Mediclaim reimbursement must be deducted from compensation: Karnataka High Court

Justice Hanchate Sanjeevkumar issued this directive while ordering an insurance company to pay a compensation of Rs 4,93,839, along with 6% annual interest, to the family members of S Hanumanthappa, after deducting Rs 1.8 lakh received from a Mediclaim policy.

Bengaluru: The Karnataka High Court has ruled that amounts received under a Mediclaim policy must be deducted from the total compensation awarded under the "medical expenses and hospitalisation charges" head under the Motor Vehicles (MV) Act.

Justice Hanchate Sanjeevkumar issued this directive while ordering an insurance company to pay a compensation of Rs 4,93,839, along with 6 per cent annual interest, to the family members of S Hanumanthappa, after deducting Rs 1.8 lakh received from a Mediclaim policy.

Hanumanthappa, a resident of Marathahalli, Bengaluru, sustained serious injuries in an accident on December 10, 2008. While returning to Seva Mandir village from Lepakshi, his motorcycle was hit by an autorickshaw, resulting in grievous injuries to him and his wife.

Following the incident, the Hindupur Rural police registered a case, and Hanumanthappa approached the Motor Accident Claims Tribunal (MACT), Bengaluru, seeking compensation.

On March 22, 2013, the tribunal awarded Rs 6,73,839 in total compensation, which included Rs 5,24,639 under medical expenses.

The insurance company challenged the tribunal’s order, arguing that the reimbursement of Rs 1.8 lakh under the Mediclaim policy made it incorrect to award the full amount of Rs 5,24,639 under medical expenses.

Citing the Karnataka High Court’s ruling in the Manish Gupta case, which established that reimbursement under Mediclaim policies must be deducted while determining compensation under the MV Act, the court upheld the insurer's contention.

“In the present case, the amount received by the claimant under the Mediclaim insurance policy is liable to be deducted from the medical expenses, while determining the compensation under the said head. The appellant (insurance company) has produced additional evidence that the claimant has received Mediclaim reimbursement amount of Rs 1.8 lakh from TTK Healthcare TPA Private Limited. This factum is not disputed by the respondents/claimants. Hence, the said additional evidence is allowed. Therefore, the said amount of Rs 1.8 lakh is deducted from the amount of Rs 5,24,639, then it would be Rs 3,44,639 under medical expenses,” the court said.