Punjab & Haryana HC: Motor accident claim tribunal can allow medical expenses more than 15000/- in petition under S 163A of Motor vehicle Act

In my opinion, the submissions cannot be accepted. It has been held by Hon'ble Supreme Court of India in a number of decisions that the second schedule contains a number of fallacies. It has to be followed in broad principles. In suitable cases where treatment is long or loss is heavy, the compensation cannot be kept confined within the limits prescribed by the second schedule. The law on the point is well settled by Hon'ble Supreme Court of India in U.P. State Road Transport Corporation Vs. Trilok Chandra MANU/SC/1154/1996 : 1996 (4) SCC 362. The decision in Trilok Chandra's case [supra] has been reiterated by Hon'ble Supreme Court in National Insurance Company Ltd. Vs. Smt. Saroj & Ors. MANU/SC/0988/2009 : 2009 (3) RCR (Civil) 431. In this view of the matter, I do not find any ground to interfere with the award passed by learned Tribunal. Consequently, the appeal is dismissed in limine. 

{Para 4}

 IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH

F.A.O. No. 3874 of 2013 [O&M]

Decided On: 26.07.2013

The Oriental Insurance Company Limited Vs. Kulwinder Kaur and Ors.

Hon'ble Judges/Coram:

Vijender Singh Malik, J.

Citation: 2014 ACJ 16252014 ACC P&H 4 1482014 RCR CIVIL 1 7562013 PLR 172 3722013 SCC ONLINE P&H 144242013 PUNLR 4 372, MANU/PH/1225/2013.

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Bombay HC: How to ascertain which perks given to employee is for his benefit and which perks are for benefit of his family for computation of compensation in motor accident?

 In the present case, the deceased was in service. As far as determination of income by way of salary is concerned, the law has been laid down by the Apex Court in case of National Insurance Company Ltd. v. Indira Srivastava and others (MANU/SC/8201/2007 : AIR 2008 SC 845) (supra). In paragraph 10 (Para 9 of AIR) of its decision, the Apex Court held thus:-

10...If some facilities are being provided whereby the entire family stands to benefit, the same, in our opinion, must be held to be relevant for the purpose of computation of total income on the basis whereof the amount of compensation payable for the death of the kith and kin of the applicant is required to be determined.... {Para 16}

The ultimate conclusion is in paragraph 19 (Para 17 of AIR) of its judgment which reads thus:-

19 The amounts, therefore, which were required to be paid to the deceased by his employer by way of perks, should be included for computation of his monthly income by way of contribution to the family as contra distinguished to the ones which were for his benefit. We may, however, hasten to add that from the said amount of income, the statutory amount of tax payable thereupon must be deducted.

17. Thus, the well settled position of law is that the amounts which were paid to the deceased by way of perks should be taken into consideration for computation of monthly income provided the perks were for the benefit of the family of the deceased. However, the allowances which were meant only for his personal benefit cannot be taken into consideration. The income-tax will have to be deducted from the income while arriving at the income for determining multiplicand. 

Due to absence of any evidence adduced by the first respondent to show that the Uniform Making Allowance, Uniform Washing Allowance, Transport Allowance, Conveyance, Medical Expenses were for the benefit of the family, the same cannot be taken into consideration for computing the loss of dependency. As far as the Academic Research Allowance is concerned, the same is payable as a perk apart from the basic salary. As suggested by the very name, it was not payable to the deceased by way of reimbursement of expenditure incurred by him. Hence, the benefit thereof was available not only to the deceased but also to his family members. Therefore, the said amount will have to be taken into consideration and will have to be added to the basic salary of Rs. 31,950/-. Thus, the gross salary comes to Rs. 34,950/- which can be rounded off to Rs. 35,000/-.

 IN THE HIGH COURT OF BOMBAY

First Appeal No. 1068 of 2012

Decided On: 31.08.2012

National Insurance Co. Ltd. Vs. Vaishali Harish Devare and Ors.

Hon'ble Judges/Coram:

Abhay Shreeniwas Oka and Sadhana S. Jadhav, JJ.

Citation: 2014 ACJ 415 Bom, MANU/MH/2291/2012.

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Bombay HC: Medical insurance payouts not deductible from Motor Vehicles Act compensation

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

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Whether insurer can refuse claim of insured on ground that he was suffering from diabetes and hypertension?

The bone of contention, or the point of dispute is the precise meaning of “complications arising from pre-existing disease will be considered part of that pre-existing condition.”. This stipulation itself occurs in an exclusion clause. There is some authority that an exclusion clause, in the context of a contract of insurance, which is an assurance whose main purpose has to be given prominance, should be construed strictly (Ref. Skandia Insurance Co. Ltd. v. Kokilaben Chandravadan & Ors., 1987 (2) SCC 654; B.V. Nagaraju v. Oriental Insurance Co. Ltd., 1996 (4) SCC 647). The primacy given to the main purpose, notwithstanding that contracting parties agreed to certain exclusions, is founded on the principle of interpretation that if contracting parties seek to achieve a certain purpose by entering into an agreement, the existence of exclusion clauses should be strictly interpreted and if it tends to defeat the main purpose, should be read down by the Court; if that is not possible, the court should altogether ignore it (Ref Halsbury, LC in Glynn v. Margeston & Co 1893 AC 351).

22. If the rule indicated in the preceding paragraph were kept in mind, it would be apparent that the object of the insurance policy is to cater to medical expenses incurred by the insured. That is the “main purpose” of the contract of insurance. The object of the exclusion clause is to except the liability of the insurer. In a sense this is at variance with the object of the policy. Nevertheless, it is a part of the contract; the court should firstly seek to harmonise the all the clauses, and attempt to give effect to it. If one proceeds on this premise, the concept of “pre-existing condition” has to be understood. Clause 4.1 defines it as any injury which existed prior to the effective date of the insurance; and any sickness or its symptoms which existed prior to the effective date of the insurance, whether or not the insured had knowledge that the symptoms were relating to the sickness. It is apparent that even if there were known diseases or conditions, which were disclosed and for which there was a likelihood of complications arising in the future, the insurer sought to distance itself from the liability. There is no dispute here that diabetes was a condition at the time of submission of proposal; so was hyper tension. In a sense these were “old ailments” the petitioner was advised to undergo ECG, which he did. The insurer accepted the proposal and issued the cover. One may ask, what then was the cover for. It is not an accident cover policy, or a life policy. Now, it is universally known that hypertension and diabetes can lead to a host of ailments, such as stroke, cardiac disease, renal failure, liver complications, etc, depending upon varied factors. That implies that there is probability of such ailments; equally they can arise in non-dibetics or those without hypertension. Unless the insurer spelt out with sufficient clairity, the purport of its clauses, or charged a higher premia, at the time of accepting the proposal, the insured would assume and perhaps, reasonably that later, unforseen ailments would be covered. Thus, it would be apparent that giving a textual effect to clause 4.1 would in most such cases render the mediclaim cover meaningless; the policy would be reduced to a contract with no content, in the event of the happening of the contingency. Therefore, I am of the opinion that clause 4.1 cannot be allowed to override the insurer's primary liability; the “main 


purpose” rule would have to be pressed into service. This finding is reinforced in this case, as the insurer renewed the policy, in 2006, after the petitioner underwent the CABG procedure.

23. In view of the above discussion, the refusal by the insurer to process and reimburse the petitioner's claim is arbitrary and unreasonable; as a state agency, it has to set standards of model behaviour; its attitude here has displayed a contrary tendency. A direction is issued to the respondent to process the petitioner's claim, and ensure that he is reimbursed for the procedure undergone by him according to the claim lodged with it, within six weeks.

HIGH COURT OF DELHI

W.P.(C) 656/2007

Hari Om Agarwal Vs Oriental Insurance Co. Ltd 

S. Ravindra Bhat, J.

Decided on 17.09.2007

Citation: 2007 SCC OnLine Del 1278 : (2007) 98 DRJ 246 : AIR 2008 Del 29

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Whether son is liable to pay medical expenses to his mother under domestic violence Act?

In this case there is no dispute that petitioner No. 1 Ganesh was liable to pay maintenance and he would also be liable to incur medical expenses as mentioned in Section 20(1)(b) of the Domestic Violence Act. However, so far as petitioner Nos. 2 and 3 are concerned, under Hindu Adoptions and Maintenance Act, 1956, as grandsons they would have been liable to pay maintenance under Section 22(1) of the Hindu Adoptions and Maintenance Act, 1956, provided their father had not been alive. When the father of petitioner Nos. 2 and 3 is alive and is capable of paying maintenance, Section 22(1) of the Hindu Adoptions and Maintenance Act, will not be applicable and under Section 20 of the Hindu Adoptions and Maintenance Act, petitioner No. 1 would be liable to pay maintenance to his mother i.e. respondent No. 2. As per Section 20 (b) of the Domestic Violence Act, the maintenance includes even medical attendance and treatment.

IN THE HIGH COURT OF BOMBAY (AURANGABAD BENCH)

Criminal Writ Petition No. 892 of 2009

Decided On: 10.02.2010

 Ganesh and Ors. Vs.  The State of Maharashtra and Ors.

Hon'ble Judges/Coram:

P.R. Borkar, J.

Citation:  2010   (112)   BOMLR   1082

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Whether family members of accused can directed to bear medical expenses of accused?

 Learned counsel for the petitioner stated that the
injection costs about Rs. 10,000/- and at some places, on
account of discount, it is available for almost Rs. 8000/-,
however, the family of the petitioner is asked to supply the
said injection and other medicines by the Hospital
Authorities. This situation cannot be countenanced. It is the

duty of the State to take care of the petitioner who is in their
custody.
5. In Pt. Parmanand Katara vs. Union of India and
ors. - (1989) 4 SCC 286, the Hon'ble Supreme Court has
held that Article 21 of the Constitution casts the obligation
on the State to preserve life. The patient, whether he be an
innocent person or be a criminal liable to punishment under
the laws of the society, it is the obligation of those who are in
charge of the health of the community to preserve life.
6. In Rama Murthy vs. State of Karnataka – (1997) 2
SCC 642, the Hon'ble Supreme Court, after reference to the
recommendations in the Mulla Committee report has held
that the society has an obligation towards prisoner's health
for two reasons. First, the prisoners do not enjoy the access
to the medical expertise that free citizens have. Their
incarceration places limitation of such access; no physician
of choice, no second opinion, and few if any specialists.
Secondly, because of the conditions of their incarceration,
inmates are exposed to more health hazards than free

citizens. Prisoners therefore, suffer from a double handicap.
7. Even recently, in Re-Inhuman Conditions in 1382
Prisons – (2017) 10 SCC 658, the Hon'ble Supreme Court
has reiterated that providing medical facilities to inmates in
prisons is a human right. The State Governments were
directed to state the availability of the medical assistance to
the prisoners and take remedial steps wherever necessary.
8. Taking into consideration the aforesaid legal position
enunciated by the Hon'ble Supreme Court, we were unable
to accept the approach of the respondents in the present
case. The record indicates that the Doctors who are treating
the petitioner have themselves advised that the petitioner
must be administered certain medications. The State, in such
circumstances, cannot avoid its responsibility or require the
petitioner or his relatives to arrange for such medicines,
particularly when there is material on record which indicates
that neither the petitioner nor his relatives are really in a
position to afford such medicines. In this view of the matter,

by order dated 13.3.2018 passed by this Court, it was
directed that adequate arrangements be made to see that
the petitioner is provided the injections as well as other
medicines required by him as advised by the doctor at State
cost. In order to see that this order is complied with, we had
adjourned the matter from time to time.
IN THE HIGH COURT OF JUDICATURE AT BOMBAY
CRIMINAL APPELLATE JURISDICTION
CRIMINAL WRIT PETITION NO. 5301 OF 2017

Ajaysingh Kuvarsingh Dahiya Vs The State of Maharashtra & Anr. 


CORAM : SMT. V.K. TAHILRAMANI, Acting C.J. &
M.S. SONAK, J.
DATE : JUNE 18, 2018.

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Supreme Court: Procedure to be followed by court for deposit of compensation amount in fixed deposit in motor accident claim petition

In a case of compensation for death it is appropriate that the Tribunals do keep in mind the principles enunciated by this Court in Union Carbide Corporation v. Union of India MANU/SC/0058/1992 : AIR1992SC248 in the matter of appropriate investments to safeguard the feed from being frittered away by the beneficiaries owing to ignorance, illiteracy and susceptibility to exploitation. In that case approving the judgment of the Gujarat High Court in Muljibhai Ajarambhai Harijan v. United India Insurance Co. Ltd. MANU/GJ/0141/1982 : (1982)1GLR756, this Court offered the following guidelines:--

(i) The Claims Tribunal should, in the case of minors, invariably order the amount of compensation awarded to the minor be invested in long term fixed deposits at least till the date of the minor attaining majority. The expenses incurred by the guardian or next friend may, however, be allowed to be withdrawn:

(ii) In the case of illiterate claimants also the Claims Tribunal should follow the procedure set out in (i) above, but if lump sum payment is required for effecting purchases of any movable or immovable property such as, agricultural implements, rickshaw, etc., to earn a living, the Tribunal may consider such a request after making sure that the amount is actually spent for the purpose and the demand is not a ruse to withdraw money;

(iii) In the case of semi-literate persons the Tribunal should ordinarily resort to the procedure set out at (i) above unless it is satisfied, for reasons to be stated in writing, that the whole or part of the amount is required for expanding and existing business or for purchasing some property as mentioned in (ii) above for earning his livelihood, in which case the Tribunal will ensure that the amount is invested for the purpose for which it is demanded and paid;

(iv) In the case of literate persons also the Tribunal may resort to the procedure indicated in (i) above, subject to the relaxation set out in (ii) and (iii) above, if having regard to the age, fiscal background and strata of society to which the claimant belongs and such other considerations, the Tribunal in the larger interest of the claimant and with a view to ensuring the safety of the compensation awarded to him thinks it necessary to do order;

(v) In the case of windows the Claims Tribunal should invariably follow the procedure set out in (i) above;

(vi) In personal injury cases if further treatment is necessary the Claims Tribunal on being satisfied about the same, which shall be recorded in writing, permit withdrawal of such amount as is necessary for incurring the expenses for such treatment;

(vii) In all cases in which investment in long term fixed deposits is made it should be on condition that the Bank will not permit any loan or advance on the fixed deposit and interest on the amount invested is paid monthly directly to the claimant or his guardian, as the case may be;

(viii) In all cases Tribunal should grant to the claimants liberty to apply for withdrawal in case of an emergency. To meet with such a contingency, if the amount awarded is substantial, the Claims Tribunal may invest it in more than one Fixed Deposit so that if need be one such F.D.R. can be liquidated."

30. Further, in Lilaben Udesing Gobel v. Oriental Insurance Co. Ltd. and Ors. MANU/SC/0420/1996 : [1996]3SCR450 the Court relied upon the said directions and further held that in Union Carbide Corporation's case (supra), this Court did not include the clause regarding literate persons' compensation and directed that it should be given the same treatment in case the Court found it necessary to do so to protect the compensation awarded to them. The Court further added one guideline as under:--

"We must add one further guideline to the effect that when the amount is invested in a fixed deposit, the bank should invariably be directed to affix a note on the fixed deposit receipt that no loan or advance should be granted on the strength of the said FDR without the express permission of the Court/Tribunal which ordered the deposit. This will eliminate the practice of taking loans which may be up to 80% of the amount invested and thereby defeating the very purpose of the order. We do hope that the Courts/Tribunal in the country will not succumb to the temptation of permitting huge withdrawals in the hope of disposing of the claim. We are sure that the Courts/Tribunals will realise their duty towards the victims of the accident so that a large part of the compensation amount is not lost to them. The very purpose of laying down the guidelines was to ensure the safety of the amount so that the claimants do not become victims of unscrupulous persons and unethical agreements or arrangements. We do hope our anxiety to protect the claimants from exploitation by such elements will be equally shared by the Courts Tribunals."

IN THE SUPREME COURT OF INDIA

Civil Appeal No. 7989 of 2002

Decided On: 03.12.2002

Nagappa Vs. Gurudayal Singh and Ors.

Hon'ble Judges/Coram:

M.B. Shah, B.P. Singh and H.K. Sema, JJ.

Citation:  (2009) 13 SCC 710

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Whether divorced muslim woman is entitled to recover medical expenses incurred by her from her former husband?

The next question to be considered is whether

the medical expenses incurred by the petitioner subsequent

to the extra judicial divorce can be claimed from her former

husband. It seems from Section 3(3) of the Act that the

Magistrate has to pass an order directing her former

husband to pay such "reasonable and fair provision and

maintenance to the divorced woman as he may determine

as fit and proper having regard to the needs of the divorced


woman, the standard of life enjoyed by her during her

marriage         and   the   means        of her  former husband

...................." Therefore, it is evident that in determining

"reasonable and fair provision and maintenance" the court

has to consider the needs of the divorced woman and fix an

amount which it deems fit and proper. In such a case, the

financial needs of the divorced woman has got importance

in arriving at the quantum.             In order to have a proper

determination, the courts have to consider such needs of

the divorced woman also. When the petitioner has been

clamouring that she has been suffering from renal disease,

for which she had to spend huge amounts, it cannot be said

that those are not needs of a divorced woman. Therefore, in

such case, if she is able to produce evidence to prove that

she had spent much amounts for such medical treatments,

no doubt she would be entitled to claim that amount from

her former husband.           It has come out that the counter

petitioner is well off.
IN THE HIGH COURT OF KERALA AT ERNAKULAM

                                                      PRESENT:

                         MR. JUSTICE B.KEMAL PASHA

             22ND DAY OF JULY 2015

                    Crl.MC.No. 2121 of 2009 
            ABBAS, S/O.MAMMU,
            V

        SOUDA K.V., D/O.KUNJIMON,
Citation:2016 CRLJ 3142 kerala
           

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Whether computation for medical expenses can be done even if bills are not produced?

Pecuniary damages awarded for medical expenses must thus be restricted to only those amounts which can be proved by the plaintiff/respondent in evidence. From the bills and receipts provided by Susan, the Learned Single Judge of the Delhi High Court found  that the medical expenses incurred were of the amount $5513.80 in Australian Dollars and ₹ 74249.05 in Indian Rupees. Susan's father, PW2, Mr. GL Beer however, had in his testimony stated that he has in fact incurred about AUD 1,50,000 as medical expenses for her care after the onset of quadriplegia. Since the plaintiff was unable to adduce bills to show for these expenses, this Court is of the opinion that only those expenses for which bills have been produced may be used in computation of damages under the head of "medical expenses".

Delhi High Court

India Tourism Development ... vs Miss Susan Leigh Beer on 30 May, 2014

Citation; AIR2015(NOC)56 Delhi

CORAM:

HON'BLE MR. JUSTICE S. RAVINDRA BHAT HON'BLE MR. JUSTICE SUDERSHAN KUMAR MISRA 

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