Medical expenses received under separate policy can’t be deducted from accident claim: HC

The single judge bench of justice Shivkumar Dige dismissed an appeal filed by Reliance General Insurance Company Limited, challenging last year’s order of the Motor Accident Claims Tribunal, Mumbai, granting compensation to a 19-year-old Andheri resident, Aman Tak, 19, who was injured in a road accident.

Mumbai: Medical expenses reimbursed to the claimant under medical insurance policy obtained by a person or his/her family cannot be deducted while computing accident claim compensation under a separate policy, the Bombay high court held on Wednesday.

“The appellant/insurance company cannot claim a deduction of the amount (medical reimbursement) for which separate premium was paid by different persons under different contractual liability. The appellant/insurance company is liable to indemnify the contractual liability between them and the owner of the offending vehicle,” the judge said. (Getty Images)

The single judge bench of justice Shivkumar Dige dismissed an appeal filed by Reliance General Insurance Company Limited, challenging last year’s order of the Motor Accident Claims Tribunal, Mumbai, granting compensation to a 19-year-old Andheri resident, Aman Tak, 19, who was injured in a road accident.

The incident took place on the afternoon of March 17, 2014, when the 19-year-old was riding a bike with one of his female friends as a pillion. At Lokhandwala Circle in Andheri West, a dumper came from behind at high speed and hit the bike. The biker and the pillion fell and the 19-year-old sustained severe injuries.

As Tak suffered around 44% permanent disability, he subsequently moved the Tribunal for compensation from the dumper owner, MK Enterprises, and its insurer – Reliance General Insurance Company Ltd. Last year, the Tribunal allowed his plea and awarded him compensation, including medical expenses.

The insurance company was aggrieved by the Tribunal awarding compensation of ₹14.44 lakh

to Tak, although he had received reimbursement of ₹12.17 lakh from another insurance company on the health insurance policy obtained by his father. The insurance company argued that, as the claimant has received an amount of ₹12.17 lakh as reimbursement of medical expenditure from another insurance company, the tribunal should have deducted the amount from awarded compensation.

Justice Dige, however, said that the father of the claimant had taken an insurance policy by paying a separate premium for his entire family and the contractual liability between the father of the claimant and the other insurance company was different than the contractual liability between driver/owner of the offending vehicle and Reliance General Insurance Company for which the owner had paid separate premium.

“The appellant/insurance company cannot claim a deduction of the amount (medical reimbursement) for which separate premium was paid by different persons under different contractual liability. The appellant/insurance company is liable to indemnify the contractual liability between them and the owner of the offending vehicle,” the judge said.