KO WAH v SAMIKANNU MANICKAVASAKAR & Anor

1 This is a judgment that documents NTUC Income’s wholly unreasonable behaviour. NTUC Income is the Defendants’ insurance provider. After the 1st Defendant knocked down Mr Koh Wah (“the late Mr Ko”) in a motor accident on 21 June 2019, NTUC Income took over conduct of the Defence, pursuant to the Defendants’ motor insurance policy. Inexplicably, they resisted certain uncontroversial claims made by the Plaintiff (see [17], [36] and [43]). This judgment therefore represents the court’s unmixed dissatisfaction with the manner in which NTUC Income has conducted itself.

2 The context: for more than half a decade after his accident, the late Mr Ko was bedridden and “permanently mentally incapacitated”, ¹ being “fully dependent on caregivers for all his activities of daily living” ² and his presentation being “consistent with advanced dementia”. ³ He had suffered such severe brain injuries from his accident that he required decompressive craniectomy and cranioplasty, with a further post-operative tracheostomy as well. Before closing submissions were tendered at the assessment of damages hearing, he passed away on 2 October 2024.

3 When the Plaintiff (suing as administrator for the late Mr Ko) brought his suit against the Defendants, NTUC Income took over conduct of the Defence from the Defendants as they (NTUC Income) would have had to foot the bill for any judgment against the Defendants. The Defendants’ lawyers – good, reputable counsel of fine standing in the bar - were therefore taking instructions from NTUC Income throughout the proceedings. The unsaid understanding was that this was essentially an insurance claim packaged in legal proceedings and adjudicated by a judicial officer. When played out during proceedings, NTUC Income’s unfounded objections – it refused to provide explanations for some of its objections even when pointedly questioned – read like the sort of casually impersonal stonewalling that some would associate with the worst administrative processes. The earnestness of the beleaguered Plaintiff offered heartbreaking contrast.

4 There are four heads of claim to adjudicate:

(a) Pain and suffering, and loss of amenities arising from injuries sustained in the accident;

(b) Loss of pre-trial earnings arising from injuries sustained in the accident;

(c) Medical expenses arising from injuries sustained in the accident; and

(d) Further expenses arising from injuries sustained in the accident.

5 This, in summary, is my award:

6 I am ordering $218,000 for the late Mr Ko’s pain and suffering, as well as loss of amenities. The best way to explain this is to:

(a) State the principles and purposes of, respectively, an award of pain and suffering, and an award for loss of amenities;

(b) Outline the injuries suffered and the treatment / medical management that was necessitated thereafter; and

(c) To match, in a proportionate manner, the various awards (for pain and suffering, or loss of amenities) to the specific losses experienced by the late Mr Ko before his demise.

7 Pain and suffering, and loss of amenities are two different types of losses. “The former depends upon the plaintiffs` personal awareness of pain, her capacity for suffering. But the latter is awarded for the fact of deprivation - a substantial loss, whether the plaintiff is aware of it or not.”: Tan Kok Lam (next friend to Teng Eng) v Hong Choon Peng [2001] SGCA 27 (“Tan Kok Lam”), citing H West & Son v Shephard [1964] AC 326. This means that “unconsciousness on the part of the victim would negative [a claim for pain and suffering] and thus render an award in respect of that claim inappropriate”: Tan Kok Lam at [28]. True, the distinction is sometimes artificial, as the High Court eloquently described in Chong Hwa Wee (by his Committee of Person and Estate, Chong Hwa Yin) v Estate of Loh Hon Fock, deceased [2006] SGHC 79 at [5]. But there are cases where the distinction is meaningful, and this is one of them.

8 The approach for assessing pain and suffering was set out in Lua Bee Kiang (administrator of the estate of Chew Kong Seng, deceased) v Yeo Chee Siong [2019] 1 SLR 145 (“Lua Bee Kiang”) at [12] – [18]. I adopt the summary I have penned elsewhere in Asher David De Laure v Norhazlina Binte Md Yusop [2023] SGDC 72 (“Asher David”) at [10]:

(a) First, the component method is applied. That involves quantifying the loss arising from each item or head of damage separately. This ensures that the loss arising from each distinct item or head of damage is properly accounted for: Lua Bee Kiang at [14]. Reference may be made to the Guidelines for the Assessment of General Damages in Personal Injury Cases (Academy Publishing, 2010) (“the Guidelines”) since they set out indicative assessment ranges for most types of personal injuries. However, these are no more than guidelines and a “good starting point” for negotiations: Lua Bee Kiang at [15].

(b) Second, the global method is applied. That involves holistically considering all the injuries, to determine whether the aggregate award is reasonable and neither excessive nor inadequate: Lua Bee Kiang at [16]. This exercise is guided by at least two considerations. The first is to avoid overcompensation, with the Court accounting for any “overlapping” injuries that either (i) together resulted in pain that would not have been differentially felt by the claimant or (ii) together gave rise to only a single disability: Lua Bee Kiang at [17]. The second consideration is to ensure that like cases are treated alike, by considering and referring to the appropriate precedents: Lua Bee Kiang at [18].

9 I have also previously used the Monetary Authority of Singapore’s online inflation calculator (“MAS Inflation Calculator”) ⁴ in Asher David (see [8]) to make past awards relevant with an appropriate uplift for inflationary pressures. This has been recently applied at the High Court in Lee Sim Leng v SMRT Buses Ltd [2025] SGHC 11 at [94] and Poongothai Kuppusamy v Huationg Contractor Pte Ltd and anor [2023] SGHC 215 at [57]. I gratefully adopt the High Court’s guidance.

10 As for the approach to loss of amenities, the Court “takes a broad-brush approach”: Noor Azlin bte Abdul Rahman and another v Changi General Hospital Pte Ltd [2021] SGCA 111 (“Noor Azlin”) at [146]. Precedents are useful (as evinced in the High Court’s approach in Soh Xia Kai Ronnie v Loke Chor Kay [2019] SGHC 136 at [34] – [40]), but the facts of the case are of first importance. That is where I now turn to.

11 I should begin by stating that the medical evidence produced by the Plaintiff was probably incomplete. The Statement of Facts tendered in support of the 1st Defendant’s criminal proceedings referenced a medical report dated 19 September 2019. This report was not tendered by the Plaintiff, and the Defendants, for whatever reason, did not see fit to put it before the Court even though it would have been highly material. That report, in all likelihood, was the sort of report requested by the traffic police in these sorts of cases, and would have been a significantly detailed medical report that outlined the precise diagnosis, any medical complications arising, as well as treatments undertaken. In contrast, the medical reports I have before me are somewhat thin for what was clearly a very serious injury. Be that as it may, I did not pursue this further since all parties – fully represented, and knowing full well that we operate in an adversarial system – appear to have been content to proceed on this basis.

12 When the late Mr Ko was rushed to the Emergency Department on 21 June 2019, he was diagnosed with a “traumatic subdural haemorrhage”. ⁵ He required “emergent brain surgeries to preserve his life”, and underwent “right external ventricular drain and left sided decompressive craniectomy”. ⁶ His consciousness was poor post-operatively and a tracheostomy was necessary too. ⁷ Subsequent to this, he underwent a cranioplasty on 16 August 2019, before being discharged on 31 August 2019. ⁸

13 The late Mr Ko’s injuries may be summarised as followed. I have taken this summary from the Statement of Facts tendered in support of the 1st Defendant’s criminal proceedings, which was undisputed at the hearing and was, most importantly, prepared on advice of a doctor’s opinion:

(a) Minimally displaced fracture traversing across the left high frontal to right high parietal, extending to the left frontal bone and left frontal sinus walls,

(b) Scalp haematoma over the left high frontal and right high parietal regions,

(c) Extensive acute subdural haematoma in the anterior falx, interhemispheric fissure and bilateral cererbal convexities,

(d) Acute subarachnoid hemmorhage components in the left high frontal and bilateral basifrontal regions.

14 Notably, the late Mr Ko was intermittently conscious from the time of his accident till his death. While it is not realistic to draw conclusions on too granular a level, I find that:

(a) Between 21 June 2019 (the time of the accident) till 31 August 2019 (his date of discharge), the late Mr Ko was unconscious and unable to appreciate his pain and suffering. He required resuscitation by the doctors on arrival at the emergency department, ⁹ and his consciousness was “poor post-operatively”. ¹⁰ These suggest to me that he was only discharged after his consciousness was brought back to relatively safer levels.

(b) There was another visit to the hospital on 10 September 2019, ¹¹ and a follow-up appointment for CT scans on 17 September 2019, ¹² but there were no medical reports issued for those. There being no suggestion otherwise, I saw no reason to suspect that his consciousness had dipped once more at that time.

(c) He visited the hospital on 14 October 2019 and was discharged on 22 October 2019. ¹³ I assume it was an emergency visit since the ambulance pick-up time was at 0115hrs, ¹⁴ but there was again, no particular evidence before me to suggest that he had lost consciousness or his faculties at that time. In much the same vein, he visited the hospital on at least a few more occasions, on 27 November 2019, ¹⁵ 16 January 2020, ¹⁶ 17 February 2020, ¹⁷ 12 March 2020, ¹⁸ 16 July 2020 (this was a virtual consultation), ¹⁹ and 25 October 2020. ²⁰ There were no medical reports given for any of these, and similarly no hard evidence that his consciousness had fallen during that period.

(d) At a tele-consultation on 5 January 2021, the attending doctor found the late Mr Ko “to be alert and obeying commands to movement only on his left arm”. ²¹ He was noted to be “able to understand simple instructions”. ²² This was consistent with the medical history that would later be taken by a psychiatrist on 24 March 2021 (“his children reported that he did raise his hand when in pain but otherwise no meaningful communication at home”). ²³

(e) At his mental capacity assessment on 24 March 2021, the psychiatrist noted that the late Mr Ko was “noted to be alert”, but that he was “unable to communicate verbally, by writing, by raising his hand, nodding or shaking his head”. The late Mr Ko was also “mute”, and “unable to repeat any part of the explanation or verbalise understanding”, being “cognitively impaired” with presentation “consistent with advanced dementia”. All this being said, “his children reported that he did raise his hand when in pain”. I am prepared to assume that from this point onwards, he was at a low level of consciousness and his ability to appreciate pain and suffering was at the very least, deteriorating.

(f) At a physical review on 18 April 2023, the doctor recorded that the late Mr Ko was in “poor conscious state”, and that he was “non-communicative”. He was pegged at “E4M3Vt” ²⁴ on the Glasgow Coma Scale, which essentially means that he was at 7 – 8 on the scale. For context, the Glasgow Coma Scale “grades a person’s level of consciousness” (Guidelines for the Assessment of General Damages in Personal Injury Cases (Academy Publishing, 2010) (“the Guidelines”) at p 3). 15 is “the maximum score” (see Public Prosecutor v Ravindran Annamalai [2013] SGHC 77 at [59]) and 3 is “the lowest possible” score (see Chai Kang Wei Samuel v Shaw Linda Gillian [2010] SGCA 22 (“Samuel Chai”) at [44]), with a score of 3 – 8 being considered “severe” (see the Guidelines at p 3). Again, I took this to mean that he was functioning at a low level of consciousness, but was mindful that there was no definitive diagnosis that he was in a completely comatose state. Indeed, “his left upper limb [was] able to raise against gravity” with his other limbs “displaying minimal movement”.

(g) The late Mr Ko required the services of a home medical doctor from 26 May 2020 onwards. ²⁵ In a report dated 1 August 2023, the doctor recorded that the “patient [was] completely non-communicative with no mental capacity. The patient is permanently mentally incapacitated in is dependent on a full time live in care-giver 24/7 for ALL activities of daily living.” ²⁶ I am therefore prepared to assume that he was, at least from 1 August 2023, completely unable to appreciate pain and suffering, up till his passing away on 2 October 2024.

15 The upshot therefore, is that:

(a) Between 21 June 2019 to 31 August 2019 (71 days, not including the last day), the late Mr Ko was completely unconscious.

(b) Between 31 August 2019 to 24 March (571 days including first day but not last day), the late Mr Ko was conscious enough to fully appreciate pain and suffering.

(c) Between 24 March 2021 to 1 August 2023 (861 days including first and last days), the late Mr Ko’s consciousness was deteriorating and his ability to appreciate pain and suffering would have likewise, been declining.

(d) Between 1 August 2023 – 2 October 2024 (428 days, not including first day, but not last day), the late Mr Ko was generally unconscious and I am willing to assume that he was effectively unable to appreciate pain and suffering.

16 In total, the late Mr Ko was labouring under his injuries for 1931 days. Of these days, he spent:

(a) 499 days (71 days + 428 days), or about 25% of the time completely unconscious,

(b) 571 days, or about 30% of the time, reasonably conscious, and

(c) 861 days, or about 45% of the time, in a state of deteriorating consciousness.

17 At the outset, I should state that NTUC Income’s instructions to the Defendants’ counsel was to completely deny the claim for pain and suffering, ²⁷ and loss of amenities. ²⁸ Their position was that the late Mr Ko had been comatose the entire time, and could not have appreciated any pain and suffering at all. This was despite:

(a) the clear evidence, as acknowledged by the Defence Counsel himself, that there were periods of time when the late Mr Ko was “alert” and “appeared to understand simple instructions”; ²⁹

(b) the uncontroversial legal position, as acknowledged by the Defence Counsel, that “where an injured person is unable to feel pain and suffering, the injured person is still entitled to damages for loss of amenities.” ³⁰ (see also Tan Kok Lam at [25] and [28]); and

(c) an explicit opportunity given for them to explain their insistence on such an unyielding and apparently unreasonable position at a further hearing (NTUC Income simply declined to explain themselves).

18 Be that as it may, it is reasonably apparent from the evidence above that the Plaintiff should be awarded damages for pain and suffering since there were at least some periods of the late Mr Ko’s life where he was able to appreciate pain and suffering. I adopt the following methodology:

(a) First, pain and suffering is calculated on the usual basis – i.e. assuming that the late Mr Ko had been fully conscious from the time of his accident till his death. I will refer to this as “the usual sum”.

(b) Second, a percentage of the usual sum ought to be awarded for the time period that he was indeed fully conscious

(c) Third, a percentage of the usual sum ought to be awarded for the time period that he was in a state of deteriorating consciousness. A reasonable discount ought to be further applied to this, for the fact that the late Mr Ko’s ability to appreciate pain and suffering was diminishing at that time.

(d) Fourth, an award for loss of amenities ought to be given for period that the late Mr Ko spent generally unconscious.

I have found support for such an approach in the Guidelines which usefully provides that “the quantum of the award will be affected […] by the degree of awareness of the physical stimuli [and] the extent of physical limitations” (see p 4 of the Guidelines). I should also add that I explicitly provided counsel an opportunity to consider the fact that neither of their approaches (the Defendants claimed that the late Mr Ko was unconscious the whole time while the Plaintiff argued that he was conscious the whole time) seemed consistent with the evidence. Neither counsel offered an alternative, or more realistic quantification methodology.

19 Where brain injury is concerned, the Court would ordinarily have regard to the various domains of brain injury, as stated in Samuel Chai at [48]–[49]: structural, psychological and cognitive.

20 Structurally, the late Mr Ko’s injury was severe. Most concerning, to my mind, was the “extensive acute subdural haematoma in the anterior falx, interhemispheric fissure and bilateral cererbal convexities”. ³¹ His post-accident surgery was invasive and extensive (“external ventricular drain and left sided decompressive craniectomy for acute subdural hematoma” and a “cranioplasty”, presumably to cover the skull defect”), ³² and the residual disability haunted him till the end of his days. An award on the highest end of the Guidelines’ range for “Skull fractures” ought to be considered. That would be $75,000. Adjusted for inflation, that would amount to $99,868.17.

21 I take the psychological and cognitive domains together. The late Mr Ko was essentially incapacitated and his condition progressively worsened over time. At one point, his Glasgow Coma Scale was recorded at “E4M3Vt” ³³ (i.e. anywhere between 7 – 8 on the scale). This appears to answer the Guidelines’ description of “very severe brain damage” at pp 3 - 4:

The applicable range in the Guidelines for such injuries is $160,000 – $250,00. The Plaintiff’s counsel has proposed $220,000 and I find that the facts support that proposal. Adjusted for inflation, that would be $292,946.64

22 Taken together, the starting point (the “usual sum”, as I’ve described above) would roughly come up to $400,000. For completeness, I am making clear that I have considered whether his pre-existing medical conditions had contributed to his bed-bound condition and have concluded that him being bedridden was entirely attributable to the accident. That was, after all, the doctor’s unequivocal testimony: “yes all current needs arose from the accident as the patient was otherwise independent of ALL activities of daily living and instrumental activities of daily living prior to the accident”. ³⁴

23 Only a percentage of the usual sum should be awarded for the period that the Plaintiff spent reasonably conscious, and therefore able to appreciate pain and suffering properly. That would be 30% of the time (see [16] above). He should therefore be awarded $120,000 for this period of his life.

24 The late Mr Ko spent about 45% of the time in a state of deteriorating consciousness. 45% of $400,000 comes up to $180,000. To this, I am applying a further 50% discount because he was in a state of deteriorating consciousness. Admittedly, 50% is an impressionistic figure. But with the evidence as it stood, I was simply not comfortable making a more granular finding. More arithmetic would have produced spurious precision at best. In the circumstances, a somewhat Solomonic assessment appeared to be fairest.

25 In sum, the Plaintiff ought to be awarded $210,000 ($120,000 + $90,000) for his pain and suffering.

26 I take the Court of Appeal’s decision in Tan Kok Lam as a starting reference point. Like the present case, the plaintiff there was knocked down in a car accident. Like the present case, she suffered serious brain damage (“left frontal brain contusion with fronto-tempero-parietal acute subdural haematoma”) and required serious treatment (“A craniectomy and evacuation of the acute subdural haematoma”). Again, like the present case, the plaintiff “was not able to respond to visual and verbal stimulation”. She was described as being in a “persistent vegetative state” (at [2]). Her life expectancy was pegged at 10 years at best (at [2]). The Court of Appeal restored the assistant registrar’s award of $80,000 for loss of amenities. I am taking that $80,000 award as a starting point.

27 The present case differs in two main aspects. The first is that the award in Tan Kok Lam was granted when the plaintiff expected to live no more than 10 years. The award, in other words, was expected to account for up to 10 further years of loss of amenities. In the present case, the award for loss of amenities should address the 499 days that the late Mr Ko spent generally unconscious (see [16(a)]). The second difference is that the late Mr Ko was generally unconscious during that period but some realistic allowance ought to be made for some possibility that he was conscious at points. In contrast, the plaintiff in Tan Kok Lam was in a “persistent vegetative state”.

28 For that reason, I am applying a 90% discount to the $80,000 award given in Tan Kok Lam. This roughly accounts for the year or so that the late Mr Ko was generally unconscious (as opposed to the 10 years that the plaintiff in Tan Kok Lam was expected to live). That comes up to $8,000 for loss of amenities.

29 Put together, the total award for pain and suffering, and loss of amenities, is $218,000. I am mindful that there is a certain degree of artificiality in the manner that I have divided up periods of the late Mr Ko’s last years. The truth is, monetary compensation for physical injury almost never feels adequate nor accurate. The layman would understandably find it inadequate or disrespectful to hear that human body parts can be priced – a bad skull fracture for $80,000, or severe brain damage for $220,000 etc. Relatedly, a bed-bound man unable to enjoy the company of his filial children in his final years, or a graceful departure as his time comes, arguably experiences a loss that hard-hearted money cannot capture. But the award given must be principled and pathos cannot prevail, not in the least because “the judicial mind [keeps] in view peripheral, but relevant, factors such as the impact on the insurers and the rate of inflation”: Chong Hwa Wee (by his Committee of Person and Estate, Chong Hwa Yin) v Estate of Loh Hon Fock, deceased [2006] SGHC 79 at [9]. This represents my best approximation of a fair, and rational process that answers all parties’ concerns.

30 There are two aspects to this head of claim: (a) how long the late Mr Ko would have continued to work had he not experienced the accident, and (b) how much he could have expected to earn on average.

31 I find that the late Mr Ko would have worked for one and a half more years from the time of the accident.

32 He was, by his son’s own account, 78 years old at the time of the accident. ³⁵ The average lifespan of a Singaporean male is 81 years old. ³⁶ The starting point, therefore, was that he would have worked for three more years if he had worked till his dying day, and if he had lived for the average lifespan of a Singaporean male.

33 To that figure, I apply a 50% discount (3 years x 50%) for the following reasons:

(a) The late Mr Ko was not an average Singaporean male. He had a history of heart failure (having even gone through a triple bypass at one point), and struggled with hypertension, diabetes, chronic obstructive pulmonary disease, among other chronic conditions. The doctor confirmed that “even without the accident the chances of him passing [were] higher”. ³⁷

(b) The late Mr Ko would have only continued working for his previous employer, a firm providing security services (“Spear”), for “as long [as they] were contracted to the assignment”. ³⁸ The Plaintiff’s counsel accepted that there was no guarantee of Spear’s contract being renewed at the job site. ³⁹

(c) The late Mr Ko may not necessarily have worked till his last day. He may have retired at some point.

34 As for his monthly income, I find that he would have earned $1,600/month on average in 2019, and $1,702.08/month on average in 2020.

(a) I derive $1,600 as the monthly average income in 2019 by taking an average of Mr Ko’s monthly salaries from January 2019 to May 2019. This was the Defendant’s approach, ⁴⁰ and the Plaintiff accepted the figure proposed by the Defendant. ⁴¹

(b) I derive $1,702.08 as the monthly average income in 2020 by applying an appropriate uplift to $1,600. The uplift itself was derived from the Progressive Wage Model, which Spear subscribed to, ⁴² and which suggested that salaries ought to increase by roughly 6.38% from 2019 to 2020. ⁴³ 106.38% of $1,600 is $1,702.08. The Defendants conceded at the hearing on 29 May 2025, that this was an appropriate way of quantifying the monthly average income in 2020. ⁴⁴ This was wise, considering that Spear had explicitly committed to giving yearly salary increases, following the Progressive Wage Model as a benchmark. ⁴⁵

Ultimately, the evidence simply did not support any of the Defendants’ arguments. Contrary to their suggestions, there was evidence that Spear “would have implemented [salary increases as set out in the Progressive Wage Model]” ⁴⁶ – Spear confirmed it in writing (“salary will increase. We will follow government’s mandate basic salary for our industry”). ⁴⁷ Similarly, there was a “documented history of salary increments during [the late Mr Ko’s] employment” ⁴⁸ – the Defendant’s own tabulations demonstrated this, ⁴⁹ and the payslips tendered in evidence bore that out as well. ⁵⁰

35 Taken together, I therefore conclude that the late Mr Ko would have earned $30,024.96, had it not been for the accident. This comprises the following:

(a) $1,600 x 6 = $9,600 (2019, 6 months)

(b) $1,702.08 x 12 = $20,424.96 (2020, 12 months)

36 Again, somewhat inexplicably, NTUC Income staunchly refused to pay for any ambulance related expenses. I cannot understand why NTUC Income would be willing to pay for hospital expenses, but not transportation to the hospital. There is nothing unreasonable about calling an ambulance to transport a bedridden man for his hospital visits. It boggled the mind why NTUC Income would have taken such an unyielding stance over something so obviously necessary. Two points:

(a) Ambulance rides are not joyrides. They are expensive, and generally accompanied by a certain amount of anxiety. Victims do not board ambulances lightly. Once receipts are produced for them (they are, after all, a species of special damages which require specific proof in order to be recoverable: Wee Sia Tian v Long Thik Boon [1996] 3 SLR(R) 513 at 517F, cited in Tan Teck Boon v Lee Gim Siong and others [2011] SGHC 169 at [19]), I would imagine that it is generally inappropriate for Defendants to question the motives for such an expense. There may, at points, be something which screams for explanation, and which warrants further investigation behind the receipts. But the starting point should be a charitable one.

(b) Each of the late Mr Ko’s ambulance rides were accompanied by contemporaneous hospital invoices. Each of these were painstakingly explored at the hearing on 29 May 2025. The papers paint a picture of the late Mr Ko’s continuing struggle with his injuries. Some of the visits ⁵¹ were short ones, for relatively routine scans. ⁵² Others were longer stays, ⁵³ where the late Ko was conveyed to the hospital urgently in the dead of the night. ⁵⁴ And the golden thread running through all the receipts, was that the late Mr Ko took the ambulance rides for perfectly legitimate reasons.

37 I am therefore allowing all of the Plaintiff’s claims for ambulance related expenses. These total $1,992 and are as follows.

38 The Defendants’ first objection was that some of the medication was used to treat the late Mr Ko’s pre-existing medical conditions, which are unrelated to the accident. There is some force in that argument. His doctor, Dr. Lai Jun Xu, confirmed that “most of the medications [which were part of the late Mr Ko’s prescription] are chronic medications”. ⁵⁵ I am therefore not granting the Plaintiff’s claim for expenses related to those. These are: ⁵⁶

(a) Beclomethasone

(b) Bisoprolol

(c) Esomeprazole

(d) Daneuron

(e) Entecavir

(f) Vivomix

(g) Lopermide

(h) Salbutamol

39 Additionally, the Plaintiff did not produce enough evidence to prove that some of the medication was related to injuries arising from the accident. Aside from claims for regular over-the-counter painkillers like aspirin and paracetamol (which I granted), the Defendants were right to be sceptical of such claims. ⁵⁷ I decline to grant the claims for these, since it was not obvious, on the face of the documents, what such medication was for. I am particularly mindful that the late Mr Ko had a storied history of pre-existing medical conditions. ⁵⁸ I am therefore wary of assuming that all medication was necessarily related to injuries arising from the accident.

40 That said, the doctor also confirmed (and the Defendants accepted) ⁵⁹ that the following medication was necessitated by medical needs arising from the accident: ⁶⁰  

(a) Doxycycline tablet

(b) Nicotinamide tablet

(c) Prednisolone

(d) Thymol

(e) Acetylcysteine

(f) Bromhexine

(g) Guaifenesin

(h) Higher doses of diabetes medication due to the administration of higher doses of steroids (e.g. Linagliptin and Metformin)

41 I am therefore granting the Plaintiff’s claims for expenses related to items at paragraph 40(a) - 40(g) above. As for the higher doses of diabetes medication (see [40(h)] above), I accept that the Defendants are not responsible for the late Mr Ko contracting diabetes. That was a pre-existing condition which predated the accident. The Defendants are only responsible for the increased dosage of diabetes medication, which in turn was necessary to accommodate the higher doses of steroids administered after the accident. I am granting the Plaintiff only half of the expenses related to diabetes medication. These are tabulated at Annex A below.

42 The Defendants’ second objection was that the Plaintiff had purchased multiple pulse oximeters and thermometers. The suggestion was that “one pulse oximeter and thermometer can be used for a long time before running out of battery or needing to be replaced.” ⁶¹ I can see some force in that reasoning, especially given that the Plaintiff appears to have purchased multiple thermometers in quick succession (see thermometers purchased on 9 February 2020 ⁶² and 17 February 2020). ⁶³ Therefore, I granted the claims for the first pulse oximeters and thermometers bought, and for batteries thereafter. These are likewise reflected in Annex A below.

43 The Defendants’ third objection was that some of the medical expenses were paid using payouts from MediShield Life. Specifically, NTUC Income instructed the Defendant’s solicitors to resist paying for any medical expenses covered by payouts from MediShield Life. Bafflingly, not one, much less a credible, reason was offered for this. Their (remarkably thin) submissions on this subject were as follows.

(a) “… [clients] have instructed us that they will not be paying […] notwithstanding the relevant case law.” ⁶⁴

(b) “[…] Notwithstanding the decision in Lo Kok Jong, the Defendants have nonetheless instructed us that they are maintaining their position and will not be paying for the medical expenses paid by MediShield Life” ⁶⁵

44 Needless to say, I found the objection to be callous and meritless. I did not accept it, and made no distinction between medical expenses paid by MediShield Life, medical expenses covered by Medisave, and those paid by cash/credit card/debit card. So long as the medical expenses were reasonably incurred and there was sufficient proof of the same, I made orders for the Defendants to compensate the Plaintiff. I explain in three main parts:

(a) The general rule is the rule against double recovery. If the Plaintiff has enjoyed any gains on account of the injury (i.e. some sort of collateral benefit fortuitously arising from the injury), that has to be taken into account when assessing his damages: Minichit Bunhom v Jazali bin Kastari and another [2018] 1 SLR 1037 (“Minichit”) at [30].

(b) There is an exception. “Even if the plaintiff’s losses had, in full or in part, been recouped by reason of collateral benefits conferred upon him by parties unrelated to the tortfeasor, the plaintiff may nonetheless in some instances be allowed to retain those collateral benefits and make a claim for the full extent of his loss from the tortfeasor without an equivalent deduction to account for the collateral benefit.”: Minichit at [83]. This is referred to as the doctrine of collateral benefits.

For this exception to apply, the test is whether the intended purpose of the payout of the collateral benefit, objectively judged, was to provide the plaintiff with a sum over and above the damages payable: Lo Kok Jong v Eng Beng [2024] SGCA 28 (“Lo Kok Jong”) at [55] – [56]. A classic example of this exception is known as the Insurance Exception: “where a plaintiff recovers any moneys under an insurance policy for which he has paid the premiums[;] the insurance moneys are not deductible from damages payable by the tortfeasor.”: Lo Kok Jong at [17].

(c) Here, the Plaintiff is seeking compensation from the Defendants for medical expenses that had already been covered by the late Mr Ko’s MediShield Life policy. On its face, this looks like double recovery: once, from MediShield Life; and a further recovery in damages from the Defendant. However, I find that that the Insurance Exception applies, and that such double recovery is permissible. This is because MediShield is effectively a nationalised insurance scheme. I’ve articulated my reasons for this elsewhere in Eng Beng v Lo Kok Jong [2020] SGDC 130 at [48]. There, I found that MediShield was in every sense, an insurance policy:

(i) That is how it is described in the MediShield Life Scheme Act 2015 (“A medical insurance scheme, known as the MediShield Life Scheme, is established for the purpose of…”: s 3(1)).

(ii) That is consistent with how insurance policies are described in the seminal case of Prudential Insurance Company v Inland Revenue Commissioners [1904] 2 KB 658 (“A contract of insurance... must be a contract for the payment of a sum of money, or for some corresponding benefit... to become due on the happening of an event, which event must have some amount of uncertainty about it, and must be of a character more or less adverse to the interest of the person effecting the insurance”); and

(iii) That is exactly how MediShield manifests in practice. The late Mr Ko paid premiums to enjoy protection and coverage under the MediShield scheme. And when certain conditions (as set out in the “policy”) were fulfilled, he received pay-outs to cover the costs of certain medical treatment/services rendered.

To adapt the language of the Court of Appeal’s judgment, “the fact that the late Mr Ko contributed [by paying premiums for MediShield Life coverage] shows that the intended purpose of the [insurance payout], objectively judged, was to provide [him] with a sum over and above the damages payable” (see [38] of Lo Kok Jong). He is therefore entitled to claim the sums from the Defendants.

45 As for the other expenses exhibited in the bundle of documents, I have studied the invoices and grant the following expenses since they appear, on their face, to be reasonably incurred and reasonably relate to the medical expenses arising from the accident. They, together with the claims I have granted at [39], [41], [42], and [44] above, have been tabulated in Annex A of this judgment. The total sum is $122,889.52.

46 However, I do not grant the Plaintiff’s request for some other medical expenses. These amount to $65,942.57. These have been tabulated in Annex B of the judgment and some brief reasons are stated there as well. I should, at this juncture, address a point that the Plaintiff’s counsel strenuously advanced at the hearing and in submissions. The submission was that the Defendant’s objections to some of the claimed expenses were not ever put to the Plaintiff during cross-examination. Accordingly, the Defendant was not entitled to rely on such objections in submissions. The implication was that I should accept the Plaintiff at his word. I disagree. The Plaintiff bears the burden of proof. Before one even begins to consider the Defendant’s objections, the Plaintiff must show what those claimed expenses are for, and why he is entitled to them. But when the tendered documents simply do not, on their face, explain what the purchase related to, ⁶⁶ or when the tendered receipts were for items like mangoes and milk, ⁶⁷ I was not convinced that the Plaintiff had even crossed the threshold of proving his basic case. My approach, therefore, has been to study each receipt carefully and to reject the claims that could not demonstrably be tied to consequences arising from the accident.

47 The Plaintiff’s difficulty is that he has no receipts or documentation proving the late Mr Ko’s medical expenses from November 2023 to 2 October 2024. There being no proof of such medical expenses, and since such medical expenses require specific proof to be recoverable, these medical expenses should not ordinarily be claimable.

48 This case, however, has somewhat extraordinary facts. For the following reasons, I am confident that I am both permitted to relax the traditional rule on special damages requiring specific proof, and that this would be an appropriate occasion to do so.

49 First, “the court has to adopt a flexible approach with regard to the proof of damage. Different occasions may call for different evidence with regard to certainty of proof, depending on the precise circumstances of the case and the nature of the damages claimed”: Noor Azlin bte Abdul Rahman and another v Changi General Hospital Pte Ltd [2021] SGCA 111 at [60]. To be clear, I recognise that these were observations made in the context of (a) a general pronouncement on the law of tortious damages, (b) where the distinction between special and general damages was clearly apparent to the Court of Appeal, and (c) there were no special caveats about the applicability of these observations to the motor injury context. That said, I see no reason why the Court of Appeal’s commonsensical guidance ought not to apply here:

50 Second, this is not the first time that the Court has granted an award for special damages, notwithstanding that there is no documentary evidence for the same. In Tan Hun Boon v Rui Feng Travel Pte Ltd and another [2017] SGHC 189 (at [145] – [147], “Tan Hun Boon”) and Siew Pick Chiang v Hyundai Engineering and Construction Co Ltd [2016] SGHC 266 (at [83] – [86]), the High Court took a practical view of the circumstances. Though the plaintiffs had failed to produce receipts for their pre-trial transport expenses, it stood to reason that some transport expenses must have been incurred in the trips to the hospital. The Court therefore arrived at an appropriate award by using a reasonable estimate of the medical expenses incurred. I note that the Court in Tan Hun Boon cautioned against too generous an approach: “any such estimate should be a conservative one, to avoid putting plaintiffs who fail to produce receipts in a better position than plaintiffs who conscientiously retain receipts and adduce them in evidence” (at [146]). I gratefully adopt that guidance.

51 Third, there were extenuating circumstances that credibly explain why the Plaintiff did not collect further documentary evidence of medical expenses from November 2023 onwards. This matter was fixed for assessment before me on 28 May 2024. The Plaintiff’s AEIC was affirmed and filed on 9 November 2023. At that time, the late Mr Ko had not passed away and any undocumented medical expenses would have naturally been addressed by the Plaintiff’s claim in future medical expenses (i.e. there was no need to collect receipts any further by that point). With the late Mr Ko’s departure, the claim in future medical expenses fell away but left behind an evidentiary deficit for the medical expenses incurred between November 2023 and 2 October 2024. That deficit is not the Plaintiff’s fault.

52 If anything, I am confident that the Plaintiff would have diligently collected and compiled further medical receipts if he had been apprised of the need to do so. The bundle of documents tendered is impressive. It tells the tale of a family methodically collating receipts over a four-year period, from multiple merchants, through multiple hospital visits, and concerning multiple caregiving needs. From diapers to DuoDERM, and milk powder to medication, the list is extensive. I have no difficulty believing that the failure to produce further medical receipts was largely (if not entirely) due to the unforeseen early demise of the late Mr Ko. The Plaintiff has, to use the language of Robertson Quay, done his “level best”.

53 For these reasons, I am adopting a reasonable estimate of the medical expenses from November 2023 and 2 October 2024 using the following methodology:

(a) First, I am assessing the average monthly medical expenses of the immediate one-year period before November 2023 (November 2022 – October 2023). This would be the fair because the late Mr Ko’s medical expenses would have stabilised by that point, and it would best represent the expenses that may have been incurred from November 2023 to 2 October 2024. I was mindful that the late Mr Ko’s expenses were higher and more volatile during the first few years following his accident. It would have been unfair to use that to project his medical expenses in his last days.

(b) Second, I am multiplying that by 11 months, such being roughly the period from November 2023 – 2 October 2024.

(c) Third, I am additionally considering whether any further discount ought to be applied, considering the High Court’s guidance in Tan Hun Boon at [146].

54 The total medical expenses for the period from November 2022 to October 2023 is $9,048.54 (see Annex A). The monthly average medical expenditure would therefore have been $754.05. Multiplied by 11 months, that would amount to approximately $8,294.50. Having considered the materials, I do not see any need for a discount either. I make clear that I have only made an estimate of the total medical expenses, and not the other further non-medical expenses during the period of November 2023 to 2 October 2024. Those are discussed below at [59(b)], [66] and [70].

55 I note that NTUC Income has, in the Defendants’ latest letter to Court dated 17 June 2025, agreed to foot the bill for the deputyship application amounting to $10,390.32. Since NTUC Income has, on behalf of the Defendants, agreed to pay the full sum, I see no reason to disturb that and grant that accordingly.

56 My only remark is that if I had been called to properly adjudicate the matter, I may not have awarded the full cost of the deputyship application to the Plaintiff. The Defendants are only responsible for the late Mr Ko’s early demise, rather than his demise itself. In that sense, Mr Ko’s estate would have had to incur the cost of a deputyship application in any event, regardless of whether there had been an accident. I would have granted a suitable discount to account for that.

57 The first order of business is defining the issue here. The parties’ submissions were at cross purposes:

(a) The Plaintiff’s case revolved around proving the necessity of hiring a domestic helper to care for the late Mr Ko. To that end, he relied ⁶⁸ on Dr Lai’s medical report (“[Mr Koh Wah is] dependent on a full time live in care-giver 24/7 for ALL activities of daily living”), ⁶⁹ and his oral testimony suggesting that had it not been for the accident, they “may not [have] continue[d]” with the domestic helper’s services. ⁷⁰

(b) The Defendants’ case appeared to have accepted that a domestic helper was necessary but questioned the extent to which the domestic helper was involved in caregiving duties. ⁷¹

58 Given the Defendants’ position, the real issue became a matter of quantification of, not entitlement to caregiver expenses. It was not, as the Plaintiff put it, an inquiry into whether “but for the accident, the Plaintiff’s family would […] have continued employ[ing] the foreign domestic helper”. ⁷² Instead, it was about assessing how much of the domestic helper’s attention was devoted to taking care of the late Mr Ko, and accordingly how much of the total salaries ought to be paid for by the Defendant. My view is that the Plaintiff ought to only be awarded two thirds of the total salaries paid to the domestic helper for three reasons:

(a) A reasonable discount ought to be applied to account for the times when the domestic helper was assisting the family with regular household chores, rather than taking care of the late Mr. Ko. Such a discount was considered and applied in Toon Chee Meng Eddie v Yeap Chin Hon [1993] 1 SLR(R) 407 (at [38]), albeit in the context of future medical expenses. That difference, at least for present purposes, is not material here. The principle of the matter is simply that the Defendants ought only to pay for expenses stemming from the accident. They should only be responsible for what they caused.

(b) There is good reason to believe that the domestic helper would have continued to assist the family in other areas besides caregiving duties for the late Mr Ko. First, the domestic helper had been in the family’s employ even before the accident. She was hired since 10 November 2018, and the accident was in June 2019. ⁷³ It is not realistic to expect that a live-in domestic helper will drastically shift gears into a full-time caregiver, especially when she was first hired to handle housework. Second, the Plaintiff conceded during cross-examination that “even without accident [the family] would still have employed [a] domestic helper”. ⁷⁴ The implicit suggestion was that the family would have continued to find the helper’s services useful even for non-accident-related duties (i.e. regular household chores).

(c) Although there were three other people living in the household at that time (the Plaintiff, his father, and his mother), ⁷⁵ it was not realistic to expect that the domestic helper would have divided her time evenly between each of the household members. The late Mr Ko obviously had far more needs than the other two household members. These would have demanded more of the helper’s attention and time. But by that same token, it was not realistic to assume that the late Mr Ko’s caregiving needs would have been borne entirely by the domestic helper. The family lived together. And it was obvious to me that the Plaintiff and his sister were heavily involved in taking care of their late father. The receipts for the late Mr Ko’s various care-related needs bore their names, ⁷⁶ and the Plaintiff was able to speak confidently about the late Mr Ko’s medical history and needs. ⁷⁷ The Plaintiff’s sister, it seems, managed the medical fees. ⁷⁸ The picture that emerged during the assessment was that of a filial duo who took their familial responsibilities seriously (even for day-to-day caregiving needs), and were assisted by the domestic helper for the same.

59 My best estimate, therefore, is that at least two thirds of the domestic helper’s time would have been dedicated to caring for the late Mr Ko. The Plaintiff should therefore be awarded two thirds of the domestic helper’s salaries. This would compose of two periods, one from 30 June 2019 to 31 October 2023 (where documentary evidence is readily available) and from 1 November 2023 to 2 October 2024 (where the evidence is lacking):

(a) The period from 30 June 2019 to 31 October 2023 – the total salaries for this period was $47,826.55. Two thirds of this would be $31,884.37.

(b) The period from 1 November 2023 to 2 October 2024 – adopting the same reasoning and methodology as that set out at [47] – [53] above, the average monthly salaries paid in the year immediately preceding the late Mr Ko’s demise was $940.42. Multiplied by 11 months (i.e. 1 November 2023 to 2 October 2024), the sum comes up to $10,344.58. Two thirds of this would be $6,896.39.

(c) The total award, therefore, would be $38,780.76‬.

60 I make clear that I am not granting the claim for the domestic helper’s dental treatment. ⁷⁹ The damage appears to be too remote, and I am simply not convinced that the Plaintiff has sufficiently proven his entitlement to the same.

61 One of the Defendant’s most strident objections was that the late Mr Ko’s milk powder ⁸⁰ was too expensive. The suggestion is that a “more cost-effective nutritional milk alternative” ought to have been used, ⁸¹ and this is part of a larger argument that the late Mr Ko could have done with less: a “less costly [mode] of transport”, a “cheaper alternative[s] to purchasing a new [pulse oximeter and thermometer]”, and a “more cost-effective nutritional milk alternative”. ⁸² But this forgets one fundamental fact: before the accident, Mr Ko was not bedridden. He was “otherwise independent of ALL activities of daily living”. ⁸³ He needed an ambulance because he was otherwise bedridden. He needed regular medical monitoring because he was bedridden. And he had to take milk powder because he could no longer consume solid food. It just happens that he had a pre-existing condition (chronic obstructive pulmonary disease) and so his milk powder – the primary form of nutritional intake he could realistically ingest – had to accommodate his pre-existing condition. ⁸⁴ As the Plaintiff himself testified, “there’s a special formula to sustain his life. We have to take special steps because the accident put him in that state.”

62 And if the suggestion was that the Plaintiff had “failed to mitigate costs by not opting for a reasonably priced and nutritionally adequate alternative, such as Ensure”, ⁸⁵ that argument is simply impermissible under the rule in Don King Martin (trading as King Excursion & Transport Provider) v Lenny Arjan Singh [2023] SGHC 334 at [58]:

63 The Defendants must plead the assertion that the plaintiff failed to mitigate his loss. They did not. The Defendants must, moreover, accept that the Plaintiff need only act reasonably, and that the “standard of reasonableness required of him is not too difficult to meet.” And finally, the Defendants must prove that Plaintiff failed to mitigate his losses. There was simply no evidence tendered by the Defendants that “Ensure” milk powder was a credible alternative, medically safe, or even cheaper, for that matter.

64 The only other argument (which the Defendants flirted with at cross-examination but did not make full submissions on) ⁸⁶ was that the late Mr Ko would have had to pay for food anyway, whether there had been an accident or not. The problem with this argument was that it was difficult to estimate how much the late Mr Ko would have otherwise spent on food had he not met with the accident. ⁸⁷ But a conservative back-of-the-napkin estimate revealed that the late Mr Ko may well have spent anywhere between $9,558 - $23,895 on meals between the period of his accident till 31 October 2023.

(a) Assuming that he had spent $2/meal (with no dining out, no snacks, and no extra expenses for celebrations or occasions), he would have spent $2 x 3 meals x 1593 days = $9,558 for the period from 21 June 2019 till 31 October 2023.

(b) Assuming that he had spent $3/meal (with no dining out, no snacks, and no extra expenses for celebrations or occasions), he would have spent $3 x 3 meals x 1593 days = $14,337 for the period from 21 June 2019 till 31 October 2023.

(c) Assuming that he had spent $5/meal (with no dining out, no snacks, and no extra expenses for celebrations or occasions), he would have spent $5 x 3 meals x 1593 days = $23,895 for the period from 21 June 2019 till 31 October 2023.

65 The total cost of milk powder purchased from the period of 21 June 2019 to 31 October 2023 added up to $16,480.83. ⁸⁸ Given the figures set out above at [64(a)] – [64(c)] above, and considering that the Defendants had no in-principle objection to paying for milk powder, ⁸⁹ the fairest award would be one which applies a suitable discount to the total costs incurred for milk powder. In my view, a 60% discount would be fair since it would roughly approximate the minimum that the late Mr Ko may have spent on food, had he not met with the accident. This brings the figure to $6,592.33.

66 As for the period between 1 November 2023 and 2 October 2024, I once again adopt the same reasoning and methodology set out at [47] – [53] above:

(a)  The average monthly expenditure on milk powder in the year immediately preceding the late Mr Ko’s demise (November 2022 – October 2023) was $218.18.

(b) Multiplied by 11 months (i.e. 1 November 2023 to 2 October 2024), that would come up to $2,340.

(c) Applying the same 60% discount discussed above, $936 would be the award for this period of the late Mr Ko’s life.

67 In total, the award would be $6,592.33 + $936 = $7,528.33.

68 Besides the above, I am also allowing certain other claimed expenses as they clearly relate to reasonable care arrangements for someone bedridden as a result of the accident. These largely relate to items such as the late Mr Ko’s adult diapers, which the Defendants have not taken objection to. The total sums come up to $3,071.51. These are tabulated at Annex C of the judgment.

69 Additionally, I reject some of the other expenses sought by the Plaintiff. The total sums come up to $5,049.45. These, together with some brief reasons for my rejecting these claims are set out at Annex D of this judgment.

70 As for the period between 1 November 2023 and 2 October 2024, I once again adopt the same reasoning and methodology set out at [47] – [53] above:

(a)  The average monthly expenditure on milk powder in the year immediately preceding the late Mr Ko’s demise (November 2022 – October 2023) was $218.18.

(b) Multiplied by 11 months (i.e. 1 November 2023 to 2 October 2024), that would come up to $249.10.

71 The usual interest rates apply, namely:

(a) 5.33% p.a. will apply for the general damages, from the date of filing of the writ till the date of judgment.

(b) 2.67% p.a. will apply for the special damages from the date of the accident (21 June 2019) till the date of judgment.

(c) Post-judgment interest of 5.33% p.a. will apply on the judgment sum. Since the sum is fairly large, I am granting the Defendants some leeway to gather the necessary sums. The post-judgment interest will therefore run from 16 September 2025 onwards.

72 I should make clear, as a concluding note, that I do not begrudge the Defendants’ lawyers at all for conveying their client’s instructions. If anything, their advocacy was candid, well-organised, and fully in line with their duties to the Court. Their submissions greatly assisted me in clarifying my thoughts, and I would commend them for the yeoman’s labour that went into scrutinising every aspect of the Plaintiff’s case, down to the last cent. In that same vein, I am appreciative of the Plaintiff tediously organising the voluminous documents produced, all of which were ably presented by his counsel. The Court is duty-bound to be impartial. But that does not preclude it from extending its sympathies to the family for this doubtlessly excruciating ordeal.

73 I will hear parties on costs at a hearing on a date to be conveyed to parties by Registrar’s Notice. If parties wish, they may tender written submissions not exceeding 3 pages (excluding cover pages and annexes) by 12 August 2025. I should make clear that while NTUC Income eventually agreed to pay (a) medical expenses paid using MediShield Life and (b) ambulance fees, it came too late. By the time these concessions came in, a full assessment had been conducted, two rounds of written submissions had been tendered, and an oral hearing had been convened as well. The value of a reasonable concession primarily lies in its ability to avert a costly legal proceeding. That cost had already been incurred in money and more.