That the appellant had purchased an insurance policy No.36060231130100003910 by paying the premium on the policy to the respondent-insurer covering the territory of India initially and later Nepal also. Santliya Tharu, wife of Ram Parshad Tharu, resident of Ward no.7, Gram Vikas Samiti, District Banke Titeeherea (Nepal) died and Ram Parshad Tharu was injured.
According to the appellant, 3 a sum of Rs.5,24,000/- (Nepalese Rupee) (INR 3,27,500/-) was paid to Jeet Bahadur Tharu, the only son of Ram Parshad Tharu and Smt.
The components of the claim, excluding interest and costs, made by the Appellant before the District Forum can be summarised in the tabular form, as under: 4 Claim Component Nepalese Rupee (NPR) Indian Rupee (INR) Death Claim Rs.5,24,000/- Rs.3,27,500/- Hospital Rs.6,54,000/- Rs.4,09,000/- Final Settlement Rs.4,80,000/- Rs.3,00,000/- Total as per claim Rs.16,58,400/- Rs.10,36,500/- 6.
On consideration of the same, the District Forum held in favour of the appellant herein, directed the respondent herein to settle the claim as per the terms and conditions incorporated in the insurance policy and to release only the payments which are legally found payable to the appellant in terms of the insurance policy.
The State Commission observed that the respondent-insurance company had deposited an amount of Rs.25,000/- before the State Commission at the time of filing the appeal and had further deposited a sum of Rs.5,75,000/- in compliance with an Order of the Commission and directed that the same shall be released to the appellant herein within a period of forty-five days of the said judgment.
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In this regard, an application has been filed by the appellant herein seeking to bring on record three documents being medical bill receipt dated 16.09.2014, 17.09.2014 and detailed inventory i.e., statement of expenditure provided by the hospital from 27.09.2014 to 01.11.2014 as Annexure P-9, in order to establish that a sum of Rs.4,39,318.99/- was paid by the appellant herein to Charak Hospital and Research Centre, Lucknow towards the treatment of Ram Prashad Tharu who had sustained injuries in the accident. The District Forum categorically directed that the opposite party i.e., respondent-insurer herein had to settle the claim as per the terms and conditions incorporated in the insurance policy and to release the payment which was legally payable to the appellant herein and to indemnify as per the insurance policy.
We have perused the said Exhibits (Annexure P9 to P28) which have been issued by Charak Hospital and Research Centre, as per which appellant had incurred expenditure of Rs.6,54,000/- (Nepalese Rupee) equivalent to Rs.4,09,000/- (Indian Rupee) in the medical treatment of Ram Prashad Tharu. We do not think that is a correct reading of the Order of the District Forum inasmuch as the District Forum had specifically referred to medical bills at Exhibits C-19 to C- 28 and had directed the insurance company to release the amount 9 found admissible to the complainant-appellant.
We observe that the submissions made on behalf of the insurance company before the NCDRC are contrary to the evidence on record as a result of which the appellant herein has been not only deprived of the aforesaid amount spent by him towards medical expenses owing to the injuries sustained by the injured Ram Parshad Tharu in the accident in respect of which there is a third-party insurance coverage, but also has been constrained to approach this Court.
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The aforesaid amounts shall be disbursed to the appellant within a period of one month from today.
Case Title: HEM RAJ Vs. THE NEW INDIA ASSURANCE COMPANY LTD. (2023 INSC 644)
Case Number: C.A. No.-004642-004642 / 2023
