Original Medical Bills instead of copies required to claim compensation for Hospital Expenses: Madras HC

Chennai: Observing that original medical bills were not filed, the Madras High Court bench recently reduced the amount of compensation that the insurance company is liable to pay in a case of death due to rash and negligent driving.

Although the Motor Accidents Claims Tribunal (MACT) had earlier awarded Rs 21,50,832 as compensation, after finding that certain claims were not supported by original medical bills, the Madras HC bench modified the amount of compensation to Rs 9,84,457.

"Though there were no effective confrontation, while cross examining P.W.1, this Court on mere perusal of the above medical bills would find a word “copy”. The same would unequivocally, manifest that those are all not the original. Therefore, there is a duty cast upon the claimants to explain as to why they have not submitted the originals of these bills," observed the Single Judge Bench of Justice C. Kumarappan

The legal heirs (claimants) of the deceased filed a claim petition on account of death of the deceased in a road accident that took place on 06.02.2017. They claimed rash and negligent driving by the offending vehicle insured by the appellant Insurance Company.

As per the claimants, due to the accident, the deceased sustained severe injuries and she was admitted in the hospital and was treated as inpatient from 07.02.2017 to 06.05.2017. Claiming that the monthly income of the deceased was Rs 20,000, the claimants prayed for a compensation of Rs 90,00,000. 

The Insurance Company disputed rash and negligent driving of the offending vehicle, and further submitted that the deceased's husband also contributed to the accident and there was no nexus between the accident and the death of the deceased. Therefore, the Insurance Company prayed for he dismissal of the claim application.

After considering the plea and perusing the material on record, the MACT awarded Rs 21,50,832 as compensation along with interest at the rate of 7.5% per annum.

Taking note of the submissions by both the parties, the HC bench referred to the Supreme Court order in the case of Oriental Insurance Company Limited V. Dhanabai Kanji Gadhvi, where the Apex court bench categorically stated that the remedy for payment of compensation under Section 163-A and 66 of M.V Act being final and independent to each other. Further, the Hon'ble Supreme Court has also in categorical terms held that the compensation cannot be claimed simultaneously, under the both provisions.

"Therefore, it is crystal clear that when an application being filed under Section 166 of the Act, then, the Court is bound by the provisions under Section 166 of the Act and there cannot be any swap, after the commencement of trial between the principles under Section 166 of the M.V. Act and Section 163-A of the M.V.Act. But, in our case, inspite of the contention of the respondent - insurance company and contrary to the above settled legal position, the Court below has curiously, applied the principle under Section 163-A of the Act, and awarded higher compensation of Rs.5,00,000/-, based upon the recent amendment made in Section 163-A of the Act, on 01.01.2019," the HC bench noted at this outset.

While considering the nexus between the accident and the death of the deceased, the HC bench observed,

"Though it has not been seriously disputed before this Court, even while independently assessing material available before this Court, and also while considering the evidence of P.W.2-Doctor, this Court is of the firm view that the deceased died only due to the accident."

"Now that this Court confirmed the finding of the Court below regarding rash and negligent of the offending vehicle, and the death of the injured due to the accident. As such the insurance Company qua this appellant is liable to pay compensation to the claimants," it further noted.

However, while deciding on the amount of compensation, the bench perused the bills, which do not contain the word "copy" and some other bills where there is a reference that the same is copy.

"Therefore, the contention put forth by the learned counsel for the appellant / insurance company that, the claimants could have got reimbursement of Ex.P9 & P11 - the medical bills cannot be brush aside. Though there were no effective confrontation, while cross examining P.W.1, this Court on mere perusal of the above medical bills would find a word “copy”. The same would unequivocally, manifest that those are all not the original. Therefore, there is a duty cast upon the claimants to explain as to why they have not submitted the originals of these bills," the bench observed at this outset.

Setting aside the amount of compensation on account of the medical bills that were a copy, the bench ordered,

"Therefore, this Court is of the view that in the interest of justice, there cannot be any claim for the medical bills- Ex.P9 and P11. Therefore the award for a sum of Rs.11,20,440/- in respect of medical bills-Ex.P9 and a sum of Rs.2,98,935/- in respect of medical bills - Ex.P10 is hereby ordered to be set aside. In respect of the other medical bills, Ex.P.11, P12 and P13, the award is hereby confirmed."

"In the result, the instant Civil Miscellaneous Appeal is partly allowed and the impugned award of the Tribunal is modified by reducing the compensation amount from Rs.21,50,832/- to Rs. 9,84,457/-. In the above award amount first claimant is entitled to Rs.3,99,457/- along with proportionate interest and costs and claimants 2 to 10 are entitled to Rs.65,000/-each along with proportionate interest," read the judgment.

To view the HC order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-original-medical-bills-219459.pdf

Also Read: Rs 59 Lakh compensation to husband of Delhi doctor who died in Road Accident: Court