In a significant ruling by the Delhi High Court, the case of Aas Mohammad vs. Insurance Company sheds light on insurance fraud and its impact on claimants. This landmark judgment sets a precedent for holding insurance companies accountable for their actions. The court’s decision brings justice to Aas Mohammad and highlights the importance of legal integrity in insurance matters.
Facts
- The injured/claimant filed an appeal against the judgment-cum-award of the Motor Accident Claims Tribunal, Patiala House Court, New Delhi.
- The injuries suffered were traumatic and would significantly impact the claimant’s daily life.
- The compensation for loss of earning capacity was re-calculated to be Rs. 1,95,000/- based on a monthly income of Rs. 10,000.
- Additional compensation was granted for mental, physical shock, pain, suffering, and loss of amenities.
- The claimant’s disability was assessed at 15% temporary and 15% permanent by medical experts.
- The claimant’s occupation as a plumber was considered in determining the disability percentage of 10% for the whole body.
- An amount of Rs. 1,20,000/- was awarded towards loss of income/earnings due to the claimant’s inability to work for a year.
- A future earning/functional disability compensation was granted based on the claimant’s age of 49 years and the severe injuries sustained in the accident.
- A 25% addition to the claimant’s notional income was made, and a disability of 10% of the whole body was recognized by the Tribunal.
- Claim petition under Sections 166 and 140 of the M.V. Act allowed for permanent disability of 85% suffered by Aas Mohd.
- Total compensation awarded is Rs. 88,33,363/-
- The insurer is trying to avoid liability based on evidence in MACP
- No compensation received by Aas Mohd., who suffered 85% permanent physical impairment in right lower limb
Arguments
- Gross injustice caused by the misconduct and dilly-dallied strategy of the Insurance Company.
- Multiple adjournments taken by the Insurance Company to lead evidence in MACP No 136/2016.
- Misery of the appellant aggravated as the driver and registered owner of the offending vehicle remain untraceable.
- Counsel for the claimant citing precedents in Mangla Ram v. Oriental Insurance Co. Ltd., Oriental Insurance Co. Ltd. v. Jayeshbhai Bhagubhai Patel, National Insurance Co. Ltd. v. K. Saravanan, V. Ravi v. M/s New India Assuarance Co. Ltd., Silli Man Subba v. Man Bahadur Subba, United India Insurance Co. Ltd. v. Guddy.
- Fraud vitiates everything and absence of insurance for third-party risks negates liability for compensation on the Insurance Company
Analysis
- In the given judgement, the issue of genuineness of the policy of insurance has been extensively discussed.
- The Insurance Company attempted to prove that the policy of insurance was forged and fabricated.
- The testimony of witnesses from the Insurance Company regarding the fake cover note did not hold up under scrutiny.
- The Tribunal found discrepancies in the stamp impressions and address details on the cover note presented as evidence.
- The Tribunal applied the principle of issue estoppel, barring the Insurance Company from re-agitating the matter in subsequent claims.
- A complaint was lodged about the use of the forged cover note, further supporting the insincerity of the insurance document.
- Various inconsistencies were highlighted in the evidence presented by the Insurance Company’s witnesses, weakening their case.
- The Tribunal’s decision to exonerate the Insurance Company from making compensation payments was found to be legally untenable.
- Challenges were made to the calculation of compensation amounts awarded, with discrepancies identified in the assessment of future income and disability percentages.
- The judgment delved into the specifics of medical expenses, future treatments, and household work disruptions experienced by the claimants.
- Overall, the analysis of the insurance policy’s validity and the subsequent legal implications formed a crucial part of the judgement.
- The decision in the Kerala High Court case of Devi T. V. vs. Jamsheer P. & Ors. involved two claimants who were injured while traveling in an auto-rickshaw.
- The Tribunal held the Insurance Company liable for compensation in one claim petition, while in the other, the liability was on the driver and registered owner, relieving the Insurer of financial liability.
- A mixed question of law and fact decided in an earlier proceeding between the same parties cannot be challenged in a subsequent proceeding between the same parties.
- The interpretation of a statute in a previous decision will be binding in a later proceeding between the same parties if the cause of action and the issue are the same.
- The Supreme Court case of Mathura Prasad Bajoo Jaiswal v. Dossbai N.B. Jeejeebhoy emphasized that the correctness of the earlier judgment is not relevant in determining the application of the rule of res judicata.
- There is limited evidence to confirm if a nursing assistant or attendant was involved in attending to the patient while she was bedridden.
- It is plausible that the patient would have required assistance with daily routines during her confinement.
- The judgement in MACP No. 136/2016 is deemed unjust as it exonerates the insurance company from compensatory liability towards the patient.
- Hence, the decision in the mentioned case with respect to the insurance company’s financial responsibility is to be overturned.
Decision
- MAC APP No 1033/2018 filed by the insurance company is dismissed.
- Compensation for nursing/attendant is enhanced to Rs. 1,00,000/- from Rs. 50,000/-.
- MAC APP No 306/2019 filed by the claimant-injured is allowed.
- A sum of Rs. 1,00,000/- awarded towards future medical treatment.
- Total compensation worked out to be Rs.16,37,555/-.
- MAC APP No 304/2019 filed by the claimant-injured is allowed.
- Total compensation awarded is Rs. 16,37,555/- with interest @ 9% per annum.
- MAC APP No 1041/2018 filed by the insurance company is dismissed.
- Total compensation of Rs. 16,37,555/- awarded to the claimant/injured.
- Insurance company to pay entire compensation of Rs. 88,33,363/- to the appellant Aas Mohammad with interest @ 9%.
- Compensation towards pain and suffering enhanced to Rs. 2,00,000/-.
- Equivalent amount of Rs. 2,00,000/- awarded towards loss of enjoyment of life.
- Total compensation worked out to be Rs. 8,96,663/- with interest @ 9% per annum.
- Compensation towards pain and suffering enhanced to Rs. 2,00,000/-.
- Equal amount of Rs. 2,00,000/- enhanced towards loss of amenities and enjoyment of life.
- MAC APP 379/2023 decided accordingly.
- Amount of compensation to be deposited within four weeks or penal interest @ 12% per annum to be paid by Insurance Company.
Case Title: ISHRAT Vs. FUTURE GENERALI INDIA INSURANCE COMPANY LTD & ORS (2024:DHC:4014)
Case Number: MAC.APP.-304/2019
