Page 55 - Insurance Times September 2023

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Supreme court directs insurance before the District Consumer Disputes Redressal Forum,
Mansa claiming deficiency in service. The respondents
company to pay 4 lakh to insured who admitted that the appellant was covered by their insurance
incurred medical expenses for policy but denied details of payment made by them The
treatment of person injured in motor forum directed the respondent to settle the claim as per
the policy and awarded 10,000 compensation to the
accident appellant.
The Supreme Court held that the insurance company was An appeal was preferred by the respondent before State
liable to reimburse the claimant when he had duly placed Commission which was dismissed. The state commission
on record the evidence of him paying the medical bills of a directed the respondent to release 6 lakhs to appellants
person injured in a motor accident in respect of which there which were deposited to them when the appeal was filed.
is third-party insurance coverage. "The District Forum had Now, respondents approached NCDRC which held that
specifically referred to medical bills and had directed the amount that was paid to the kin of the deceased has to be
insurance company to release the amount found admissible given to appellants. However, it held that there was no
to the appellant. The appellant was naturally under the evidence on record to show that appellants paid money to
impression that the amounts covered under the medical bills the one injured in an accident.
would also be payable. Even, the State Commission had
stated to the same effect." the court observed. Aggrieved by this order, Appellants filed an SLP before the
Supreme Court. They sought to bring on record medical bills
The Supreme Court bench comprising Justices BV
paid by them towards the treatment of the injured person
Nagarathna and Justice UjjalBhuyan was hearing an appeal
against the order of NCDRC which had denied the claims of CONTENTIONS The appellants argued that evidence of
appellant for reimbursement of medical expenses. The court reimbursement of medical expenses was on record in the
further observed, "the appellant herein has been not only form of exhibits already before the forums. He submitted
deprived of the aforesaid amount spent by him towards that the district forum had asked the respondent to release
medical expenses owing to the injuries sustained by the the payment as legally payable and indemnify as per the
injured Ram ParshadTharu in the accident in respect of insurance policy. Even the state commission directed them
which there is a third-party insurance coverage but was also to release the amount admissible.
constrained to approach this court." SUPREME COURT'S VERDICT The court noted that the

The Court set aside the order of NCDRC and directed the respondents had not disputed the medical documents
respondent to pay 4 lakh along with interest and imposed a furnished by the appellant showing payment to a medical
nominal cost of 30,000 payable to the appellant. hospital towards the treatment of an injured person in the
BACKGROUND OF THE CASE The appellant owned a accident. It observed that the respondent's contention
Mahindra pickup vehicle and had purchased an insurance before the NCDRC that "there was no evidence on record"
policy from respondents for a period between 2013-2014 to show the payment was made is wrong. NCDRC proceeded
covering India and later extended it to Nepal also. In on the basis that the district forum had disallowed the claim
September 2014, he visited Nepal where he met with an of the appellant and he didn't challenge this as well.
accident that killed a lady, and one person was injured. He Therefore, his claim cannot be allowed.
paid 10,36,500 compensation for full and final settlement However, the Supreme Court opined that this was wrong
of all claims due to death and injury so caused.
since the district forum had specifically referred to medical
He sought reimbursement/indemnity from the respondent bills in exhibits and directed the respondent to release the
which they refused to pay. Therefore, he filed a complaint amount so admissible. The Court observed that "the

The Insurance Times September 2023 49