Full Judgment Text
2026 INSC 498
REPORTABLE
IN THE SUPREME COURT OF INDIA
CIVIL APPELLATE JURISDICTION
CIVIL APPEAL NO. OF 2026
(@ Special Leave Petition (Civil) Nos.18267 of 2025)
NEW INDIA ASSURANCE
COMPANY LIMITED … APPELLANT(S)
VERSUS
DOLLY SATISH GANDHI & ANR. …RESPONDENT(S)
J U D G M E N T
SANJAY KAROL J.
Leave Granted.
THE APPEAL
2. ‘A’ met with an accident. They filed a claim before the jurisdictional
1
Tribunal i.e., Motor Accidents Claims Tribunal seeking compensation in which
1
MACT
Signature Not Verified
Digitally signed by
NAVEEN D
Date: 2026.05.15
18:39:52 IST
Reason:
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 1 of 27
inter alia , loss of income, future prospects, special diet, transportation and
medical expenses have been claimed for. Simultaneously, claims set out with
insurance under the claim of medical insurance for the very same medical
expenses are allowed and money received. Is it legally permissible for the MACT
to account for such amounts received, and as such deduct the same or not, is the
question involved herein.
3. A Bench of three Judges of the High Court of Judicature at Bombay in
deciding a conflict between judgments of the said Court, namely The New India
2
Assurance v. Dineshchandra Shantilal Shah and Ors , on the one hand, and
3
Vrajesh Navnitlal Desai v. K. Bagyam and Anr ., Royal Sundaram Alliance
4
Insurance Co. Ltd., Kolkata v. Ajit Chandrakant Rakvi and Anr , on the other,
in terms of the impugned judgment , held that the amount received by a claimant
by way of his own Mediclaim, is not deductible when such a claimant is before
the jurisdictional MACT seeking compensation for injuries he has suffered as a
result of an accident. New India Assurance Co. Ltd., is aggrieved and questions
the correctness of such a finding before us, in this appeal.
3.1 We are, therefore, to decide the question of law as to whether the
amount of money received as Mediclaim, in terms of a ediclaim policy, is
deductible from an award passed by a Claims Tribunal or not. The factual
matrix in which this question arises does not have a bearing on the
conclusion of this question of law, and hence, is not relevant for the present
2
(2013) 09 BOM CK 0240 (First Appeal No.657 of 2013)
3
2005 SCC OnLine Bom 156
4
2019 SCC OnLine Bom 496
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determination.
ARGUMENTS OF THE PARTIES
4. We heard the learned Counsel for the parties.
4.1 Learned Counsel for the appellant submitted:
4.1.1 It is an admitted position that the respondent-insured has
already been reimbursed for medical expenses through a Mediclaim
policy. Once such reimbursement has taken place, the loss under that
specific head is neutralized and so, awarding the same amount again
under the head of medical expenses would go beyond restitution and
lead to or result in a duplication of benefit. The appellant-insurer has
submitted this position to be inconsistent with the principle of just
compensation.
4.1.2 This position, it is argued, has found support in the decision
of this Court in Reliance General Insurance Co. Ltd. v. Shashi
5
Sharma , where the Court emphasised that double benefits should
not be granted while computing compensation in reference to a claim
petition arising out of a motor vehicle accident. In that case, amounts
received by the claimants by way of ex gratia financial assistance
have been held liable for deduction from compensation awarded
under a corresponding head. The underlying rationale was that
overlapping benefits under the same head distort the concept of just
5
(2016) 9 SCC 627
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compensation.
4.1.3 The appellant-insurer also dealt with the judgment in Helen
6
C. Rebello v. Maharashtra SRTC , which held that benefits such as
life insurance, provident fund and pension, are not deductible since
they accrue independently of the accident and would be payable in
any event. However, the appellant-insurer has submitted that the
present case stands on a different footing. A Mediclaim
reimbursement is directly linked to the injury sustained in the
accident and has arisen only because of the medical expenses
incurred due to that event. Unlike life insurance proceeds, it is not a
benefit that accrues irrespective of the accident. Even on the
principle articulated in Helen Rebello (supra) amounts that bear a
direct causal connection with the loss in question are liable to be
adjusted to avoid duplication.
4.1.4 The statutory framework has also supported this position.
7
Under Sections 146 and 147 of the Motor Vehicles Act 1988 ,
insurance against third party risk has been mandatory, and the
insurer has been required to indemnify the owner or driver for
liability arising from death or bodily injury caused by the use of the
vehicle. However, such liability has been premised on the existence
of an actual loss. If the medical expenses have already been
reimbursed, the question arisen is whether any liability survives in
6
(1999) 1 SCC 90
7
MVA
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respect of that head. The appellant-insurer has submitted that in the
absence of a subsisting loss, there can be no corresponding liability
to compensate.
4.1.5 It has further been submitted that the distinction between
statutory and contractual liability, as discussed in Helen Rebello
(supra) has arisen in the context of death cases where certain
pecuniary advantages have accrued to the dependents independently
of the accident. In contrast, the present matter has involved an injury
claim where the reimbursement of medical expenses has been
directly and exclusively connected to the accident. This has created
a clear overlap between the loss claimed and the amount already
received, making it a case where the principle against double
recovery applies with full force.
4.1.6 The appellant-insurer has also relied on the decision in
8
Oriental Insurance Co. Ltd. v. R. Swaminathan , where this Court
has approved the deduction of medical expenses that had already
been reimbursed by the employer. Even though the Court had
enhanced compensation under other heads, it consciously did not
award medical expenses again, recognizing that such duplication is
impermissible.
4.2 Per contra , the learned counsel for the respondent – insured
contended:
8
CA 2715 of 2002
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4.2.1 There exists a distinction between statutory and contractual
entitlements. Compensation under the MVA is a statutory right that
arises upon proof of negligence and resulting injury. It is not
contingent upon any prior contribution by the claimant. In contrast,
a Mediclaim policy constitutes a contract of insurance, supported by
the payment of premiums and governed by agreed terms. The
respondent-insured submits that these two entitlements operate in
separate domains, and that the statutory right to compensation cannot
be diminished by importing considerations arising from a contractual
benefit.
4.3. In Helen Rebello (supra) the Court held that amounts such as
provident fund, pension, and life insurance proceeds are not liable to be
deducted from compensation under the MVA, as they bear no correlation
to the accident. The respondent – insured, submits that the governing
principle emerging therefrom is that deductions are permissible only where
a direct nexus exists between the receipt and the accident giving rise to the
claim.
4.3.1 This principle was reiterated in United India Insurance
9
Co. Ltd. v. Patricia Jean Mahajan , where the Court held that
insurance proceeds and other benefits cannot be deducted unless
they are directly attributable to the accidental death or injury. The
respondent insured submits that a broad interpretation encompassing
9
(2002) 6 SCC 281
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all post-accident receipts would defeat the object of awarding just
compensation and unjustly benefit the wrongdoer.
4.3.2 Further reliance is placed on Sebastiani Lakra v. National
10
Insurance Co. Ltd. , where the Court reaffirmed that benefits
arising from contractual or service-related entitlements, including
insurance, pension, and gratuity, cannot be deducted from
compensation. The respondent insured contends that such benefits
accrue independently of the accident and cannot be treated as gains
arising from the same cause.
4.3.3. The respondent-insured also submits that the principle
11
recognised in Bradburn v. Great Western Railway Co affirms that
damages payable by a wrongdoer are not to be reduced on account
of insurance benefits received by the injured party. This ensures that
the appellant insurer or the tortfeasor does not derive advantage from
the prudence of the claimant in securing insurance coverage.
4.3.4. Turning to the statutory framework, the respondent-insured
submits that the MVA is a beneficial legislation intended to provide
relief to victims of motor accidents. Section 166 confers the right to
claim compensation, while Section 168 obligates the Tribunal, to
award just compensation based on fairness, reasonableness, and
equity. As elucidated in National Insurance Co. Ltd. v. Pranay
12
Sethi , the determination of just compensation must strike a balance
10
(2019) 17 SCC 465
11
(1874-80) All ER Rep 195
12
(2017) 16 SCC 680
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and reflect a realistic assessment of loss. The respondent insured
contends that deducting Mediclaim benefits would undermine this
objective and result in inadequate compensation.
4.3.5. In response to the contentions of the appellant-insurer, it is
submitted that no prejudice or irreparable loss is caused by allowing
the respondent-insured to receive both contractual and statutory
benefits. The liability under the MVA arises from the wrongful act
of the driver, whereas the liability under the Mediclaim policy arises
from a contract supported by consideration. The respondent-insured
submits that these liabilities are distinct and coexist without overlap
and that the appellant- insurer retains the ability to adjust premiums
in accordance with risk.
4.4 It should be noted that in the course of arguments, learned counsel
for the appellant pointed out that there were contrarian views galore on this
question, and that the question needed to be settled, specifically in the
context of Mediclaim/medical insurance.
ANALYZING DIVERGENT VIEWS
5. We find, somewhat surprisingly, that single judges as also division
benches even of the same Court, have taken opposite views across the High
Courts. One view is that Mediclaim, as a claim is independent from a claim
under Section 166 MVA and the award received need not be deducted. In
a tabular form we further take notice of such a view taken by the High
Court(s).
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BOMBAY HIGH COURT CASES
1. Vrajesh Navnitlal Desai v. K. Bagyam,
1J
2005 SCC OnLine Bom 156
2. Royal Sundaram Alliance Insurance Co. Ltd. v. Ajit
Chandrakant Rakvi,
2019 SCC OnLine Bom 496
1J
3. State of Goa v. Michael Joaquim F.D. Souza, 2022 SCC
OnLine Bom 1672
1J
4. United India Insurance Co. Ltd. v. Anjana, 2012 SCC OnLine
Bom 129
1J
5. Reliance General Insurance Co. Ltd. v. Aman Sanjay Tak,
2023 SCC OnLine Bom 883
1J
MADHYA PRADESH HIGH COURT CASES
6. Madhya Pradesh State Road Trans. Corpn. v. Priyank, 1999
SCC OnLine MP 18
2J
7. Mamta Yadav v. Amrat Singh,
2023 SCC OnLine MP 7166
1J
OTHER HIGH COURTS CASES
8. Shaheed Ahmed v. Shankaranarayana Bhat, 2008 SCC
OnLine Kar 166
[Kar. HC]
1J
9. Royal Sundram General Insurance Co. Ltd. v. Meenakshi
Mann, 2019 SCC OnLine P&H 7801
[Punjab & Haryana HC]
1J
10. New India Assurance Company Limited v. Bimal Kumar
Shah, 2018 SCC OnLine Cal 10368
[Cal. HC]
2J
11. National Insurance Co. Ltd. v. Bijumon, 2010 SCC OnLine
Ker 4775 [Ker. HC]
1J
12. National Insurance Co. Ltd. v. Aman Kapur, 2013 SCC OnLine
Del 4891 [Del. HC]
1J
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6. The other view is that the amount received from a Mediclaim is in fact
deductible from the total compensation, which in a tabular form we indicate the
cases as under:-
S. No. Case Title Bench Strength
DELHI HIGH COURT CASES
Jaswant Kaur Sethi v. Tamal Das, MAC. APP. No. 352 of 2006 1J
1.
National Insurance Co. Ltd. v. R.K. Jain, 2012 SCC OnLine
2.
Del 3303
1J
3. National Insurance Co.
v. Deepmala Goel, 2012 SCC OnLine Del 1958
1J
IFFCO Tokio General Insurance Co. v.
4.
Kisanlal Sharma , 2019 SCC OnLine Del 11091
[Claimant surrendered claim under medical expenses]
1J
1J
IFFCO Tokio General Insurance Co. Ltd. v. Shambhu
5.
Pathak, 2012 SCC OnLine Del 1361
1J
6. National Insurance Co. Ltd. v. Shiela Avinashi, 2012 SCC
OnLine Del 532
1J
Bajaj Allianze General Insurance Co. Ltd. v. Ganpat Rai
7.
Sehgal, 2012 SCC OnLine Del 42
1J
8. UP State Road Transport Corporation v. Rama Chugh, 2019
SCC OnLine Del 11627
1J
New India Assurance Co. Ltd. v. Arjun Singh, 2019 SCC
9.
OnLine Del 11625
1J
Oriental Insurance Co. Ltd. v. Ravi Jain, 2025 SCC OnLine
10.
Del 8966
KERALA HIGH COURT CASES
2J
11. National Insurance Company Ltd. v. Akber Badsha, 2015
SCC OnLine Ker 26742
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2J
Mariamma James v. Alphones Antony, 2016 SCC OnLine Ker
12.
29226
PUNJAB AND HARYANA HIGH COURT CASES
13. National Insurance Co.
Ltd. v. Shashank Bhardwaj, CWP No. 9763 of 2015
1J
14. ICICI Lombard General Insurance Co. v.
Harminder Singh Rosha, FAO No. 4755 of 2016
1J
1J
United India Insurance Co. Ltd. v. Jaswant Singh, FAO No.
15.
532 of 2014
BOMBAY HIGH COURT CASES
16. The New India Assurance Co. v. Dineshchandra
Shantilal Shah & Ors. First Appeal No. 657 of 2013
1J
1J
17. Shirkant @ Srikant Kashinath Gaude v. Suryakant
Uttam Gaude. F.A. No. 64 of 2009
MADRAS HIGH COURT CASES
2J
18. S. Sevagi v. State of Express Transport, C.M.A. Nos. 3618–
3620 of 2013
MADHYA PRADESH HIGH COURT CASES
19. Jitendra vs. Rahul, MANU/MP/0366/2008 1J
OUR CONSIDERATION
7. Inter-alia , two opposing reasons come forth from the perusal of the above-
mentioned High Court decisions. Those in favor of deduction hold so in view of
the principle of “ double benefit ” since the same medical expenses would be
compensated from two sources. Those against the deduction posit that the origin
of the two methods of compensating the same is different and, therefore, it cannot
be said to exclude each other. One is a statutory remedy and the other arises out
of a contract. Let us understand the same.
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7.1 T he principle governing “ double benefit ” in motor accident
claims is that there should be no duplication for the same head of loss in
respect of the victim/claimant in a claim petition arising out of a motor
vehicle accident. A claimant cannot recover compensation twice for the
same injury or loss, as that would amount to unjust enrichment . The
unquestionable position is that compensation must be “ just
compensation ” which is meant to fairly make good the loss suffered, not
to create a windfall. Therefore, where two payments in relation to the very
same claim petition compensate for the same loss, one of them must
ordinarily be adjusted or deducted.
7.2. What is to be examined is the source and nature of the benefit.
The primary consideration in such an analysis is whether the additional
benefit is a substitute for the same loss, in which case it is liable to be
deducted, or whether it is independent, or an entitlement, in which case it
is not. For instance, where the family of a deceased person receives
statutory compensation or ex gratia payment from the State on account of
death, such amount may be deducted from the compensation awarded
under MACT. The reasoning therefor, is straightforward. Both payments
are addressing the same loss. Similarly, where one aspect of
compensation directly replaces the same income stream lost due to the
accident, and is triggered by that very event, permitting full recovery
under both heads would amount to double compensation.
7.2.1. However, the position is different where the benefit is
independent in nature. It has repeatedly been clarified by this
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Court that certain payments cannot be deducted merely because
they accrue upon death. Employment benefits such as provident
funds, gratuity, and pension are not deductible, as they arise from
the contract of employment and represent deferred earnings or
accrued rights. They are not compensation for the accident, but
entitlements earned over time.
7.3 Let us now look at the primary reason taken by those who have
favoured the grant of both MACT compensation and Mediclaim.
7.3.1 A statutory benefit is an entitlement that exists because a
law creates it. Its source is legislation enacted by the State, and
not any private agreement between individuals. Meeting the
conditions laid down in the statute ipso facto , leads to entitlement.
There is nothing required further such as negotiation or consent.
Such benefits are generally in furtherance/fulfillment of broader
public purposes like welfare, regulation, and they can be altered
or withdrawn only if the law itself is amended.
7.3.2. A contractual benefit, on the other hand, is in the nature
of a private agreement between parties. Its source is the contract
itself, and the benefit flows from the parties having mutually
agreed to certain terms. These benefits depend on consent and are
defined by what the contract provides. They are enforceable under
the law of contract and cannot be changed except in accordance
with the terms of the agreement.
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7.3.3. The distinction, put simply, is that a statutory benefit
flows from the authority of law, while a contractual benefit flows
from the will and agreement inter se parties. Naturally, statutory
benefits are available to all persons, provided that they fulfill its
prerequisites whereas a contractual benefit is limited inter se the
parties.
8. Having noticed the crucial distinction, we now move to appreciating the
law on deductions from motor accident claims.
8.1 Helen Rebello
In this case, the husband of the appellant was gravely injured while
travelling on a bus of the Maharashtra State Road Transport Corporation,
when it collided with a bus of the Karnataka State Road Transport
Corporation, while he was on his way from Rathore Badruk to Pune,
eventually succumbing to the injuries sustained. The quantum of
compensation was not subject matter of challenge before the co-ordinate
Bench of this Court. The issue was whether the amount received by the
appellant and other legal heirs in the form of the life insurance policy of
the deceased was deductible from the compensation received under the
1939 version of the MVA. The Court, speaking through A.P Misra J.,
discussed a number of English cases and then observed that Section 110,
of the 1939 Act made clear that the constitution of the Tribunal was not
meant to “include that which the claimant receives on account of other
forms of deaths, which he would have received even apart from accidental
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 14 of 27
death. Thus, such pecuniary advantage would have no correlation to the
accidental death for which compensation is computed. Any amount
received or receivable not only on account of the accidental death but that
which would have come to the claimant even otherwise, could not be
construed to be the “pecuniary advantage”, liable for deduction.”
Observations made further ahead are also apposite for the present case:
“How thus an amount earned out of one's labour or contribution
towards one's wealth, savings, etc. either for himself or for his
family which such person knows under the law has to go to his heirs
after his death either by succession or under a Will could be said to
be the “pecuniary gain” only on account of one's accidental death.
This, of course, is a pecuniary gain but how this is equitable or could
be balanced out of the amount to be received as compensation under
the Motor Vehicles Act. There is no corelation between the two
amounts. Not even remotely. How can an amount of loss and gain
of one contract be made applicable to the loss and gain of another
contract. Similarly, how an amount receivable under a statute has
any corelation with an amount earned by an individual. Principle of
loss and gain has to be on the same plane within the same sphere, of
course, subject to the contract to the contrary or any provisions of
law.”
8.2 Patricia Jean Mahajan
This case concerned the death of an Indian origin, USA-based doctor who
died while on a visit to this Country, travelling from Jaipur to Delhi. The
Tribunal awarded a sum of Rs. 1.16 crores with 12% interest p.a., as
against a claim of Rs. 54 Crores. The appellant challenged the
determination before the High Court of Delhi. The compensation was
enhanced to Rs. 16.12 crores with the said interest. Still further, the merits
of the computation were challenged before this Court. Brijesh Kumar J.,
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 15 of 27
writing for the Court recorded agreement with the principle in Helen
Rebello (supra) . Considerable discussion was made in regard to
transposing absolute numbers in terms of US earnings to India, applying
the exchange rate thereto, and awarding compensation, but such a view
was not entirely accepted in view of issues such as the possibility of over
compensating, and also mechanical use of the multiplier, which would
mean high multiplicand and high compensation on account of directly
translating USD to its equivalent value in INR. It was observed:
“ 36. …. According to the decisions referred to in the earlier part
of this judgment, it is clear that the amount on account of social
security as may have been received must have a nexus or relation
with the accidental injury or death, so far to be deductible from
the amount of compensation. There must be some correlation
between the amount received and the accidental death or it may
be in the same sphere, absence ( sic ) the amount received shall not
be deducted from the amount of compensation. Thus, the amount
received on account of insurance policy of the deceased cannot
be deducted from the amount of compensation though no doubt
the receipt of the insurance amount is accelerated due to
premature death of the insured. So far as other items in respect of
which learned counsel for the Insurance Company has
vehemently urged, for example some allowance paid to the
children, and Mrs Patricia Mahajan under the social security
system, no correlation of those receipts with the accidental death
has been shown much less established. Apart from the fact that
contribution comes from different sources for constituting the
fund out of which payment on account of social security system
is made, one of the constituents of the fund is tax which is
deducted from income for the purpose. We feel that the High
Court has rightly disallowed any deduction on account of receipts
under the insurance policy and other receipts under the social
security system which the claimant would have also otherwise
been entitled to receive irrespective of accidental death of Dr
Mahajan. If the proposition “receipts from whatever source” is
interpreted so widely that it may cover all the receipts, which may
come into the hands of the claimants, in view of the mere death
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 16 of 27
of the victim, it would only defeat the purpose of the Act
providing for just compensation on account of accidental death.
Such gains, maybe on account of savings or other investment etc.
made by the deceased, would not go to the benefit of the
wrongdoer and the claimant should not be left worse off, if he
had never taken an insurance policy or had not made investments
for future returns.
(emphasis supplied)
8.3 Shashi Sharma
In this matter, the question that concerned the Court was whether
compensation under MVA is affected by the grant of compensation under
Haryana Compassionate Assistance to Dependents of deceased
Government Employees Rules, 2006 issued under Article 309 of the
Constitution of India. It was held that since both these grounds of
compensation have statutory force, claimants cannot be permitted to set up
claims under both scenarios. The relevant discussion of the three-judge
Bench is reproduced below:
“ 25. The claimants are legitimately entitled to claim for the loss
of “pay and wages” of the deceased government employee against
the tortfeasor or insurance company, as the case may be, covered
by the first part of Rule 5 under the 1988 Act. The claimants or
dependants of the deceased government employee (employed by
the State of Haryana), however, cannot set up a claim for the same
subject falling under the first part of Rule 5—“pay and
allowances”, which are receivable by them from employer (the
State) under Rule 5(1) of the 2006 Rules. In that, if the deceased
employee was to survive the motor accident injury, he would have
remained in employment and earned his regular pay and
allowances. Any other interpretation of the said Rules would
inevitably result in double payment towards the same head of loss
of “pay and wages” of the deceased government employee
entailing in grant of bonanza, largesse or source of profit to the
dependants/claimants. Somewhat similar situation has been spelt
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 17 of 27
out in Section 167 of the Motor Vehicles Act, 1988 which reads
thus:
“ 167. Option regarding claims for compensation in
certain cases .—Notwithstanding anything contained
in the Workmen's Compensation Act, 1923 (8 of 1923)
where the death of, or bodily injury to, any person gives
rise to a claim for compensation under this Act and also
under the Workmen's Compensation Act, 1923, the
person entitled to compensation may without prejudice
to the provisions of Chapter X claim such
compensation under either of those Acts but not under
both .”
(emphasis supplied)
26. Indeed, similar statutory exclusion of claim receivable under
the 2006 Rules is absent. That, however, does not mean that the
Claims Tribunal should remain oblivious to the fact that the claim
towards loss of pay and wages of the deceased has already been
or will be compensated by the employer in the form of ex gratia
financial assistance on compassionate grounds under Rule 5(1).
The Claims Tribunal has to adjudicate the claim and determine
the amount of compensation which appears to it to be just. The
amount receivable by the dependants/claimants towards the head
of “pay and allowances” in the form of ex gratia financial
assistance, therefore, cannot be paid for the second time to the
claimants. True it is, that the 2006 Rules would come into play if
the government employee dies in harness even due to natural
death. At the same time, the 2006 Rules do not expressly enable
the dependants of the deceased government employee to claim
similar amount from the tortfeasor or insurance company because
of the accidental death of the deceased government employee.
The harmonious approach for determining a just compensation
payable under the 1988 Act, therefore, is to exclude the amount
received or receivable by the dependants of the deceased
government employee under the 2006 Rules towards the head
financial assistance equivalent to “pay and other allowances” that
was last drawn by the deceased government employee in the
normal course. This is not to say that the amount or payment
receivable by the dependants of the deceased government
employee under Rule 5(1) of the Rules, is the total entitlement
under the head of “loss of income”. So far as the claim towards
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 18 of 27
loss of future escalation of income and other benefits is
concerned, if the deceased government employee had survived
the accident can still be pursued by them in their claim under the
1988 Act. For, it is not covered by the 2006 Rules...”
8.4 Sebastiani Lakra
In this case, the Court while dealing with the total compensation payable
to the claimants on account of the death of the 52 year old government
servant, the question was whether the amount received by the claimants
13
under the Employees Family Benefit Scheme being Rs.50,082/- per
month should be deducted from the compensation as calculated by the
Tribunal. The High Court had allowed the deduction, however, did not
provide any reasons for having taken such a view. This Court concluded
that the case stood on a different footing from Shashi Sharma as the
benefit herein was not statutory in nature. Further, it was observed that the
amount payable under the EFB Scheme happens only once the benefits
received by the legal heirs of the deceased are deposited. In other words,
amounts of gratuity and all other benefits totaling to Rs.27,43,991/- were
deposited and now they were receiving Rs.50,082/- per month till the date
of retirement as would have been, of the deceased. The Court noted that
this situation was beneficial for the claimants since, if the two amounts are
compared, even a 12% interest rate on Rs.28,00,000/- approximately would
be about Rs.22000/- less per month. The said amount, therefore, could not
be deducted at the time of computation under MVA.
13
EFB
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 19 of 27
8.5 Swaminathan
In this case, a co-ordinate Bench of this Court allowed an appeal filed by
the Insurance Company being aggrieved by the increase of compensation
beyond the original claimants ask. While this submission was rejected and
it was held that the Court could increase the compensation beyond what
had been asked for by the claimants, it was observed that the deduction of
medical expenses by the learned Single Judge on account of the fact that
the employer had already paid the same, was affirmed. We are, however,
of the view that the holding in this case may not aid the appellant insurer
herein for the reason that the observation made by this Court arose in a
specific fact of the employer having reimbursing medical expenses.
Neither reimbursement by the employer a general condition prevalent
across cases, nor is it clear from the order of this Court whether the
respondent in the said case had a Mediclaim policy to his name.
9. Having considered judgments of this Court as above, we are of the
considered opinion that the answer to the question raised in this appeal is not a
matter of Sherlockian deduction. A Mediclaim policy is a policy that is purchased
by a person, accounting for the uncertainties of life and preparing a financial base
for an unfortunate possible eventuality. The human body is a coming together of
intricate systems where there is always a possibility that something may go wrong
or may need mending. In today’s time when medical expenses are skyrocketing
for a variety of reasons, the ability to meet such expenses, suddenly as and when
they may arise, is not something that rests with all. It is, as such, a necessary facet
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 20 of 27
of preparation that people undertake. It doesn’t specifically deal with accidental
coverage only.
10. The contractual benefit of reimbursement of medical expenses as a result
of this policy is, therefore, independent of any other claim. The provisions of the
MVA are only triggered in the unfortunate eventuality if a death or injury arising
out of a motor vehicle an accident occurs. That in itself, when it does arise, cannot
eclipse the contractual benefit to which a person who has paid premiums, is
entitled too. Compensation under MVA while it recognizes reimbursement of
medical expenses is distinct from the contractual benefit, though it may be with
respect to the very same heads. If the view of the High Courts that this would
amount to “ double benefit ” is agreed to by this Court, a peculiar situation will
arise. On the one end, it may save compensation from being affected by double
benefit , if it can be called that, but on the other, it would denude the claimant of
the benefits that arise out of them parting with their hard-earned money in the
form of Mediclaim premiums. It would also amount to an undue advantage to the
company granting the Mediclaim policy to the claimant if the claimant’s claim is
extinguished by the award of the MACT having granted medical expenses for,
they would have received the premium but would not be required to pay any
amount in the event of medical bills having arisen. Similarly, it may amount to
an unjust benefit to the insurer of the offending vehicle if they are not required to
compensate under one of the heads of medical expenses solely on account of the
fact that the claimant had received the benefit of a policy for which they had been
paying premiums for years on end. There is yet another aspect. The guiding
yardstick in Mediclaim vis a vis MVA is different. In the former, a Mediclaim
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 21 of 27
policy is taken up to a certain amount and if the claim of the policy holder once
found to be holding merit go beyond it, the holder has no option but to foot the
bill out of pocket however in the latter, because of its beneficial nature the only
guide is the broad principle of just and fair compensation. Put differently, the
compensation that may be awarded thereunder has no strict monetary limits.
11. We may also say that looking at these two amounts as “ double benefit ”
may not be appropriate since one situation is only the fruit of amounts already
paid in the past. Only because they appear same or similar, they cannot be termed
as “ double benefit ”. Still further there is another reason why these two amounts
stand on a different footing. The amount received under MVA arises from a
beneficial legislation and as guided by just compensation which is intended to put
the injured or the claimants ( legal representatives of the deceased ) in a position,
as far as possible, at least monetarily, if the accident in question had not taken
place. Naturally, this stands on a higher pedestal - not only because it is a statutory
entitlement of compensation but also because the nature of the statute is entirely
beneficial. To equate these two amounts to pulling down the MVA or
unnecessarily hyping up the Mediclaim policy.
A SECONDARY, BUT IMPORTANT ISSUE
12. There is one other issue that we must address. The chart that is given in
paras 4 and 5 of this judgment reveals something unsettling. There are contrary
positions of law being taken by the same High Court, whether it be by the benches
of the same strength or by the benches of lesser strength in ignorance of
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pronouncements made by the benches of higher strength. Some illustrations from
the tables above are:
DELHI HIGH COURT CASES
Sl.No.
Mediclaim Not Granted Bench
Strength
Mediclaim Granted Bench
Strength
1. Jaswant Kaur Sethi v. Tamal Das,
MAC. APP. No. 352 of 2006
1J National Insurance Co.
Ltd. v. Aman Kapur,
2013 SCC OnLine Del
4891
1J
1J
2. National Insurance Co. Ltd. v. R.K.
Jain, 2012 SCC OnLine Del 3303
[ Distinguishes Helen Rebello ]
1J
3. National Insurance Co.
v. Deepmala Goel, 2012 SCC OnLine Del
1958
1J
4. IFFCO Tokio General Insurance Co.
v. Kisanlal Sharma , 2019 SCC
OnLine Del 11091
[Claimant surrendered claim under
medical expenses]
5. National Insurance Co. Ltd. v. Shiela
Avinashi, 2012 SCC OnLine Del 532
1J
6. Bajaj Allianze General Insurance Co.
Ltd. v. Ganpat Rai Sehgal, 2012 SCC
OnLine Del 42
1J
7. UP State Road Transport Corporation
v. Rama Chugh, 2019 SCC OnLine Del
11627
1J
8. New India Assurance Co. Ltd. v. Arjun
Singh, 2019 SCC OnLine Del 11625
1J
9. Oriental Insurance Co. Ltd. v. Ravi
Jain, 2025 SCC OnLine Del 8966
1J
KERALA HIGH COURT CASES
10. National Insurance Company Ltd. v.
Akber Badsha, 2015 SCC OnLine Ker
26742
2J
National Insurance Co.
Ltd. v. Bijumon, 2010
SCC OnLine Ker 4775
1J
11. Mariamma James v. Alphones Antony, 2016
SCC OnLine Ker 29226
2J
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 23 of 27
PUNJAB AND HARYANA HIGH COURT CASES
12. National Insurance Co.
Ltd. v. Shashank Bhardwaj,
2016 SCC OnLine P&H 19393
1J Royal Sundram General
Insurance Co. Ltd. v.
Meenakshi Mann, 2019
SCC OnLine P&H 7801
1J
1J
13. ICICI Lombard General Insurance Co. v.
Harminder Singh Rosha,
2018 SCC OnLine P&H 7738
1J
14. United India Insurance Co. Ltd. v.
Jaswant Singh, FAO No. 532 of 2014
1J
15. Vishal v. Bugga Singh, 2016 SCC OnLine
P&H 1338
BOMBAY HIGH COURT CASES
16. The New India Assurance Co. v.
Dineshchandra
Shantilal Shah & Ors. First Appeal No. 657
of 2013
1J Vrajesh Navnitlal Desai
v. K. Bagyam, 2005 SCC
OnLine Bom 156
1J
1J Royal Sundaram Alliance
Insurance Co. Ltd. v. Ajit
Chandrakant Rakvi, 2019
SCC OnLine Bom 496
1J
17. Shirkant @ Srikant Kashinath Gaude
v. Suryakant Uttam Gaude.
F.A. No. 64 of 2009
18. State of Goa v. Michael
Joaquim F.D. Souza,
2022 SCC OnLine Bom
1672
1J
19. United India Insurance
Co. Ltd. v. Anjana, 2012
SCC OnLine Bom 129
1J
20. Reliance General
Insurance Co. Ltd. v.
Aman Sanjay Tak, 2023
SCC OnLine Bom 883
1J
MADHYA PRADESH HIGH COURT CASES
21. Jitendra vs. Rahul, MANU/MP/0366/2008 1J Madhya Pradesh State
Road Trans. Corpn. v.
Priyank, 1999 SCC
OnLine MP 18
2J
C.A.No…..of 2026 @ SLP©No.18267 of 2025 Page 24 of 27
Mamta Yadav v. Amrat
Singh, 2023 SCC OnLine
MP 7166
1J
13. When such inconsistencies are left unaddressed, it leads to various
problems, primary among them being that it leads to judicial inconsistency and
uncertainty. This creates difficulties for counsel and the Court for, opposing
judgments may give clients hope for differing outcomes or even for a Court in
the future to have to examine multiple cases with differing opinions on the same
point. Till such times the opposing views exist, judicial uncertainty is in play for
settled precedents ensure definitive outcomes but if contrary views exist, it
becomes a matter of choice to follow one and leave aside the other, and it remains
no longer, a matter of law. Connected to this is its direct impact on judicial
efficiency for if the law on a point is clear it is a matter of fair ease to follow
settled precedents leading to a reduction in future effort thereby saving time.
Performing a judicial duty or rendering justice which is certain, just, fair and
expeditious.
14. When considering these issues, the roles both the Bar and the Bench must
be addressed. Counsel appearing in Court to plead the case of a particular party
making all effort possible, while balancing ethics and their duty towards the
Court, to secure a victory for their clients. It is this duty towards the Court which
requires them to bring to the Court’s notice judgments both that aid their case and
also those that do not. It is here that the counsel’s awareness of law and grasp on
facts are their greatest assets, enabling them to distinguish judgments that may
seemingly be against them and still secure a favourable order. This duty is all the
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more important in the present day because all the Courts are polyvocal. Tens of
orders and judgments are pronounced every day across a range of issues and so,
the Court before which they are appearing may not be aware of the latest
pronouncement. They must disclose the same to the Court ensuring consistency.
That being so, the entire burden cannot be placed only on counsel. The Court
itself has an independent tri-fold duty, to apply correct law even if the counsel
does not cite the same, ensure consistency with precedent, and avoid per incuriam
decisions. While this duty is one part of reality, a Court hearing nearly hundred
matters a day and in some cases across a variety of laws and jurisdictions, having
to dictate daily orders, write judgments and so much more, is the other part. So,
in essence, both the Bar and the Bench are responsible for minimising the
problems that arise in the face of inconsistent judicial opinion. They are both
constituents of the justice delivery system, and all actions must be guided by a
sense of service to the system, further facilitating reduction of pendency.
CONCLUSION
15. In fine , we hold that the amount received as part of Mediclaim/medical
insurance is not deductible from compensation as calculated by the concerned
Tribunal, adjudicating a claim for compensation under the MVA which may also
include compensation under the head of medical expenses, if claimed. These two
stand on a different footing - one is statutory while the other is contractual and
the latter is only a sequitur of premiums having been paid in the past while the
other is an entitlement as a consequence of an accident or death in a motor vehicle
accident.
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16. The matter is remanded to the High Court for making a determination
consistent with this opinion. The appeal is dismissed as meritless. Pending
application(s), if any, shall stand disposed of.
…………..……………….J
(SANJAY KAROL)
……………………………J.
(VIPUL M. PANCHOLI)
New Delhi;
May 15, 2026
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