel for the insurance

company has not disputed these documents, instead, the contention of

the insurer before the NCDRC was that “there is no evidence on record”

to show that the payment was made. This is not a correct submission

or statement made on behalf of the insurer.

14. NCDRC has also noted that since the appellant herein did not

assail the Order of the District Forum regarding disallowing of the said

amount, the same had been disallowed. We do not think that is a correct

reading of the Order of the District Forum inasmuch as the District

Forum had specifically referred to medical bills at Exhibits C-19 to C-

28 and had directed the insurance company to release the amount 9

found admissible to the complainant-appellant. The appellant herein

was naturally under the impression that the amounts covered under

the medical bills would also be payable. Even, the State Commission

had stated to the same effect that the claims as per the terms and

conditions incorporated in the insurance policy had to be released if

found admissible and to the extent of entitlement of the insured.

However, the NCDRC, on the basis of the submission of the

learned counsel for the insurer, disallowed the disbursement of the

medical bills on the premise that there was no evidence on record and

that the appellant herein had not contested the Order of the District

Forum before the State Commission. As a consequence, the appellant

had to approach this Court for seeking reimbursement of the medical

bills paid by the appellant for the treatment of Ram Prasad Tharu.

15. We observe that the submissions made on behalf of the insurance

company before the NCDRC are contrary to the evidence on record as a

result of which the appellant herein has been not only deprived of the

aforesaid amount spent by him towards medical expenses owing to the

injuries sustained by the injured Ram Parshad Tharu in the accident in

respect of which there is a third-party insurance coverage, but also has

been constrained to approach this Court. We find that the stand of the

insurer in this case is not fair and just.

10

16. In view of the aforesaid discussion, we allow this appeal and set

aside that portion of the Order of the NCDRC disallowing

indemnification of the amount spent towards medical expenses by the

appellant-insured. We direct the respondent-insurance company to pay

the amount, Rs.4,09,000/- (Indian Rupee) in terms of Exhibits P-9 to

P-28 with interest at the rate of 7% per annum from the date of filing of

the complaint before the District Forum till its realisation. We also

impose a nominal cost of Rs.30,000/- payable to the appellant herein.

The aforesaid amounts shall be disbursed to the appellant within a

period of one month from today.

…………………………….J. [B.V. NAGARATHNA]

..……….………………….J. [UJJAL BHUYAN]

New Delhi;

25th July, 2023.