HEM RAJversusNEW INDIA ASSURANCE CO. LTD

              [2023] 9 S.C.R. 1187 : 2023 INSC 644                        1187


                              HEM RAJ                                     A
                                  v.
            THE NEW INDIA ASSURANCE CO. LTD.
                   (Civil Appeal No. 4642 of 2023)
                           JULY 25, 2023                                  B
      [B. V. NAGARATHNA AND UJJAL BHUYAN, JJ.]
       Consumer Protection – Appellant-insured is the owner of the
vehicle covered by an insurance policy issued by respondent-insurer
– Vehicle met with an accident – Medical expenses were borne by
                                                                          C
the appellant in the treatment of the injuries sustained by the injured
– Indemnification of – Held: Evidence in the form of Exhibits C-19
to C-28 issued by the Hospital were on record, as per which the
appellant had incurred expenditure in the medical treatment of the
injured – The insurance company did not dispute these documents,
instead, the contention of the insurer before the NCDRC was that          D
there is no evidence on record to show that the payment was made –
The stand of the insurer in this case is not fair and just – Appellant
was not only deprived of the amount spent by him towards medical
expenses owing to the injuries sustained by the injured in the
accident in respect of which there is a third-party insurance
                                                                          E
coverage, but has also been constrained to approach this Court –
The portion of the order of the NCDRC disallowing indemnification
of the amount spent towards medical expenses by the appellant, set
aside – Respondent to pay Rs.4,09,000/- in terms of the Exhibits
with interest at the rate of 7% p.a from the date of filing of the
complaint before the District Forum till its realization – Cost of        F
Rs.30,000/- be paid to the appellant – Insurance.
      CIVIL APPELLATE JURISDICTION : Civil Appeal No.4642
of 2023.
      From the Judgment and Order dated 25.07.2019 of the National
Consumer Disputes Redressal Commission, New Delhi in RP No.2363           G
of 2017.
      Ritesh Khatri, Adv. for the Appellant.
     Rameshwar Prasad Goyal, J. P. N. Shahi, Advs. for the
Respondent.                                                               H
                                1187
1188             SUPREME COURT REPORTS                            [2023] 9 S.C.R.


 A            The Judgment of the Court was delivered by
              NAGARATHNA, J.
              Leave granted.
              2. This appeal has been filed by the insured seeking indemnification
 B     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
 C     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 of India initially
       and later Nepal also. The period of the policy was from 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
 D     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.
 E     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
 F     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
 G     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, 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
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     HEM RAJ v. THE NEW INDIA ASSURANCE CO. LTD.                            1189
                 [B. V. NAGARATHNA J.]

Tharu and Bhagat Bahadur Tharu on a claim for death as well as vehicle      A
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/
                                                                            B
- (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     C
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    D
by the Appellant before the District Forum can be summarised in the
tabular form, as under:



                                                                            E




                                                                            F

        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,
                                                                            G
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.
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1190            SUPREME COURT REPORTS                           [2023] 9 S.C.R.


 A            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 parties let in
       their evidence in the matter as well as filed their written arguments.
 B
              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
 C     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
 D     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
 E     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
       the NCDRC. The NCDRC held that a sum of Rs.3,27,500/- was paid
 F     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
 G     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
 H     detailed inventory i.e., statement of expenditure provided by the hospital
     HEM RAJ v. THE NEW INDIA ASSURANCE CO. LTD.                             1191
                 [B. V. NAGARATHNA J.]

from 27.09.2014 to 01.11.2014 as Annexure P-9, in order to establish         A
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.       B
       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     C
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   D
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.            E
       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
ordered to be disbursed to the appellant, hence, the appellant has filed     F
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      G
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
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1192            SUPREME COURT REPORTS                           [2023] 9 S.C.R.


 A     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
 B     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 found
       admissible to the complainant-appellant. The appellant herein was
 C     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.
 D            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
 E     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
 F     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.

 G           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
 H
      HEM RAJ v. THE NEW INDIA ASSURANCE CO. LTD.                               1193
                  [B. V. NAGARATHNA J.]

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

Divya Pandey                                                  Appeal allowed.   B
(Assisted by : Roopanshi Virang, LCRA)




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