Reliance General Insurance Company Limited vs Priyanka Das and Others

S.V.N. BHATTI, J.

On 10.04.2011 at around 05.30 pm, Sushant Prabhakaran and Priyanka Das, the Claimant herein, were riding a motorcycle and proceeding towards Gurgaon. A truck bearing No. HR-55-2812 hit the motorcycle, resulting in an accident. Sushant Prabhakaran fell under the wheels of the said truck and died on the spot. The truck bearing No. HR-55-2812 was insured by Reliance General Insurance Company Limited. The Claimant sustained grievous injuries to several parts of her body. On the complaint of a passerby/third party, Radhe Shyam Kaushik, FIR No. 198 was registered at Police Station Gadmukteshwar.

The Claimant was admitted immediately as a patient at Anand Hospital, Meerut, with pelvic fractures and blindness. The Claimant was admitted and treated at Fortis Hospital, Noida, between 12.04.2011 and 11.06.2011. During the first phase of hospitalisation, the Claimant underwent pelvic reconstruction. She was further admitted and treated at Kailash Hospital, Noida, between 11.06.2011 and 26.08.2011 for rectal/colostomy surgeries.

On 30.01.2014, the Claimant appeared before Dr. Radhika Tandon (AIIMS, New Delhi) for assessment of visual impairment. Dr. Radhika Tandon certified that the Claimant suffered 100 per cent visual disability and is a handicap as a result of the accident. The Claimant survived the surgeries, trauma, and pain, and thereafter filed MACT Petition No. 94 of 2014, claiming compensation of Rs. 12 Crores along with interest at 15 per cent per annum. At the time of the accident, the Claimant was 35 years old and was working as Deputy Group Manager with IBM Daksh, Concentrix Daksh Services India Pvt. Ltd., in Cyber City, Gurgaon. The Claimant sought the sum referred to above based on her additional qualification, the injuries suffered, the loss of quality of life, and the need for 24-hour nursing assistance. The Gastrointestinal Surgery Department, AIIMS, New Delhi, certified on 08.01.2015 that the Claimant requires a permanent colostomy stoma for life.

The Claimant examined herself as PW-9 and had PW-1 to PW-11 examined on her behalf, and Exhibits P-1 to P-556. The evidence of PW-9 and of Deepak Swami, examined as PW-6, a Deputy Manager at IBM Daksh, Concentrix Daksh Services India Pvt. Ltd. in Cyber City, Gurgaon, is important for disposing of the Civil Appeals. PW-6 deposed to the Claimant's salary particulars, the increase in her salary, and that the Claimant remained on leave without pay from the employer for 19 months.

The Tribunal assessed functional disability at 60 per cent and noted that her Cost to Company has increased from 16 lakhs to 19 lakhs per annum post-accident, and that there is no net loss of income to the Claimant. The Tribunal, in the Award dated 03.04.2017, calculated the loss of future income at Rs. 98,78,105/- and awarded a total compensation of Rs. 1,35,53,298/-. The Tribunal, on the extent of injuries, the periods of hospitalisation, and the direct and indirect expenses during the Claimant’s hospitalisation, analysed the pleadings, evidence and held as follows:

Notwithstanding the above extent of injuries, in deciding the Claimant's entitlement to compensation, the Tribunal has examined the functional and physical disability the Claimant has suffered. The Tribunal's consideration of functional and physical disability is stated as follows:

The Tribunal examined the documentary evidence produced in support of the claim for medical expenses, etc. The important aspects are negligence and the fastening of liability in the award of compensation. The Tribunal held as follows:

This led to the Insurer filing FAO No. 3608 of 2017 and the Claimant filing the cross-appeal bearing FAO No. 5436 of 2017 before the High Court of Punjab and Haryana. The High Court dismissed FAO No. 3608 of 2017 and partially allowed the Claimant’s cross-appeal. The primary aspects on which the High Court modified the Tribunal’s view were the functional disability, which it increased from 60 per cent to 80 per cent, and the award of a 50 per cent increase towards future prospects on the proved salary of the Claimant. Regarding the injuries recorded, the High Court noted as under:

The High Court awarded compensation for attendant charges, special diet, future medical expenses, loss of income during hospitalisation/treatment, pain and suffering, loss of marriage prospects, and a lump-sum amount for transportation and accidental expenses for amenities, as claimed by the Claimant. It is appropriate to present the compensation awarded by the Tribunal and the High Court in the following table: -

Hence, the Civil Appeals are at the instance of the Insurer and the Claimant. In Civil Appeal Nos. 12087-12088 of 2026, the Insurer primarily assails the determination and award of compensation, contending that:

Per contra, the Claimant in Civil Appeal No. 12089 of 2026 prays for enhancement of compensation principally by contending that: -

On 17.10.2025, this Court passed an order directing the Claimant to appear before the Medical Board of Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, for a medical re-examination to determine the functional and physical disability the Claimant has suffered on account of the accident injuries. The Medical Board consisted of representatives from Neurology, Neurosurgery, Ophthalmology, General Surgery, CIO, and Physical Medicine and Rehabilitation (PMR). The Report dated 28.02.2026 concludes that the Claimant suffered a total permanent physical impairment of 100 per cent of the whole body due to the said incident.

The learned Senior Counsel appearing for the Insurer contends that the compensation awarded to the Claimant, even assuming, without admitting, that the Claimant suffered 100 per cent permanent physical impairment, is excessive. The Claimant has neither lost employment opportunities nor earning capacity. Therefore, the functional disability should be the yardstick for determining compensation under the permissible heads.

Per contra, the learned Senior Counsel for the Claimant contends that the latest Medical Board report from a reputed Government hospital entitles the Claimant to enhanced compensation, as this is a case of life without functional limbs/organs. The argument on actual and functional disability in the case at hand is rendered insignificant by the contemporaneous report. The Insurer is estopped from disputing or denying additional compensation, having accepted the suggestion for a fresh evaluation of the Claimant by a competent Medical Board.

We have heard the learned Counsel and perused the record, particularly the Medical Board’s Report dated 28.02.2026. The said Report is taken on record and marked as Court Exhibit.

The Insurer’s case is on actual and functional disability. Even if the Claimant has suffered 100 per cent permanent physical impairment from continuous employment, the compensation awarded is either excessive or she is not entitled to any more.

The contention is merely noted and rejected. The Medical Board’s opinion will now be the guiding factor in determining the compensation for injuries suffered by the Claimants in the accident dated 10.04.2011. The Insurer’s argument is tested from both perspectives. Firstly, if the latest report of the Medical Board indicates less permanent physical impairment to the Claimant, the Insurer would press the argument for determining the compensation as assessed by the Medical Board. Therefore, once the Medical Board’s report is against the Insurer’s argument, it cannot be heard to argue that the compensation is payable at a lesser percentage than assessed by the duly constituted Medical Board. Having invited the Medical Board’s opinion, for which no objection could be taken by either of the parties, and considering the number of surgeries the Claimant had undergone, the compensation has to be accordingly re-determined.

The medical assessment conducted pursuant to this Court’s directives evaluates the Claimant’s condition. On 27.02.2026, a multi-disciplinary Medical Board at Vardhman Mahavir Medical College & Safdarjung Hospital, chaired by Dr. Vandana Chakravarty, examined the Claimant. The Medical Board concluded that the Claimant suffers from a 100% Permanent Physical Impairment (PPI) affecting her whole body. Further, Exhibit P1, issued by Dr Radhika Tandon of the Dr Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS New Delhi, established that the Claimant is 100% visually handicapped due to post-traumatic bilateral cortical blindness. Furthermore, Exhibit P2, provided by Dr. Peush Sahni of the Department of Gastrointestinal Surgery at AIIMS, confirmed that the continuity of her large intestine could not be restored because of a complication due to a communication between the rectal stump and a wound in her lower back, thus necessitating a permanent stoma for the rest of her life.

The calculation of functional disability depends on assessing the victim’s earning capacity in the open, competitive market, rather than on retention in a specific, highly accommodated role. Evidence before the High Court, specifically the Career Growth Letter dated 06.02.2018 from her employer, confirmed that the Claimant lost out on her normal career growth and promotional progression, including advancement to the positions of General Manager, Director, or Vice President, as a result of the accident. The record further indicates that she is able to perform her current duties only through specially created software, flexible working hours, and extreme accommodations provided by her employer as an act of corporate compassion.

Based on the official Medical Board Report issued by Vardhman Mahavir Medical College & Safdarjung Hospital, which evaluated the Claimant and certified a 100% PPI of the whole body due to post-traumatic head injury with cortical blindness, pelvic fracture, and a permanent colostomy, the compensation calculation shifts from the High Court’s 80% assessment to a 100% functional disability because the Claimant’s capacity to independently secure, sustain, or advance employment in the open labour market has been entirely extinguished.

The Court is exercising its discretion in the peculiar facts and circumstances of this case to arrive at just and fair compensation payable to the Claimant. The Claimant is a well-educated lady with a reasonable income. In the circumstances of the present case, which shall not be treated as a precedent, a reasonable sum for the loss of marriage prospects, i.e., Rs. 20,00,000/-, is considered. Therefore, the compensation on the basis of 100 per cent functional disability/permanent physical impairment needs to be revised as follows:

Hence, the total compensation awarded is Rs. 3,77,84,297/- (Three Crores Seventy-Seven Lakhs Eighty-Four Thousand Two Hundred and Ninety-Seven), with interest at 7.5 per cent per annum from the date of the Claim Petition until the entire amount is realised.

The Civil Appeal Nos. 12087-12088 of 2026 are dismissed, and the Civil Appeal No. 12089 of 2026 filed by the Claimant is allowed in part as indicated above.

Pending Application(s), if any, shall stand disposed of accordingly. No order as to costs.