State Consumer Disputes Redressal Commission
Hdfc Life Insurance Co. Ltd. vs Kamaljit Kaur on 24 March, 2026
1
STATE CONSUMER DISPUTES REDRESSAL COMMISSION
U.T., CHANDIGARH
[ADDITIONAL BENCH]
Appeal No. : 124 of 2025
Date of Institution : 11.03.2025
Date of Decision : 24.03.2026
HDFC Life Insurance Company Limited, 11th Floor, Lodha Excelus, Apollo
Mills Compound, N. M. Joshi Road, Mahalaxmi, Mumbai - 400011 through
its Authorised Signatory or its Managing Director
Presently filed through Sh. Arpit Higgins, working as Chief Manager - Legal
in HDFC Life Insurance Co. Ltd. having its office at SCO No.149-151, Sector
43-B, Chandigarh
....Appellant/Opposite Party
Versus
Kamaljit Kaur, aged about 41 years, Wd/o Late Sh. Baljit Singh R/o House
No.1671, Sector 33D, Chandigarh - 160020
...Respondent/Complainant
BEFORE: MRS. PADMA PANDEY, PRESIDING MEMBER
SH. RAJESH K. ARYA, MEMBER ARGUED BY :-
Sh. Nitin Thatai, Advocate (on VC) alongwith Ms. Monika Thatai, Advocate for the appellant Sh. Abhishek Kaushik, Advocate for the respondent PER RAJESH K. ARYA, MEMBER The instant appeal has been filed by the opposite party- HDFC Life Insurance Company Limited (appellant herein) seeking setting aside of order dated 30.09.2024 passed by District Consumer Disputes Redressal Commission-I, U.T., Chandigarh (hereinafter to be referred as 'District Commission') vide which, Consumer Complaint bearing No.225 of 2021 filed 2 by the complainant - Kamaljit Kaur (respondent herein) has been allowed against the opposite party by granting following relief:-
"14. In view of the above discussion, the present consumer complaint succeeds and the same is accordingly allowed. OP is directed as under:-
(i) to pay ₹31,00,000/- to the complainant alongwith interest @ 9% per annum (simple) from the date of institution of the present consumer complaint till onwards
(ii) to pay ₹25,000/- to the complainant as compensation for causing mental agony and harassment;
(iii) to pay ₹10,000/- to the complainant/s as costs of litigation.
15. This order be complied with by the OP within a period of 45 days from the date of receipt of certified copy thereof, failing which the amount(s) mentioned at Sr.No.(i) & (ii) above shall carry penal interest @ 12% per annum (simple) from the date of expiry of said period of 45 days, instead of 9% [mentioned at Sr.No.(i)], till realisation, over and above payment of ligation expenses.
2] In brief, the case of the complainant before the District Commission was that her husband had obtained an HDFC Life Group Credit Protect Plus Insurance Plan bearing Master Policy No.PP000069 on 06.03.2019 after paying a premium of ₹51,431/-, in which the complainant
- Kamaljit Kaur was nominated as beneficiary with a sum assured of ₹31 lakhs. On 18.03.2019, the life assured was admitted to Healing Hospital, Sector-33, Chandigarh with complaints of high grade fever and difficulty in breathing and despite treatment, he unfortunately expired on 23.03.2019, the cause of death being reported as cardiac arrest. Being the nominee, the complainant lodged a claim with the opposite party, which was repudiated vide letter dated 31.01.2020 on the allegation of suppression of pre-existing diseases such as Alcoholic Liver Disease, Diabetes Mellitus Type-II, Hypoglycaemic Brain Injury, Opioid Addiction and Metabolic Toxic Encephalopathy. It was the specific case of the complainant that her husband was not suffering from any such ailments prior to 18.03.2019 and that the repudiation, based merely on the admission notes and without any evidence of prior illness or heart-related disease, was arbitrary, erroneous and unsustainable.
33] On the other hand, the opposite party, in its reply before the District Commission, pleaded that the Deceased Life Assured (DLA), namely Mr. Baljit Singh, was admitted to Healing Hospital due to uneasiness and subsequently expired on 23.03.2019 due to cardiac arrest. The complainant applied for the death claim on 20.09.2019, where after the opposite party appointed KLCR Investigations Pvt. Ltd. to verify the past medical history of the DLA. As per the investigation report dated 26.11.2019 and the medical records of Healing Hospital, Chandigarh, it was found that the DLA was suffering from Alcoholic Liver Disease, Diabetes Mellitus Type II, Hypoglycemic Brain Injury, Opioid Addiction and Metabolic Toxic Encephalopathy since 2016 i.e. prior to the inception of the insurance policy and was undergoing treatment for the same. It was further pleaded that despite specific questions put to the DLA in the enrolment form, particularly under Clause 22, all answers were falsely given in the negative, thereby concealing material facts, which was evident from the discharge summary dated 13.10.2016 and the death report issued by the treating doctor. It was further pleaded that on account of such alleged suppression and false declarations, the opposite party rejected the death claim vide letter dated 31.01.2020.
4] The complainants led evidence in support of their cases before the District Commission.
5] The District Commission, after hearing the Counsel for the parties and going through the evidence on record, allowed the consumer complaint, as stated above.
6] The order of the District Commission has been assailed by the opposite party on the ground that the District Commission has gravely erred in law and on facts by ignoring the admitted case of the complainant herself that the Deceased Life Assured (DLA), Late Sh. Baljit Singh Sohi, voluntarily availed a loan from HDFC Bank and to secure the same, on his own free will chose HDFC Life Group Credit Protect Plus Insurance Plan, submitted a duly signed Member Enrolment Form dated 04.03.2019 after the terms and conditions were read over and explained to him and was issued a Certificate of Insurance commencing from 06.03.2019 to 05.03.2022, thereby 4 attracting the statutory presumption of knowledge and consent as settled in Grasim Industries Ltd. v. Aggarwal Steel (2010) 1 SCC 83. 7] It has further been submitted that the District Commission failed to appreciate that the respondent - complainant never denied submission of the proposal form and that the DLA expressly declared that any non-disclosure of material facts would render the policy void. It has further been submitted that upon receipt of an early death claim, the appellant conducted a lawful investigation which conclusively established, through duplicate discharge summary duly issued by Healing Hospital on 26.11.2019 and corroborated by the unimpeached testimony of the treating doctor Dr. N.P. Singh, that the DLA was suffering from serious pre-existing ailments including Alcoholic Liver Disease, Diabetes Mellitus-II, Hypoglycaemic Brain Injury, Opioid Addiction and Metabolic Toxic Encephalopathy, all of which were deliberately concealed in the proposal form. It has further been submitted that the rejection of this evidence on the sole ground of non-production of originals is contrary to settled law on admissibility of secondary evidence as laid down in Rakesh Mohindra v. Anita Beri (2016), M. Chandra v. M. Thangamuthu (2010) 9 SCC 712, M. Chandra v. M. Thangamuthu (2010) 9 SCC 712 and Jagmail Singh v. Karamjit Singh (2020), especially when the duplicate record stood duly authenticated by the treating doctor whose testimony was never disputed in cross-examination.
8] It has further been submitted that the complainant's subsequent plea blaming the agent, without impleading or examining him, is legally impermissible in view of Senior Manager LIC v. Rajesh Kumar (2020). It has further been submitted that the impugned findings further violate the settled doctrine of uberrimae fidei, as reiterated in Satwant Kaur Sandhu v. New India Assurance Co. Ltd., 2009 (4) CLT 398 (SC), Reliance Life Insurance Co. Ltd. v. Rekhaben Nareshbhai Rathod (Civil Appeal No. 4261 of 2019), Sunita Rani v. PNB MetLife, 2017 (2) CPR 489 (NCDRC) and Suraj Mal Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd., (2010) 10 SCC 567, ignoring that repudiation within the statutory period under Section 45 of the Insurance Act, 1938 was fully justified; thus, the 5 order under challenge, being founded on conjectures, misreading of evidence and misapplication of settled law, is liable to be set aside. 9] On behalf of the respondent-complainant, it has been argued that the District Commission has rightly appreciated the evidence and applied settled principles of law in holding the appellant guilty of deficiency in service and unfair trade practice. It has been submitted that the authorized hospital representative appeared with the record and made a categorical statement before the Commission (order dated 13.12.2022), which itself cast serious doubt on the appellant's allegation of suppression of material facts and rather, demolished its case. It has further been submitted that the entire repudiation was based on photocopies of alleged medical records procured through a private investigation agency, which were admittedly not originals, not in the custody of the appellant and were never proved in accordance with the Indian Evidence Act, thus, having no evidentiary value.
10] It has further been submitted that even the testimony of Dr. N.P. Singh, summoned at the instance of the District Commission, remained unsupported by any contemporaneous or authenticated medical record, as the purported observations regarding ailments of 2015/2016 were not borne out from the case file and in fact, Healing Hospital itself stood established only on 24.11.2016, rendering the relied-upon record inherently unreliable. It has further been submitted that the District Commission correctly held that the appellant failed to discharge its burden of proving concealment of any pre-existing disease. It has further been submitted that the alleged records were not even in near proximity to the policy commencement date of 06.03.2019 nor was any cogent evidence led to establish that the alleged ailments had any nexus with the cause of death, rendering repudiation impermissible in view of the law laid down in Life Insurance Corporation of India and Anr. Versus Sudesh, 2012 (2) CPJ 65; Sulbha Prakash Motegaonkar Vs. Life Insurance Corporation of India, Civil Appeal No.8245 of 2015 decided by Hon'ble Supreme Court on 05.10.2015 and Om Prakash Ahuja v. Reliance General Insurance Co. Ltd., 2023 (3) CPJ 36 and consistent NCDRC precedents. It has further been submitted that the 6 findings of the District Commission are based on a proper scrutiny of evidence and sound judicial reasoning, warranting dismissal of the present appeal.
11] We have heard the Counsel for the parties and have also gone through the record, the impugned order and the written arguments of the parties very carefully.
12] Before proceeding further, it may be stated here that alongwith this appeal, a miscellaneous application bearing No.279 of 2025 has been filed by the appellant for condonation of delay of 18 days (as per the office 86 days) in filing the same. The respondent contested the application orally. In the application, it has been stated that the certified copy of the order rendered by District Commission on 30.09.2024 was dispatched on 24.10.2024, which was delivered at the Head Office of the appellant Company on 29.10.2024 at Mumbai. However, the said copy of order was not traceable at Mumbai Head Office and a paid certified copy was applied on 19.12.2024, which was received on the same date. It has further been submitted that subsequently, the comments were called upon from the counsel for the company on 20.12.2024 and after getting approvals for filing the appeal, the Counsel sought all the documents which were requisite to file the appeal and immediately present appeal has been filed. It has further been submitted that the delay in filing the appeal is not intentional but is circumstantial. After going through the contents of the application, which is supported by an affidavit and in view of law settled by Hon'ble Supreme Court of India in Pundlik Jalam Patil Vs. Executive Engineer, Jalgaon Medium Project, (2008) 17 SCC 448 and Basawaraj and Anr. Vs. Special Land Acquisition Officer, (2013) 14 SCC 81, the appellant has shown rational reason for the delay, which has been caused due to bonafide reasons. Therefore, for the reasons given in the application which is supported by an affidavit and finding sufficient cause, the delay in filing the appeal is condoned. MA/279/2025 stands disposed of accordingly. 13] Now coming on to the merits of the case, it may be stated here that the District Commission has allowed the consumer complaint of the respondent-complainant holding that although the opposite party 7 repudiated the claim alleging suppression of material facts regarding the DLA's prior illness, the repudiation was not supported by reliable evidence; the investigation report relied upon by the opposite party was based on doubtful hospital records containing discrepancies in dates and originating from a different hospital (Inscol Hospital), while the originals were not produced for verification. The District Commission further observed that the oral statements of hospital officials and the doctor were not substantiated by authenticated medical records and the alleged pre-existing ailment was not proved by cogent evidence. In our opinion and for the reasons to be recorded hereinafter, the view held by the District Commission while allowing the complaint is totally contrary to the documentary evidence on record.
14] Bare perusal of record of the District Commission transpire that the DLA - Baljit Singh filled the Member Enrollment Form - SMQ Regulated Entity on 04.03.2019 for obtaining HDFC Life Group Credit Protect Plus with 'Life Option' vide Annexure OP-2, in pursuance to which, Master Policy No.PP000069 was issued on 06.03.2019 in the name of Baljit Singh, Annexure OP-3, insuring his life and securing Loan obtained by him, commencing from 06.03.2019 up to the date of loan termination i.e. 05.03.2022 and the initial sum assured was ₹31,00,000/-. The complainant
- Kamaljit Kaur was nominated as beneficiary in the said policy. The DLA died on 23.03.2019 and on filing death claim of the DLA - Baljit Singh, the appellant - opposite party appointed KLCR Investigations Pvt. Ltd., as Investigator to investigate the claim, who vide its Investigation Report dated 26.11.2019, Annexure OP-5, recorded at Page 4 of its report (internal Page 74 of District Commission's record) and under "Agency Over all remarks and conclusion", at Page 5 (internal Pages 75-76 of the record) as under:-
"We have procured the record of life insured from our reliable links in Healing Hospital. Insured was admitted in the hospital from 13.10.2015 to 14.10.2016. Due to Alcoholic liver disease, Diabetic Mellitus 2, Brain injury. Opioid addition, Metabolic Toxic. Insured was admitted in the hospital from 18.03.2019 to 23.03.2019. Due to alcoholic liver disease, chronic liver disease, chronic kidney disease. Death Summary attached herewith."8
15] Further, the date of admission i.e. 13.10.2015 and date of discharge i.e. 14.10.2016 stands corroborated from the Discharge Summary of Healing Hospital, Annexure OP-6 (Colly.). In this Discharge Summary, under the column "Diagnosis", following conditions of the DLA - Baljit Singh Sohi is mentioned:-
Alcoholic Liver Disease Diabetes Mellitus Type II Hypoglycemic Brain Injury Opioid addiction Metabolic Toxic Encephalopathy Thereafter, it is recorded in the Discharge Summary as under:-
"41 years/male patient brought to Inscol emergency in hospital ambulance in acute alcohol intoxication. And drowsy admitted for further management. Patient was stated on cap Benfomet, tab topirol, tab accamprol, Syp looz, Inj pantocid, Inj thiamin and I/V fluids. Now patient's condition has improved and is being discharged with following recommendations."
16] It may be stated here that during the period 13.10.2015 to 14.10.2016, Dr. N. P. Singh (Regd. No.25962 PMC) was the treating Physician/Surgeon of the DLA - Baljit Singh Sohi.
17] Another important document placed on record by the appellant
- opposite party is the DEATH REPORT of Baljit Singh Sohi, at internal Page 79 of District Commission's record. The "brief summary of diseased illness", in this death report, is recorded as under:-
"46 years/male patient admitted with complaint of loss of appetite, weakness, fever and poor intake. Patient is a known case of alcoholic liver disease, chronic kidney disease and was not taking anything orally for few weeks. He was started on IV Fluids, antibiotics and other supportive treatment. Fever work up includes urine culture and blood culture were sent. 1 unit of blood was transfused in view of severe anemia. On 20/03/2019 patient had sudden onset of difficulty in breathing and altered sensorium. Patient was shifted to ICU and put on mechanical ventilation. ABG was done which was suggestive of severe metabolic acidosis. Soda bicarbonate infusion was started & urgent nephrology consultations was sought for haemodialysis. NCCT head was done which was normal study. 2 D echo was done which showed presence of vegetation on mitral and aortic valves. Blood culture showed growth of staphylococcus aureus. Patient had anemia and low platelets counts for which 3 units RDP and 4 units PRBC transfused. 3 sessions of haemodialysis 9 was done. Antibiotics coverage was given for infective endocarditis and sepsis. D 50% was given for hypoglycemia. Inotropic support given to maintain BP. Arterial and venous colour Doppler was done on 23/03/2019 which was s/o left SFA thrombus. At about 3:00 pm on 23/03/2019, patient had fall in saturation while he was undergoing dialysis. Subsequently patient started developing deterioration in vitals. Poor prognosis explained to patient's relatives. Patient had sudden cardiac arrest on 23/03/2019 at 08:45 pm. CPR was started immediately according to ACLS protocol. Despite of all measures and resuscitative measures, patient could not be resuscitated and was declared dead at 09:26 pm on 23/03/2019."
"Final Diagnosis" in the Death Report was mentioned as under:-
Infective endocarditis Sepsis Septic shock Thrombocytopenia Acute kidney injury Anemia Metabolic acidosis Respiratory failure In view of above documentary evidence on record, it is our considered opinion that the investigation report dated 26.11.2019 (Annexure OP-5) relied upon by the appellant-opposite party clearly prove beyond any reasonable doubt that the deceased life assured, Baljit Singh, had a prior history of hospitalization at Healing Hospital from 13.10.2015 to 14.10.2016 for serious ailments including Alcoholic Liver Disease, Diabetes Mellitus Type-II, hypoglycemic brain injury, opioid addiction and metabolic toxic encephalopathy, which further stands duly corroborated by the Discharge Summary (Annexure OP-6 Colly.). The said discharge record further reflects that he was brought to the emergency in a state of acute alcohol intoxication and drowsiness and was treated accordingly before being discharged upon improvement. The investigation report also establishes his subsequent hospitalization from 18.03.2019 to 23.03.2019 for alcoholic liver disease and chronic kidney disease, culminating in his death. 18] It is also coming out from the Discharge Summary, as extracted above, that the DLA - Baljit Singh Sohi was admitted to the hospital on 18.03.2019 with weakness, fever, loss of appetite and very poor food 10 intake. He already had serious liver and kidney disease. His tests showed that he had a severe blood infection that had spread to his heart valves (infective endocarditis) along with severe anemia and low platelets. His condition suddenly worsened with breathing difficulty and confusion, so he was shifted to the ICU, placed on a ventilator and given dialysis, blood transfusions, strong antibiotics and medicines to support his blood pressure. However, despite intensive treatment, his health continued to decline. On 23/03/2019, he suffered a cardiac arrest and although doctors performed CPR immediately, he could not be revived and was declared dead at 9:26 pm. 19] Thus, the material placed on record establishes that the deceased had significant pre-existing medical conditions much prior to the issuance of the policy, as evidenced from authentic hospital records procured during investigation.
20] Not only above, it is worth mentioning that while proposing the policy in question and filling the Member Enrollment Form - SMQ, Annexure OP-7, the DLA - Baljit Singh, answered the most important questionnaires at Sr. No.1 and 6 in the negative, as under:-
1. Have you ever suffered or are currently suffering from: Yes No
(a) Chest pain or heart attack or any other heart disease
(b) Cancer, tumour growth or cyst of any kind (c) Stroke, paralysis, Epilepsy, any psychiatric/mental disorder, disorder of brain/nervous system or any kind of physical disabilities (d) Asthma, tuberculosis or lung disorder (e) Disease or disorder of muscles, bones or joint, arthritis or blood disorder (anaemia) or any endocrine disorder. (f) Disease of the kidney, digestive system (stomach, pancreas, gall bladder, intestine), Liver, Hepatitis B or C or HIV/AIDS infection (g) Diabetes, High blood pressure.
6. Are you taking any medication or has a doctor ever Yes No attended to you for any conditions, diseases or impairment not mentioned above (except cough or cold)?
21] In our considered opinion, the above medical questionnaire forms a material and integral part of the proposal form, requiring the proposer to make full and truthful disclosure of his past and existing 11 medical conditions. The questions specifically sought information regarding diseases of the liver, kidney, diabetes, blood disorders, brain disorders and any prior medical treatment. The record, however, reveals that prior to the issuance of the policy, the Life Assured was suffering from Alcoholic Liver Disease, Diabetes Mellitus Type-II, hypoglycemic brain injury, opioid addiction and other related ailments and had even undergone hospitalization for the said conditions. These ailments squarely fall within the scope of clauses (f) and (g) of Question No.1 as well as Question No.6 pertaining to prior medical attendance and treatment. The policy in question was issued to the DLA - Baljit Singh Sohi on the basis of duly filled and signed proposal form. It is pertinent to mention here that no prudent individual would simply sign on a form without being aware or satisfied with the contents of the same and it is held by the Hon'ble Supreme Court of Indian in M/s Grasim Industries Ltd. & Anr. Vs. M/s Aggarwal Steel, 2010 (1) SC 33 that "When a person signs a document, there is a presumption, unless there is proof of force of fraud, that he has read the document properly and understood it and only then he has affixed his signatures thereon, otherwise no signature on a document can ever be accepted." Before acceptance of the proposal form, the DLA had enough information qua the questionnaires, to which, he answered in the negative and did not disclose the material information with regard to his prior ailments/treatment. Therefore, failure to disclose such significant and material medical history amounts to suppression of material facts on the part of the proposer (DLA).
22] The case of the appellant - opposite party further stands corroborated from the statement of Dr. N. P. Singh recorded before the District Commission on 22.12.2023, during the pendency of the consumer complaint, which reads thus:-
"Stated that I am posted at Senior Consultant Internal Medicine since 1999. I have brought the record pertaining to Baljeet Singh Sohi who was treated by me on 13.10.2016. In 2016, he was diagnosed with Alcoholic Liver Disease, Opiod Addiction, Metabolic Toxic Encephalopathy. In the year 2019, during his treatment, he was diagnosed with Alcoholic Liver Disease, 12 Chronic Kidney Disease, Infective Endocarditis Sepsis, Septic Shock, Acute Kidney Injury, Respiratory Failure."
23] Thus, in our considered opinion and as stated above, the case of the appellant-opposite party stands further strengthened and duly corroborated by the categorical statement of Dr. N. P. Singh, Senior Consultant, Internal Medicine as the said witness, who had personally treated the Life Assured, produced the relevant medical record and unequivocally deposed that as early as 13.10.2016, the deceased was diagnosed with Alcoholic Liver Disease, Opioid Addiction and Metabolic Toxic Encephalopathy. The doctor further affirmed that during the subsequent hospitalization in the year 2019, the Life Assured was diagnosed with Alcoholic Liver Disease, Chronic Kidney Disease, Infective Endocarditis, Sepsis, Septic Shock, Acute Kidney Injury and Respiratory Failure. The testimony of Dr. N. P. Singh (treating doctor), being based on contemporaneous medical records and rendered on oath, carries substantial evidentiary value and leaves no room for doubt that the deceased was suffering from serious and chronic ailments much prior to the issuance of the policy. This uncontroverted medical evidence lends clear support to the appellant's contention regarding the existence of pre-existing diseases and establishes that the ailments were neither recent nor incidental but were part of a continuing medical history of the Life Assured. It may be stated here that in Rakesh Mohindra Vs. Anita Beri & Ors., 2016 (16) SCC 483, the Hon'ble Supreme Court of India while referring to Section 65 of the Evidence Act, which deals with the circumstances under which secondary evidence relating to documents may be given to prove the existence, condition or contents of the documents, observed in Para 17 and 22 as under:-
"17. The pre-conditions for leading secondary evidence are that such original documents could not be produced by the party relied upon such documents in spite of best efforts, unable to produce the same which is beyond their control. The party sought to produce secondary evidence must establish for the non-production of primary evidence. Unless, it is established that the original documents is lost or destroyed or is being deliberately withheld by the party in respect of that 13 document sought to be used, secondary evidence in respect of that document cannot accepted.
22. It is well settled that if a party wishes to lead secondary evidence, the Court is obliged to examine the probative value of the document produced in the Court or their contents and decide the question of admissibility of a document in secondary evidence. At the same time, the party has to lay down the factual foundation to establish the right to give secondary evidence where the original document cannot be produced. It is equally well settled that neither mere admission of a document in evidence amounts to its proof nor mere making of an exhibit of a document dispense with its proof, which is otherwise required to be done in accordance with law."
Similar view is expressed by Hon'ble Supreme Court in case titled Jagmail Singh & Anr. Versus Karamjit Singh & Ors., 2020 AIR Supreme Court 2319. Further before the National Consumer Disputes Redressal Commission, New Delhi in case titled 'ICICI Prudential Life Insurance Co. Ltd. & Anr. Versus Pradeep Chandrakant Shinde & anr.', 2015 (3) CLT (NC) 528, both the Fora below rejected the repudiation of both the claims because the respondents/complainants had produced xerox copies of the so called papers before the District Forum. However, the Hon'ble National Commission observed in Para 10 that it was clearly mentioned in the medical certificate dated 22.08.2008 of Sangli Medicares Pvt. Ltd., Sangli that the insured (deceased) was a case of alcoholic liver cirrhosis with ascitis and hepatic encephalophy and it is accompanied by other documents and the medicines pertained to the above said disease. In Para 14, the Hon'ble Apex Court observed that a doctor would never file false affidavit in order to support the insurance company, who appeared to be guileless. The Hon'ble National Commission, while allowing the revision petitions, set aside the order passed by the Fora below and dismiss the complaints. However, in our considered view, the District Commission has failed to consider this important aspect of the matter while passing the impugned order, which has been passed contrary to law settled as discussed above. 24] It may be stated here that in Life Insurance Corporation Vs. Sunita & Ors., Civil Appeal No.3518 of 2025 decided on 03.03.2025, the Hon'ble Supreme Court has clearly and building upon the principles in Rekhaben Nareshbhai Rathod (supra), the Hon'ble Supreme Court 14 reaffirmed the sanctity of the principle of Uberrimae Fidei (Utmost Good Faith) in insurance contracts. The Hon'ble Supreme Court held in Paras 11 to 16 as under:-
"11. The appellant contends that the claim was repudiated based on clear evidence that the deceased was a chronic alcoholic. The prescription slip from Siwach Hospital, dated 02.05.2014 -one day before the deceased's hospitalization at Ganga Ram Hospital-explicitly mentions a history of "chronic alcohol intake." Thus, the hospitalization and subsequent death resulted from a self- afflicted condition due to alcohol misuse, which falls squarely within the policy's exclusion clause.
12. The respondent-claimants, on the other hand, argue that there is no cogent evidence to support the repudiation. They submit that the existence of an insurance policy and the death of the insured entitle them to reimbursement of medical expenses.
13. Upon examining the record, we find merit in the appellant's submissions. The lower forums failed to correctly interpret the terms and conditions of the Jeevan Arogya Plan. Notably, this is a hospital cash benefit policy, not a medical reimbursement policy. Therefore, even if the claim had been otherwise valid, the claimants would not have been entitled to full reimbursement of hospitalization costs, as directed by the lower forums.
14. More significantly, the deceased provided false information in the proposal form. The relevant question in the form asked:
"Does the Life Insured consume Alcohol/Cigarettes/Bidis or tobacco in any form?" The deceased answered "No." The policy was issued based on this declaration. However, evidence on record-including the Siwach Hospital prescription-clearly establishes that the deceased was a chronic alcoholic. This fact was not disclosed at the time of obtaining the policy. Since the Jeevan Arogya Plan was issued under a Non-Medical General Scheme (where no pre-policy medical examination was conducted), the insurer relied solely on the accuracy of the insured's declarations.
15. The SCDRC rejected the Siwach Hospital prescription on the ground that it was dated nearly a year after the policy was taken. However, this reasoning is flawed. Chronic liver disease, caused by prolonged alcohol consumption, does not develop overnight. The deceased's alcoholism was a long- standing 15 condition, which he knowingly suppressed while subscribing to the policy. Given this suppression of material facts, the appellant was justified in repudiating the claim under the exclusion clause.
16. The NCDRC erred in concluding that the deceased's death was unrelated to his pre-existing liver disease. The record shows that he was hospitalized for severe abdominal pain and vomiting- complications commonly associated with chronic liver disease. He remained hospitalized for nearly a month before succumbing to a cardiac arrest. Given this medical history, it cannot be said that the cardiac arrest was an isolated event, unrelated to the pre-existing chronic liver disease. 25] Further in Para 19, the Hon'ble Supreme Court, held, inter alia as under:-
"......The deceased's chronic alcoholism and liver disease were material facts that were deliberately suppressed when the policy was obtained. Given the clear exclusion clause, the appellant was justified in repudiating the claim."
Thus, in Life Insurance Corporation of India Vs. Sunita & Ors. (supra), the Hon'ble Supreme Court, while reaffirming the foundational principle of uberrimae fidei (utmost good faith), ruled that the deliberate suppression of chronic alcoholism in a proposal form constitutes a fundamental breach of the insurance contract. The Hon'ble Apex Court set aside the lower forums' findings, clarifying that in non-medical insurance schemes, the insurer relies entirely on the insured's declarations, making the disclosure of lifestyle habits absolute; it specifically noted that chronic liver disease as evidenced by clinical symptoms like abdominal pain and vomiting is a progressive condition that does not develop overnight, thereby proving the existence of the habit prior to the policy's inception. Furthermore, the Hon'ble Apex Court established a critical medical-legal link by ruling that a terminal event like cardiac arrest cannot be viewed as an isolated incident when it is preceded by complications of chronic substance abuse, ultimately justifying the repudiation of the claim under the policy's exclusion clauses due to the deceased's knowing concealment of material health facts. 26] Further in a recent judgment in Usha Chopra and Others Vs. LIC and others, RSA-2359-1996 decided on 03.11.2025, the Hon'ble High 16 Court of Punjab and Haryana has held that the concealment of a chronic and progressive condition, such as diabetes and hypertension proved by documentary evidence of medication and reimbursement, cannot be regarded as trivial or inadvertent. In the context of a life insurance contract, the existence of diabetes is therefore a material fact having a direct bearing on the expectancy of life and the insurer's assessment of risk. Particularly in a non-medical policy, where no independent health examination is conducted, the insurer relies exclusively upon the proposer's declaration regarding his state of health. Non-disclosure of a chronic ailment such as diabetes, which is known to have potential fatal consequences, constitutes suppression of a material circumstance and strikes at the very root of the principle of uberrima fides i.e. the utmost good faith, on which the entire edifice of insurance law is founded. Further in PNB Metlife India Insurance Company Limited and anr. Versus Ajmer Kaur (Since Deceased) Through Her Lrs and anr., Civil Writ Petition No.13584 of 2022 decided on 29.10.2025, the Hon'ble Punjab and Haryana High Court held that "Insurance contract based on utmost good faith - Insured must disclose all relevant and material facts regarding health and medical conditions in the proposal form. Insurance company has the right to repudiate the claim if material facts concerning pre-existing conditions are concealed, especially when such conditions contribute to the insured's death." 27] It is settled law that contracts of insurance are contracts of utmost good faith (uberrima fides) and any concealment or non-disclosure of material information that would influence the insurer's decision vitiates the contract. Further the doctrine of uberrimae fidei is the cornerstone of insurance law. Unlike ordinary commercial contracts, an insurance contract is one where the insurer necessarily relies upon the disclosures made by the proposer, as the facts relating to health, habits and lifestyle are exclusively within the knowledge of the proposer. The Hon'ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Company Limited, 2009 (8) SCC 316 has unequivocally held that non-disclosure of a material fact, even if not directly connected with the cause of death, vitiates the contract of insurance. Similarly, in Reliance Life Insurance Co. Ltd. Vs. 17 Rekhaben Nareshbhai Rathod, Civil Appeal No.4261 of 2019 decided on 24.04.2019, the Hon'ble Apex Court reaffirmed that suppression or misstatement of material facts at the proposal stage entitles the insurer to repudiate the policy, especially when such facts have a direct bearing on the assessment of risk. Further in Mahakali Sujatha Vs. The Branch Manager, Future Generali India Life Insurance Company Limited & Another, 2024 SCC Online SC 525, the Hon'ble Supreme Court has observed in Para 18, inter alia, as under:-
"18. For a better appreciation of the controversy, it would be important to analyse the maxim of uberrimae fidei that governs the insurance contracts. It may also be observed that insurance contracts are special contracts based on the general principles of full disclosure inasmuch as a person seeking insurance is bound to disclose all material facts relating to the risk involved. Law demands a higher standard of good faith in matters of insurance contracts which is expressed in the legal maxim uberrimae fidei. The plea of utmost good faith has also been taken by the respondent, for contending that the insured- deceased had a duty to disclose the details of the previous policies, as the same was sought in the application form. However, the insured failed in his duty to correctly answer the question about his previous policies......"
Further analyzing the law relating to the maxim uberrimae fidei as was dealt with by it (Hon'ble Apex Court ) in the case of Manmohan Nanda vs. United India Insurance Co. Ltd., (2022) 4 SCC 582, ("Manmohan Nanda") and the duty of insured as summarized in MacGillivray on Insurance Law, (12th Edn., Sweet & Maxwell, London, 2012 at p. 477), the Hon'ble Apex Court, observed in Para 20, inter alia, as under:-
"The aforesaid principles would apply having regard to the nature of policy under consideration, as what is necessary to be disclosed are "material facts" which phrase is not definable as such, as the same would depend upon the nature and extent of coverage of risk under a particular type of policy. In simple terms, it could be understood that any fact which has a bearing on the very foundation of the contract of insurance and the risk to be covered under the policy would be a "material fact".
The Hon'ble Apex Court further observed in Paras 22, 23, 27, 28, 29 & 32, inter alia, as under:-
"22. Just as the insured has a duty to disclose all material facts, the insurer must also inform the insured about the terms 18 and conditions of the policy that is going to be issued to him and must strictly conform to the statements in the proposal form or prospectus, or those made through his agents. Thus, the principle of utmost good faith imposes meaningful reciprocal duties owed by the insured to the insurer and vice versa. This inherent duty of disclosure was a common law duty of good faith originally founded in equity but has later been statutorily recognised as noted above. It is also open to the parties entering into a contract to extend the duty or restrict it by the terms of the contract.
23. The duty of the insured to observe utmost good faith is enforced by requiring him to respond to a proposal form which is so framed to seek all relevant information to be incorporated in the policy and to make it the basis of a contract. The contractual duty so imposed is that any suppression or falsity in the statements in the proposal form would result in a breach of duty of good faith and would render the policy voidable and consequently repudiate it at the instance of the insurer.
27. If a fact, although material, is one which the proposer did not and could not in the particular circumstances have been expected to know, or if its materiality would not have been apparent to a reasonable man, his failure to disclose it is not a breach of his duty.
28. Full disclosure must be made of all relevant facts and matters that have occurred up to the time at which there is a concluded contract. It follows from this principle that the materiality of a particular fact is determined by the circumstances existing at the time when it ought to have been disclosed, and not by the events which may subsequently transpire. The duty to make full disclosure continues to apply throughout negotiations for the contract but it comes to an end when the contract is concluded; therefore, material facts which come to the proposer's knowledge subsequently need not be disclosed.
29. Thus, a proposer is under a duty to disclose to the insurer all material facts as are within his knowledge. The proposer is presumed to know all the facts and circumstances concerning the proposed insurance. Whilst the proposer can only disclose what is known to him, the proposer's duty of disclosure is not confined to his actual knowledge, it also extends to those material facts which, in the ordinary course of business, he ought to know.....
32. From the aforementioned discussion, it is clear that the principle of utmost good faith puts reciprocal duties of disclosure on both parties to the contract of insurance. These reciprocal duties mandate that both the parties make complete disclosure to each other, so that the parties can take an 19 informed decision and a fair contract of insurance exists between them. No material facts should be suppressed, which may have a bearing on the risk being insured and the decision of the party to undertake that risk. However, not every question can be said to be material fact and the materiality of a fact has to be adjudged as per the rules stated in the aforementioned judgment."
28] Thus, in view of the foregoing discussion, the evidence brought on record and the settled legal position governing contracts of insurance, this Commission finds itself in complete and respectful disagreement with the findings returned by the District Commission. As stated above, it is a trite and foundational principle of insurance jurisprudence that a contract of insurance is one of uberrimae fidei--utmost good faith--casting a solemn and affirmative duty upon the proposer to make a full, true and complete disclosure of all material facts within his knowledge which would have a bearing on the assessment of risk by the insurer. The obligation is not passive but active; it is not confined to answering questions in a mechanical manner but extends to disclosing every circumstance which a prudent insurer would consider relevant while deciding whether to accept the proposal and, if so, on what terms. In the present case, the record unmistakably reveals that the Deceased Life Assured (DLA), Late Sh. Baljit Singh Sohi, was suffering from serious systemic ailments including Alcoholic Liver Disease, Chronic Kidney Disease, Diabetes Mellitus Type-II and other allied complications prior to the issuance of the policy. These were not minor or transient conditions but chronic, progressive and life-threatening disorders directly impacting life expectancy and risk evaluation. Such ailments undeniably constituted material facts, the disclosure of which was imperative at the proposal stage.
29] However, the proposal form submitted by the DLA conspicuously omitted any reference to these significant medical conditions and instead projected a state of good health, thereby inducing the insurer to issue the policy on standard terms. The material on record, including medical documentation and treatment history, clearly demonstrates that these conditions were pre-existing and within the personal knowledge of the DLA at the time of obtaining the insurance cover. The non-disclosure, 20 therefore, cannot be brushed aside as inadvertent, trivial or immaterial; rather, it strikes at the very root of the contractual relationship between the parties. It is settled law that suppression of a material fact, whether fraudulent or otherwise, renders the contract voidable at the instance of the insurer. The test of materiality is not whether the fact actually influenced the cause of death but whether it would have influenced the judgment of a prudent insurer in accepting or declining the risk. The nexus between the suppressed ailment and the eventual cause of death is not determinative; what is determinative is the effect of the non-disclosure on the underwriting decision. In the instant case, ailments such as Alcoholic Liver Disease and Chronic Kidney Disease are grave conditions with significant mortality implications and no prudent insurer would have issued the policy on the same terms had these facts been disclosed. The concealment, therefore, materially altered the risk profile and vitiated the very basis upon which the contract was founded.
30] The District Commission, in overlooking the gravity and legal consequences of such suppression, failed to appreciate that insurance contracts are founded upon trust and transparency and that any breach thereof disentitles the beneficiary from claiming under the policy. Consumer Fora, though vested with equitable jurisdiction to redress genuine grievances, cannot rewrite contracts or extend sympathy in disregard of settled legal principles. Equity follows the law and cannot supplant it. Where the insured has approached the insurer with unclean hands by withholding critical medical information, the foundation of the claim itself stands eroded. The doctrine of utmost good faith is not a mere technicality but the lifeblood of insurance law; once breached, the insurer is within its rights to repudiate the policy.
31] The repudiation in the present case was not arbitrary, whimsical or mala fide but was based on cogent material demonstrating deliberate and material suppression. The insurer conducted investigation, examined medical records and upon being satisfied that the policy had been procured by misrepresentation of health status, exercised its contractual and legal right to repudiate the claim. Such repudiation is squarely in 21 consonance with the established principles laid down by the Hon'ble Supreme Court and the Hon'ble National Commission in a catena of judgments (as referred to above) holding that non-disclosure of serious pre- existing diseases vitiates the policy irrespective of the duration between issuance and death. The District Commission cannot countenance a situation where an insured, after consciously concealing grave ailments, secures a policy and thereafter, upon occurrence of the insured event, seeks enforcement of the contract as though the duty of disclosure were optional. To permit such enforcement would amount to rewarding misrepresentation and undermining the sanctity of contractual obligations. The fact that the death was due to cardiac arrest does not absolve the insured of the prior duty to disclose systemic diseases which materially affected his health profile. Insurance underwriting is a scientific process dependent upon accurate disclosure; distortion of that disclosure nullifies the insurer's consent. Consent obtained through suppression is no consent in the eyes of law. Therefore, this Commission holds that the concealment by the DLA was conscious, material and directly violative of the principle of uberrimae fidei, thereby rendering the policy voidable and justifying the insurer's decision to repudiate the claim. Further the omission on the part of the proposer to disclose the aforesaid pre-existing ailments constitutes clear non-disclosure of material facts, which the District Commission has totally failed to consider and appreciate while passing the impugned order against the appellant - opposite party.
32] The findings of the District Commission, having failed to appreciate these settled doctrines and having proceeded on an erroneous interpretation of evidence and law, cannot be sustained. Consequently, the repudiation of the claim by the appellant-insurer is held to be legally justified, fair, reasonable and strictly in accordance with the governing principles of insurance law and no deficiency in service can be attributed to the insurer in the facts and circumstances of the present case. The impugned order, thus, deserves to be set aside and the consumer complaint of the respondent - complainant is liable to be dismissed.
2233] For the reasons recorded above, we allow the appeal and set aside the impugned order dated 30.09.2024 passed by District Commission-I, U.T., Chandigarh. Consequently, consumer complaint No.225 of 2021 is dismissed with no order as to costs.
34] Pending applications, if any, in this appeal stand disposed of accordingly.
35] Compete record, in safe custody, alongwith certified copy of this order be sent to the District Commission concerned forthwith. 36] File be consigned to Record Room after completion. Pronounced 24.03.2026.
(PADMA PANDEY) PRESIDING MEMBER (RAJESH K. ARYA) MEMBER *Ad*