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Hem Raj vs. The New India Assurance Co. Ltd. (2023 INSC 644)

Civil Appeal · 2023 INSC 644Decided 25 Jul 2023
Civil Appeal No. 4642 of 2023
B.V. Nagarathna · Ujjal Bhuyan

Background

Hem Raj, owner of a Mahindra pick-up vehicle insured in India and specially extended to cover Nepal, was involved in an accident in Nepal in September 2014 in which one person died and another, Ram Prashad Tharu, was seriously injured. Hem Raj paid compensation to the deceased's family and also bore the injured man's medical treatment costs of about Rs. 4,09,000 at a Lucknow hospital, then sought reimbursement from his insurer, New India Assurance, which refused to pay. After the District Consumer Forum and State Consumer Commission both ruled substantially in his favour, the National Consumer Disputes Redressal Commission (NCDRC) allowed reimbursement of the death compensation but disallowed the medical expense claim, wrongly accepting the insurer's claim that there was "no evidence on record" of the medical payments.

Decision Breakdown

The Supreme Court examined the medical bills (Exhibits C-19 to C-28, later filed as Annexures P-9 to P-28) from Charak Hospital and Research Centre, Lucknow, and found the insurer's counsel had not actually disputed these documents before the NCDRC: the claim of "no evidence" was factually incorrect. The Court also found the NCDRC wrongly read the District Forum's order as having already rejected the medical expense claim, when in fact the District Forum had referred to those very medical bills and directed the insurer to pay whatever was legally admissible. Holding the insurer's stand "not fair and just," the Court set aside the part of the NCDRC's order disallowing the medical expenses, and directed New India Assurance to pay Rs. 4,09,000 with 7% interest from the date the complaint was filed, plus a cost of Rs. 30,000, all within one month.

Lesson Learnt

An insurer cannot defeat a genuine, documented claim by simply asserting in argument that "there is no evidence," when the underlying bills and receipts are in fact on the case record and undisputed by the insurer's own counsel: consumer forums and courts will look past such unsupported assertions to the actual documentary evidence.

Official source (sci.gov.in)View Judgment (PDF)

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