The Supreme Court of India held the New India Assurance Company Ltd. liable to reimburse the claimant, Hem Raj, for medical expenses incurred in a motor accident where there was third-party insurance coverage. The court found that the claimant had duly provided evidence of paying medical bills for an injured person involved in the accident.
Background of the Case:
Hem Raj owned a Mahindra pickup vehicle and had purchased an insurance policy from New India Assurance Company Ltd. for the period between 2013 and 2014, covering both India and Nepal. In September 2014, while in Nepal, he met with an accident that resulted in the death of a lady and injuries to another person named Ram Parshad Tharu. To settle all claims arising from the accident, Hem Raj paid compensation amounting to 10,36,500.
He subsequently sought reimbursement from the insurance company, which refused to pay, citing a lack of details regarding the payments made by Hem Raj. In response, he filed a complaint before the District Consumer Disputes Redressal Forum, Mansa, claiming deficiency in service. The forum directed the insurance company to settle the claim as per the policy and also awarded a compensation of 10,000 to Hem Raj.
The insurance company appealed the forum's decision before the State Commission, but the appeal was dismissed. The State Commission directed the insurance company to release 6 lakhs to Hem Raj, which was deposited when the appeal was filed.
The insurance company then approached the National Consumer Disputes Redressal Commission (NCDRC), where it was ruled that the amount paid to the kin of the deceased should be given to Hem Raj, but there was no evidence on record to prove that he had paid money to the injured person, Ram Parshad Tharu.
Supreme Court Verdict: Aggrieved by the NCDRC's decision, Hem Raj filed a Special Leave Petition (SLP) before the Supreme Court. In the appeal, he sought to present medical bills as evidence of the medical expenses he had paid for Ram Parshad Tharu's treatment.
Upon reviewing the case, the Supreme Court observed that the insurance company had not contested the medical documents provided by Hem Raj, which clearly showed the payments made towards the treatment of the injured person. The court noted that the NCDRC's contention that there was no evidence on record was erroneous, as the district forum had specifically referred to medical bills in exhibits and directed the insurance company to release the admissible amount.
The Court further remarked that Hem Raj was under the impression that the medical bills would also be covered, a notion supported by the State Commission's view that claims should be released insofar as Hem Raj was entitled to them.
Based on these findings, the Supreme Court set aside the NCDRC's order and directed the insurance company to reimburse Hem Raj with 4 lakhs along with interest. Additionally, a nominal cost of 30,000 was imposed on the insurance company, payable to Hem Raj.
Case Title: Hem Raj v New India Assurance Co. Ltd.
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