ANSWER TO THE QUESTION REFERRED
18. In the light of the foregoing discussion, we are of the considered opinion that the question as framed ought to be answered in the negative. Thus, any amount received by a claimant under a mediclaim policy or under a medical insurance policy is not liable to be deducted from the amount of compensation payable to a claimant under the head “medical expenses” in proceedings under Section 166 of the M.V. Act.
Any Amount Received By Accident Victim from Mediclaim Cannot Be Deducted from Compensation to be paid to the Claimants as same is independent contract. Insurer are liable to pay even if Claimants receive amount from Mediclaim.
IN THE HIGH COURT OF JUDICATURE AT BOMBAY
CIVIL APPELLATE JURISDICTION
FIRST APPEAL NO.1344 OF 2014
The New India Assurance Co. Ltd. Vs Mrs. Dolly Satish Gandhi
CORAM : A.S. CHANDURKAR, MILIND N. JADHAV & GAURI GODSE, JJ
Dated: 28TH MARCH 2025.
JUDGMENT : [ Per A.S. Chandurkar, J. ]
Citation: 2025:BHC-AS:14458-FB
1. The question placed for consideration before this larger Bench is
“Whether the amount received by a Claimant under a Mediclaim Policy or
under a Medical Insurance Policy is liable to be deducted from the amount
of compensation payable to a Claimant under the head “Medical
Expenses” in proceedings under Section 166 of the Motor Vehicles Act,
1988 ?”
Decision leading to the Reference :
2. In First Appeal No.1344 of 2014 (The New India Assurance Co. Ltd.
Vs. Mrs. Dolly Satish Gandhi and Anr.), a challenge has been raised to the
judgment of the Motor Accident Claims Tribunal, Mumbai awarding
monetary compensation to the claimant. One of the grounds of challenge
is that the amount awarded by the Motor Accident Claims Tribunal (for
short, “Tribunal”) towards medical expenses could not have been so
awarded in view of the fact that the claimant had received these expenses
under a Mediclaim Policy from the Insurance Company.
3. When the First Appeal was heard, amongst other decisions, the
judgment in First Appeal No.657 of 2013 (The New India Assurance Vs.
Dineshchandra Shantilal Shah and Ors.), decided on 19th September 2013
taking the view that the amount received under a Mediclaim Policy by a
claimant was liable to be deducted from the amount of compensation that
was liable to be awarded towards medical expenses was relied upon by
the Insurance Company. On the other hand, the claimant sought to rely
upon the decisions in Vrajesh Navnitlal Desai Vs. K. Bagyam and Anr.,
2006 ACJ 65 and Royal Sundaram Alliance Insurance Co. Ltd., Kolkata Vs.
Ajit Chandrakant Rakvi and Anr., 2019(6) Mh.L.J. 386 to contend that the
amount received under a Mediclaim Policy was not liable to be set-off or
deducted from the amount of compensation payable under Section 166 of
the Motor Vehicles Act, 1988 (for short, “M.V. Act”).
4. The learned Single Judge noticed the divergent views in Vrajesh
Navnitlal Desai and Royal Sundaram Alliance Insurance Co. Ltd. (supra)
on one hand and in Dineshchandra Shantilal Shah and Ors. (supra) on the
other. The latter decision did not notice the earlier views on that point.
Hence, by the order dated 29th June 2020, the First Appeal was directed to
be placed before the Hon’ble the Chief Justice for constituting a larger
Bench to decide the said question. Accordingly, the said question has been
referred to the Full Bench.
Submissions on behalf of the Insurer :
5. Mr. Vineet Naik, learned Senior Advocate representing the New
India Assurance Company Limited at the outset referred to the nature of
various insurance policies available along with their distinct terms and
conditions. Referring to Section 124 of the Indian Contract Act, 1872, it is
urged that a general insurance contract operates on the principle of
“indemnity” and is thus contingent in nature. It would be enforceable only
when some loss occurs and if such loss has already been compensated
from another source, nothing further was required to be done under the
contract of indemnity. The loss thus sustained by a claimant could be
claimed only once and not on multiple occasions. On being indemnified
under an insurance policy, there would be no justification to again award
any further amount to such insured in a claim filed under Section 166 of
the M.V. Act. He sought to differentiate between a “health insurance
policy” and a “life insurance policy”. Under the provisions of Section 166
of the M.V. Act, fair and just compensation was required to be awarded to
a claimant by the Tribunal on being satisfied of the entitlement of the
claimant to receive compensation. While doing so, it would be necessary
for the Tribunal to bear in mind the fundamental principle of insurance
which was to place the insured person in a position that he / she was or
would have been had the unforeseen eventuality of an accident not
occurred. Under the garb of awarding just and fair compensation, the
Tribunal could not proceed to award compensation under the head
“medical expenses” notwithstanding the fact that the claimant as an
insured had already received the amount of medical expenses under a
mediclaim policy. This would amount to a wind-fall to the claimant or
double compensation in such eventuality. It was submitted that there was
a direct co-relation between the accident suffered by a claimant and
medical expenses incurred as a result of such accident. Having received
the amount of claim under a mediclaim policy, deduction of such amount
from the medical expenses incurred as a result of the accident would only
be justified. On medical treatment being undertaken on account of an
accident suffered due to an unforeseen accident, the same would give a
cause of action to a claimant to seek reimbursement of expenses incurred
towards medical treatment. The option to claim such amount would not
be available as against the tortfeasor and from the insurer. The learned
Senior Advocate referred to the decisions in Helen C. Rebello and Ors. Vs.
Maharashtra State Road Transport Corporation and Anr., (1999) 1 SCC 90
and United India Insurance Co. Ltd. and Ors. Vs. Patricia Jean Mahajan
and Ors., (2002) 6 SCC 281 to emphasise the principle of balancing
between losses and gains while arriving at the amount of compensation
that could be awarded. Inviting attention to the judgment of the
Karnataka High Court in New India Assurance Company Limited,
Bangalore Vs. Manish Gupta and Anr., 2013 ACJ 2478, it was submitted
that it was rightly held that the amount paid by an insurer under a
mediclaim policy was liable to be deducted from the amount of claim
towards medical expenses. He also referred to the decisions of the Kerala
High Court in The National Insurance Company Ltd. Vs. Akber Badsha and
Ors., 2016 ACJ 807 and Mariamma James W/o. Late James Joseph and
Ors. Vs. Alphones Antony S/o. Antony Kurian and Ors., 2016 SCC OnLine
Ker 29226 to contend that the view taken therein of deducting the amount
of claim granted under a mediclaim policy from the amount of
compensation payable was the correct view. It was thus submitted that the
question as framed ought to be answered in the affirmative by holding
that the amount received by a claimant under a mediclaim policy or under
medical insurance was liable to be deducted from the amount of
compensation payable to a claimant under the head “medical expenses” in
proceedings under Section 166 of the M.V. Act.
Submissions on behalf of the Insured :
6. On the other hand Mr. T.J. Mendon, learned counsel appearing for
the claimant in the First Appeal urged that the question as framed was
liable to be answered in the negative. According to him, a mediclaim
policy is based on a contract between the insurer – an insurance company
and the insured – the purchaser of such policy. The rights of the parties are
governed by contractual terms under such policy. On a claim being made
on the occurrence of an accident in the case of a mediclaim policy, the
insured is entitled to the benefits of the same. Under the provisions of
Section 168 of the M.V. Act, a claimant is entitled to an amount of just
compensation which claim is liable to be satisfied by the insurer of the
offending vehicle. Such liability is statutory in nature and it flows from the
concept of a ‘compulsory third party insurance policy’. The contentions
raised on behalf of the insurance company was based on the provisions of
Section 1A of the Fatal Accidents Act, 1855 (for short, “FA Act”). With
enactment of the Motor Vehicles Act, initially in 1939 and thereafter the
present M.V. Act, a statutory right was created in favour of a victim of a
motor vehicle accident to receive just compensation. While awarding an
amount of just compensation, the tort-feaster would not be entitled to get
benefit of a claim amount that is received by victim of an accident
pursuant to an independent contract. The statutory liability under the M.V.
Act cannot be watered down on the basis of any such contractual
agreement. The learned counsel referred to the decision of the three Judge
Bench of the Supreme Court in Sebastiani Lakra and Ors. Vs. National
Insurance Co. Ltd. and Anr., 2019 ACJ 34 and submitted that after
considering the earlier decisions in Helen C. Rebello, Shashi Sharma
(supra) and Vimal Kanwar Vs. Kishore Dan, 2013 ACJ 1441 (SC) it had
been held in clear terms that amounts received by a deceased or an
injured on account of contractual relations entered into were not liable to
be deducted so as to defeat the statutory entitlement. He also referred to
the judgment of the Division Bench of this Court in Maharashtra State
Road Transport Corporation Vs. Tulsabai Tukaram Kadave and Ors., 1990
ACJ 523 as well as the judgment of learned Single Judge in State of Goa
Vs. Michael Joaquim F.d. Souza & Ors., 2022 SCC OnLine Bom 1672
taking the view against such deduction. According to him, the view taken
by learned Single Judge in Ajit Chandrakant Rakvi, (supra) on the same
lines was the correct view. It was thus submitted that the right to receive
just compensation under the provisions of the M.V. Act was statutory in
nature while benefit under a mediclaim policy was payable in view of a
contract entered into between the insurer and the victim. Considering the
nature of liability, the amount of just compensation could not be reduced
by deducting any amount received under a mediclaim policy. It was thus
submitted that the question as framed be answered in the negative.
Submissions of Amicus Curiae :
7. Mr. Gautam Ankhad, learned Amicus Curiae referred to the nature
of statutory liability of an insurer under the provisions of the M.V. Act visa-
vis the nature of contractual liability under a mediclaim policy.
According to him, with the repeal of the F.A. Act by virtue of enactment of
the Motor Vehicles Act, 1939 followed by introduction of Section 94
therein in 1946 as well as the amendment of Section 110A in 1956, a
statutory right to claim compensation was conferred on a victim of a
motor vehicle accident. Such right being statutory in nature, the same
could not be diluted by permitting deduction of any amount received by
such victim on account of any contractual obligation under a mediclaim
insurance policy. He referred to the decisions in Helen C. Rebello and P
Patricia Jean Mahajan (supra) to indicate the legal principles leading to
the said decisions. He invited attention to the decision in Bradburn Vs.
Great Western Rail Company, (1874-80) All England Reports 195 to
submit that the right of a plaintiff to receive damages could not be
affected by virtue of any amount received under an accident insurance
policy. Referring to Section 168 of the M.V. Act, it was urged that the said
provision being part of a welfare legislation, the same ought to be
construed in favour of a claimant / victim who had suffered an accident.
While satisfying a mediclaim, there is no loss caused to the insurer
inasmuch as it receives premium from the insured. There is always an
option to increase the quantum of premium by virtue of the subsisting
contract and there is also a provision for denying “no claim bonus” to the
insured. As a result, there is no loss caused to the insurer. However, if a
deduction is permitted on account of receipt of the amount of mediclaim
by an insured, it would result in granting an unjust benefit to the insurer
resulting in its unjust enrichment. Reliance was also placed on the decision
in Rajasthan State Road Transport Corporation Vs. Alexix Sonier and Anr.
(2015) 17 SCC 758 and the judgments of learned Single Judges in United
India Insurance Company Limited Vs. Anjana Nileshkumar Parmar and
Anr., 2012(3) Mh.L.J. 914, Shrikant Vs. Suryakant Uttam Gaude and Ors.,
2021 All MR 25, National Insurance Company Ltd. Vs. Vaswati Samiran
Ganguly and Anr., First Appeal No.368 of 2016 decided on 24th June 2019
and Reliance General Insurance Company Ltd. Vs. Aman Sanjay Tak, 2023
SCC OnLine Bom 883 in this regard. It was thus urged that consistent with
the view taken by this Court in its various decisions except the one in
Dineshchandra Shantilal Shah (Supra), the question as framed was liable
to be answered in the negative.
Mediclaim policy, in general :
8. A mediclaim policy is broadly understood as a contractual
arrangement between an insured and an insurance company as insurer.
On payment of amount of premium towards a mediclaim policy, the
insured is covered against health related expenses arising either due to
hospitalization on account of specified sickness or accidental injuries. A
mediclaim policy is also considered as a form of investment as well as a
mode of tax planning. It is in the nature of provision made towards an
uncertain future. In short, it is purely a contractual agreement based on
terms agreed between the insured and the insurer.
On the subject of insurances, reference can be made to the decision
in Bradburn (supra). Bramwell, J. has observed as under :
“It is not worthwhile to go into it, but the subject of
insurances will be found to have been thoroughly
discussed a few years ago in Dalby v. India and London
Life Assurance Co. (1) in the Court of Common Pleas. A
man pays the premiums upon these accident policies
upon this kind of footing, namely, that his right to all
indemnity in case of an accident shall be, an equivalent
for the mischief or injury that happens to him. He gets
more, no doubt, if the mischief happens than all the
premiums which he has paid would amount to; but he
runs the chance that he will not get anything at all; and
therefore it is, I say, that he ought to have this sum in
addition to the damages that he may have sustained at
the hands of the defendants by reason of the accident
itself; for otherwise he would has a loser by insuring
against accidents in a case where the railway company
was in the wrong.”
JUST COMPENSATION :
9. Under Section 166(1) of the M.V. Act, a claim for compensation
arising out of an accident can be made by a person who has sustained an
injury or by the owner of the property or where the death has resulted
from the accident, by all or any of the legal representatives of the
deceased or by any agent duly authorized by the person injured or all or
any of the legal representatives of the deceased as the case may be. Under
Section 168(1) of the M.V. Act, the Claims Tribunal is empowered to hold
an inquiry into the claim and thereafter subject to the provisions of
Section 162 of the M.V. Act, make an award determining the amount of
compensation which appears to it to be just and specifying the person or
persons to whom such compensation shall be paid. While holding any
inquiry under Section 168 of the M.V. Act, the Claims Tribunal is required
to follow a summary procedure in accordance with the rules made in this
behalf.
The Constitution Bench in National Insurance Company Ltd. Vs.
Pranay Shah and Ors., (2017) 16 SCC 680 while considering the
provisions of Section 168 of the M.V. Act has observed as under :-
55. Section 168 of the Act deals with the concept of "just
compensation" and the same has to be determined
on the foundation of fairness, reasonableness and
equitability on acceptable legal standard because
such determination can never be in arithmetical
exactitude. It can never be perfect. The aim is to
achieve an acceptable degree of proximity to
arithmetical precision on the basis of materials
brought on record in an individual case. The
conception of "just compensation" has to be viewed
through the prism of fairness, reasonableness and
non-violation of the principle of equitability. In a
case of death, the legal heirs of the claimants cannot
expect a windfall. Simultaneously, the compensation
granted cannot be an apology for compensation. It
cannot be a pittance. Though the discretion vested
in the tribunal is quite wide, yet it is obligatory on
the part of the tribunal to be guided by the
expression, that is, "just compensation". The
determination has to be on the foundation of
evidence brought on record as regards the age and
income of the deceased and thereafter the apposite
multiplier to be applied. The formula relating to
multiplier has been clearly stated in Sarla Verma Vs.
DTC, (2009) 6 SCC 121 and it has been approved in
Reshma Kumari Vs. Madan Mohan, (2013) 9 SCC
65. The age and income, as stated earlier, have to be
established by adducing evidence. The tribunal and
the courts have to bear in mind that the basic
principle lies in pragmatic computation which is in
proximity to reality. It is a well-accepted norm that
money cannot substitute a life lost but an effort has
to be made for grant of just compensation having
uniformity of approach. There has to be a balance
between the two extremes, that is, a windfall and
the pittance, a bonanza and the modicum.”
It is thus evident that the Claims Tribunal is not only empowered
but is also duty-bound to award “just compensation”. It is in the aforesaid
backdrop that the question referred to the Full Bench requires
consideration.
In the passing, reference may also made to the provisions of Section
163-A of the M.V. Act which is a special provision as to payment of
compensation on a structured formula basis. Under the aforesaid
provision, the claimant is not required to plead or establish that the death
or permanent disablement in respect of which a claim has been made was
due to any wrongful act or neglect or default of the owner of the vehicle
or vehicles concerned or of any other person. Schedule-II to the M.V. Act
prescribes the manner in which compensation under Section 163-A is
required to be adjudicated. In Item-3 thereof, general damages in case of
death includes medical expenses – actual expenses incurred before death
supported by bills / vouchers not exceeding as one-time payment to be
Rs.15,000/-. We may only observe that in the decision in Pranay Sethi
(supra), it has been noted that Schedule-II to the M.V. Act has not been
followed since the decision in U.P. State Road Transport Corporation Vs.
Trilok Chandra, (1996) 4 SCC 362. Reference is made to the aforesaid
only to indicate that actual medical expenses incurred to the extent of
Rs.15,000/- are admissible under Section 163-A of the M.V. Act without
providing for any deduction therefrom on account of any amount received
under a mediclaim policy.
CONSIDERATION OF DECISIONS OF THE SUPREME
COURT
10. In Helen C. Rebello and Ors. (supra), a Bench of two learned Judges
of the Supreme Court considered the question as to whether the life
insurance money received on account of a demise of the insured was liable
to be deducted from the amount of compensation that the claimants –
family members were entitled to receive under the Act of 1939. After
referring to various decisions including the decision in Bradburn (supra),
it was held that the amount of insurance is payable only on the
contingency referred to in the contract and if the contingency of injury or
death does not happen, the insured is the gainer as it receives more under
premium than to pay on maturity of the policy. In case the contingency
occurs, the claimant is the gainer as he receives the amount even before
paying the full premium and the gain is to the proportion of the balance
unpaid premium, whether on account of injury or death. In paragraph 35
of the said decision, it has been observed as under :-
“35. ……………………….. Similarly, life insurance policy is
received either by the insured or the heirs of the insured
on account of the contract with the insurer, for which the
insured contributes in the form of premium. It is
receivable even by the insured if he lives till maturity
after paying all the premiums. In the case of death, the
insurer indemnifies to pay the sum to the heirs, again in
terms of the contract for the premium paid. Again, this
amount is receivable by the claimant not on account of
any accidental death but otherwise on the insured’s
death. Death is only a step or contingency in terms of the
contract, to receive the amount. Similarly any cash, bank
balance, shares, fixed deposits, etc. though are all a
pecuniary advantage receivable by the heirs on account
of one’s death but all these have no corelation with the
amount receivable under a statute occasioned only on
account of accidental death. How could such an amount
come within the periphery of the Motor Vehicles Act to
be termed as “pecuniary advantage” liable for deduction.
When we seek the principle of loss and gain, it has to be
on a similar and same plane having nexus, inter se,
between them and not to which there is no semblance of
any corelation. The insured (deceased) contributes his
own money fro which he receives the amount which has
no corelation to the compensation computed as against
the tortfeasor for his negligence on account of the
accident. As aforesaid, the amount receivable as
compensation under the Act is on account of the injury
or death without making any contribution towards it,
then how can the fruits of an amount received through
contributions of the insured be deducted out of the
amount receivable under the Motor Vehicles Act. The
amount under this Act he receives without any
contribution. As we have said, the compensation payable
under the Motor Vehicles Act is statutory while the
amount receivable under the life insurance policy is
contractual.”
11. In Patricia Jean Mahajan and Ors. (supra), after referring to the
decision in Helen C. Rebello and Ors. (supra), it was held that the amount
received on account of social security must have a nexus or relation with
the accidental injury or death, for being deductible from the amount of
compensation. The amount received on account of an insurance policy of
the deceased cannot be deducted from the amount of compensation
though a receipt of the insurance amount was accelerated due to
premature death of the insured. This decision was also rendered by a
Bench of two learned Judges.
12. In Sebastiani Lakra and Ors. (supra), the aforesaid two decisions
were considered by a Bench comprising of three learned Judges. After
considering the provisions of Section 168 of the M. V. Act which required
payment of “just compensation” to the claimants, it was held in
paragraphs 12 and 13 as under :-
“12. The law is well settled that deductions cannot be
allowed from the amount of compensation either on
account of insurance or on account of pensionary
benefits or gratuity or grant of employment to a kin of
the deceased. The main reason is that all these
amounts are earned by the deceased on account of
contractual relations entered into by him with others.
It cannot be said that these amounts accrued to the
dependents or the legal heirs of the deceased on
account of his death in a motor vehicle accident. The
claimants / dependents are entitled to ‘just
compensation’ under the Motor Vehicles Act for death
of the deceased in a motor vehicle accident. Therefore,
the natural corollary is that the advantage which
accrues to the estate of the deceased or to his
dependents as a result of some contract or act which
the deceased performed in his lifetime cannot be said
to be the outcome or result of the death of the
deceased even though these amounts may go into the
hands of the dependents only after his death.
13. As far as any amount paid under any insurance policy
is concerned, whatever is added to the estate of the
deceased or his dependents is not because of the death
of the deceased but because of the contract entered
into between the deceased and the insurance company
from where he took out the policy. The deceased paid
premium on such life insurance and this amount
would have accrued to the estate of the deceased
either on maturity of the policy or on his death,
whatever be the manner of his death. These amounts
are paid because the deceased has wisely invested his
savings. Similar would be the position in case of other
investments like bank deposits, shares, debentures,
etc. The tortfeasor cannot take advantage of the
foresight and wise financial investments made by the
deceased.”
From the aforesaid decisions, it is now clear that the amount
received on account of insurance is due to the contractual obligations
entered into by the insured with others. Having paid premium it was clear
that the beneficial amount would accrue to the share of the deceased
either on maturity of the policy or on death, whatever be the manner of
death. The tortfeasor cannot take advantage of the foresight and wise
financial investments made by the deceased. This is the settled position of
law.
DECISIONS PERMITTING DEDUCTION OF
AMOUNT RECEIVED UNDER A MEDICLAIM POLICY
13. In Dineshchandra Shantilal Shah and Ors. (supra), the learned
Single Judge was considering an appeal filed by the New India Assurance
Company wherein the award passed by the Tribunal was under challenge.
Before the Tribunal it was noted that an amount of Rs.5,14,286/- towards
compensation included the amount of reimbursement that was granted
under a mediclaim policy of the claimant. It was urged by the insurer that
the amount received under the mediclaim policy was liable to be deducted
from the total amount of compensation as the claimant had already been
reimbursed the said amount. After referring to the judgment of the Delhi
High Court in National Insurance Company Ltd. Vs. R.K. Jain and Ors.,
2012 SCC OnLine Del 3303 (MSE Appeal No.346/2010 decided on 2nd
July 2012) and on the basis of ratio of the decisions of the Supreme Court
in Helen C. Rebello and Patricia Jean Mahajan (supra), it was held that the
amount received by the claimant under the mediclaim policy was liable to
be deducted from the total amount of compensation.
In our considered opinion, a deduction of the amount received
under a mediclaim policy by the claimant could not be directed to be so
deducted in the light of the law laid down in Sebastiani Lakra and Ors.
(supra) after considering the ratio of the decisions in Helen C. Rebello and
Patricia Jean Mahajan (supra). As held therein, the amount under a
mediclaim policy is received in view of a contract entered into by the
claimant with the insurance company and the same is received in view of
the terms of the contract. It is thus clear that the ratio of the decision in
Dineshchandra Shantilal Shah and Ors. (supra) does not indicate the
correct legal position.
14. We may note that the Karnataka High Court in Manish Gupta and
Anr. (supra) considered a reference made to the Division Bench as to
whether the amount received under a mediclaim policy could be deducted
from the total amount of compensation awarded under Section 168 of the
M.V. Act. It was held that the amount received by a claimant under a
mediclaim policy was required to be deducted from the total amount of
compensation received by the claimant under the head “medical
expenses”. It was further held that if no amount was received under the
mediclaim policy, the Tribunal was then required to assess the amount
spent by the claimant towards medical expenses and grant such amount
with respect to the bills produced. Similarly if the amount awarded under
a mediclaim policy was less than the actual amount spent by the claimant
towards medical expenses, the shortfall or the balance was required to be
made good by the tortfeasor.
15. The Division Bench of the Kerala High Court in Akber Badsha and
Ors. (supra) also considered a similar reference made to the Division
Bench as regards permissibility of deduction of the amount received by the
claimant under a mediclaim policy. After referring to various decisions
including the judgment of the Karnataka High Court in Manish Gupta and
Anr. (supra), a similar view was taken that such deduction of the amount
received under a mediclaim policy from the total amount of compensation
was permissible.
In our view, in the light of the decision in Sebastiani Lakra and Ors.
(supra), the deduction of any amount received by a claimant under a
mediclaim policy would not be permissible. We are therefore not in a
position to agree with the view taken by the Karnataka High Court and the
Kerala High Court in the aforesaid two decisions.
DECISIONS DISALLOWING DEDUCTION OF
AMOUNT RECEIVED UNDER A MEDICLAIM POLICY
16. Various learned Single Judges have taken the view that any amount
received under a medicalim policy is not liable to be deducted from the
amount of compensation awarded under the head “medical expenses”.
Such view as taken in Vrajesh Navnitlal Desai, Ajit Chandrakant Rakvi,
Anjana Nileshkumar Parmar, Vaswati Samiran Ganguly, Suryakant Uttam
Gaude and Aman Sanjay Tak (supra) is consistent with the view taken by the Supreme Court in Sebastiani Lakra and Ors. (supra) that no such deduction of the amount of mediclaim from the amount of compensation awarded is permissible. It is not necessary for us to refer to various other decisions rendered by learned Single Judges that have consistently taken the view that the amount received under a mediclaim policy is not liable to be deducted from the amount of compensation awarded under Section
168 of the M.V. Act. In our view, the legal position has been correctly laid
down in the aforesaid decisions of this Court.
17. We may also refer to the judgment of the Division Bench of the
Calcutta High Court in New India Assurance Company Ltd. Vs. Bimal
Kumar Shah and Anr., 2019 ACJ 1532 in this regard. Dipankar Datta, J.
(as His Lordship then was) in his concurring opinion held that what a
victim gets from his mediclaim policy is the return for making payment of
premiums. It is the hard-earned money that he puts in towards premium
which is thereafter returned to him upon happening of an accident. The
return that a victim receives from his insurer on a claim arising out of a
mediclaim policy in the circumstances is consolation money. To consider
such benefit as a benefit received from other sources while determining
the amount of compensation would be a narrow minded approach, not
intended in the best interest of the victim. He therefore observed that the
money received by an accident victim as return for money invested by him
ought not to be comprehended as a benefit received and therefore the
question of the victim being doubly benefited did not and could not arise.
We are in respectful agreement with the aforesaid view as taken after
referring to the decisions in Helen C. Rebello and Patricia Jean Mahajan
(supra).
ANSWER TO THE QUESTION REFERRED
18. In the light of the foregoing discussion, we are of the considered opinion that the question as framed ought to be answered in the negative. Thus, any amount received by a claimant under a mediclaim policy or under a medical insurance policy is not liable to be deducted from the amount of compensation payable to a claimant under the head “medical expenses” in proceedings under Section 166 of the M.V. Act.
19. Before parting, we place on record our appreciation for the valuable
assistance rendered by learned counsel to the Court enabling the reference
to be answered. We also acknowledge the efforts of the learned Amicus
Curiae in this regard.
The First Appeal be now placed before the learned Single Judge for
its consideration on merits.
[GAURI GODSE, J.] [MILIND N. JADHAV, J.] [A.S. CHANDURKAR, J.]
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