High Court enhanced medical compensation awarded to a road accident victim. The court held the insurance company must pay the difference between actual medical bills and the portion reimbursed by the employer, ordering joint and several liability.
Respondents directed to pay Rs. 3,30,778/- as medical expenses within 45 days.
This page shows the compact analysis of this judgement. The full analysis — procedural history, issue-by-issue holdings with ratio and obiter, advocates, and paragraph-level evidence for every claim — is being added to the record in batches and will appear here when this judgement has been through it.
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FAO No.4018 of 2008 (O&M)
IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH
FAO No.4018 of 2008 (O&M) Date of decision: 18.4.2012
K.C.Beniwal
...Appellant
Versus
Vijay Kumar and others
...Respondents
CORAM: HON'BLE MR.JUSTICE JITENDRA CHAUHAN
Present: Mr.Rajeev Godara, Advocate for the appellant
Mr.Ravinderr G. Arora, Advocate for respondent No.3.
Jitendra Chauhan, J. (Oral)
The present appeal has been preferred by the injured -appellant, seeking enhancement of the compensation amount awarded by the learned Motor Accident Claims Tribunal, Sirsa (for short 'the Tribunal') vide award dated 19.5.2008, on account of the injuries suffered by the him in a road accident on 4.9.2004.
Learned counsel for the appellant contends that the injuredappellant is a government employee. He suffered multiple grievous injuries in a road accident on 4.9.2004. He further submits that on treatment, he actually incurred Rs. 13,94,804/-, out of which, an amount of Rs.10,64,026/was reimbursed to him as per the norms of the PGI/AIIMS by the employer. He further submits that he could not produce the rejection letter and other
FAO No.4018 of 2008 (O&M) 2
representation before the learned Tribunal, vide which the remaining amount was not reimbursed to him. However, the same are proved and issued by the Fortis Hospital, Mohali, wherefrom the appellant took the treatment.
On the other hand, learned counsel for the respondentInsurance Company has contended that the proved bills and other expenses incurred on his treatment stand reimbursed by the department as per the rates of the PGI/AIIMS. He further states that the appellant did not place on record the documents establishing the amount spent. Therefore, the case may be remanded back so that the appellant may lead evidence.
I have heard the learned counsel for the parties and perused the
record.
As per the testimony of PW5 Mr.Deepak Saini, Executive Medical Officer of Record, it is amply established that the appellant incurred Rs.13,94,804, for his treatment. The amount was duly paid by him as was made out from the Bill Ex.PW5/A. The only controversy requires for consideration by this Court is as to “whether the actual amount incurred by the appellant on treatment is to be paid or only the amount admissible as per PGI/AIIMS rates is to be paid.”
So far the liability of the employer i.e. Director, Technical Education Department, Haryana is concerned, it was only to the extent of the rates prescribed by the PGI/AIIMS and the same have been paid to the appellant and a sum of Rs.10,64,026/- out of total actual incurred expenses was reimbursed by the Employer i.e. Director, Technical Education
FAO No.4018 of 2008 (O&M) 3
Department, Haryana as per PGI/ AIIMS rates. The fact remains that expenses of rs.13,94,804/- were actually incurred and paid by the appellant as per the testimony of PW5 Mr.Deepak Saini. Therefore, this Court feels that this is not a case, which requires to be remanded back. The expenses incurred by the appellant are proved. The Insurance Company has not paid any amount to the appellant. The amount was paid by the employer i.e. Director, Technical Education Department Haryana and the remaining amount i.e. Rs.3,30,778/- which was incurred and stands paid by the appellant from his own pocket, is to be paid by the respondents. Ordered accordingly.
The respondents are directed to pay further sum of Rs.3,30,778/- as medical expenses jointly and severally to the appellant within 45 days from the date of the receipt of the certified copy of the judgment, failing which, the appellant shall be entitled to get interest @ 7.5% per annum from the date of the filing of the appeal, till its realisation.
In view of the above, the present appeal is partly allowed and the impugned award is modified to the above extent.
(JITENDRA CHAUHAN) JUDGE
18.4.2012 gsv
1 issue framed by the court
Whether the insurance company is liable to pay the difference between the actual medical expenses incurred and the amount reimbursed by the employer.
K.C. Beniwal
Vijay Kumar
Jitendra Chauhan
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
