MOTOR VEHICLES ACT, 1988 – Ss. 146, 147, 166 and 168 – Compensation – Medical expenses – Mediclaim policy – Deduction of Mediclaim reimbursement from MACT compensation – Permissibility – Distinction between statutory and contractual benefits – “Double benefit” principle – Scope.
Claimants injured in motor vehicle accident received reimbursement of medical expenses under Mediclaim policy and also claimed compensation under Motor Vehicles Act before Motor Accident Claims Tribunal – Conflict of judicial opinion among various High Courts as to whether Mediclaim amount is deductible from compensation awarded under head of medical expenses – Reference considered.
Held : Amount received under Mediclaim/medical insurance policy is not deductible from compensation awarded under Motor Vehicles Act even where compensation includes medical expenses. Mediclaim policy is contractual in nature and benefit flowing therefrom is consequence of premiums paid by insured over period of time. Compensation under Motor Vehicles Act, on other hand, is statutory entitlement arising from wrongful act causing accident and is governed by principle of just compensation.
Principle against “double benefit” applies only where two payments compensate same loss from same source or within same legal sphere. Benefits which are independent in nature and arise from separate contractual or statutory foundations are not liable to deduction. Mediclaim reimbursement cannot be treated as windfall or unjust enrichment since claimant receives such amount only because of prior contribution by payment of premiums.
If Mediclaim amount were deducted from MACT compensation, it would unjustly benefit insurer of offending vehicle and simultaneously deprive claimant of fruits of prudence and financial planning. Mediclaim and compensation under MVA operate in distinct domains; one arises from private contract while other flows from beneficial legislation enacted for protection of motor accident victims.
Benefits such as provident fund, gratuity, pension and insurance proceeds which accrue independently of accident are not deductible from compensation under Motor Vehicles Act. Same principle applies to Mediclaim reimbursement.
Helen C. Rebello v. Maharashtra SRTC, (1999) 1 SCC 90; United India Insurance Co. Ltd. v. Patricia Jean Mahajan, (2002) 6 SCC 281; Sebastiani Lakra v. National Insurance Co. Ltd., (2019) 17 SCC 465, followed.
Reliance General Insurance Co. Ltd. v. Shashi Sharma, (2016) 9 SCC 627, distinguished.
(Paras 7 to 15)
HELD
Compensation under Motor Vehicles Act is statutory in nature whereas Mediclaim reimbursement flows from contractual obligation arising out of payment of premiums by insured. These benefits occupy separate legal fields and one cannot be deducted from the other. (Paras 7.3.1 to 7.3.3 and 15)
Doctrine against double benefit applies only where same loss is compensated twice from same source or within same sphere. Independent contractual entitlements cannot be adjusted against statutory compensation payable under beneficial legislation. (Paras 7.1 and 7.2)
Mediclaim reimbursement is result of claimant having paid premiums over years and cannot be treated as pecuniary advantage flowing from accident itself. Deduction thereof would unjustly enrich insurer of offending vehicle. (Paras 9 to 11)
Courts and counsel are duty-bound to ensure consistency in precedents and avoid conflicting judicial opinions, particularly where divergent views exist within same High Court. (Paras 12 to 14)
RESULT
Appeal dismissed. Held that Mediclaim/medical insurance amount is not deductible from compensation awarded under Motor Vehicles Act. Matter remanded to High Court for determination in accordance with law declared by Supreme Court.
