Page 59 - Insurance Times April 2023

Insurance Caselaws

Whether there is any strait jacket formula for What are the rules to be observed for making
awarding compensation under the heads, pain a proposal for insurance?
and suffering and loss of amenities and
Manmohan Nanda
happiness?
v.
Sri. Benson George
United India Assurance Co. Ltd. and Ors.
v.
I(2022)CPJ20(SC)
Reliance General Insurance Co. Ltd
Policy type- Overseas Mediclaim Policy-B
Civil Appeal No. 1540 of 2022
Policy type- Third Party Insurance The Supreme Court while allowing an insurance claim of the
insured under a mediclaim policy summarized the rules to
The Supreme Court examined its previous decisions in Raj be observed in making a proposal for insurance, namely, (a)
Kumar v. Ajay Kumar and Anr. (2011)1SCC 343 and Lalan D. a fair and reasonable construction must be put upon the
v. Oriental Insurance Company Limited (2020)9SCC 805, and language of the question which is asked, and the answer
observed that the amount of compensation to be awarded given will be similarly construed; (b) carelessness is no
under the heads, pain and suffering and loss of amenities excuse, unless the error is so obvious that no one could be
and happiness cannot be based on a straight jacket formula. regarded as misled; (c) an answer which is literally accurate,
It depends upon the facts and circumstances of each case so far as it extends, will not suffice if it is misleading by reason
and varies from person to person who has suffered due to of what is not stated; (d) where the space for an answer is
the accident. So far as awarding compensation under the left blank, leaving the question un-answered, the reasonable
head pain, shock, and suffering is concerned, multiple factors inference may be that there is nothing to enter as an
are required to be considered namely, prolonged answer; (e) where an answer is unsatisfactory, as being on
the face of it incomplete or inconsistent the insurers may,
hospitalization, the grievous injuries sustained, the
as reasonable men, be regarded as put on inquiry, so that if
operations underwent and the consequent pain, discomfort
and suffering. Similarly, loss of amenities and happiness they issue a policy without any further enquiry they are
assumed to have waived any further information; (f) a
suffered by the claimant and his family members also depend
proposer may find it convenient to bracket together two or
upon various factors, including the position of the claimant
more questions and give a composite answer; (g) any answer
post accident, and whether, he is in a position to enjoy life
given, however accurate and honest at the time it was
and/or happiness which he was enjoying prior to the
written down, must be corrected if, up to the time of
accident. The Court accordingly enhanced the compensation
acceptance of the proposal, any event or circumstance
awarded to the claimant under the head loss of amenities
supervenes to make it inaccurate or misleading.
and happiness.
The Insurance Times April 2023 51