State Consumer Disputes Redressal Commission
Aegon Life Insurance vs Santosh Devi on 22 December, 2025
FA/45/2023
Aegon Life Insurance Co. Ltd. Vs Santosh Devi
BEFORE THE RAJASTHAN STATE
CONSUMER DISPUTES REDRESSAL
COMMISSION, CIRCUIT BENCH,
UDAIPUR
FIRST APPEAL NO: 45/2023
Aegon Life Insurance Co. Ltd.
A-201, 2nd Floor, Leela Business Park, Andheri-Kurla
Road, Andheri East, Mumbai, 400059
...Appellant/ Opposite Party
-VERSUS-
Santosh Devi
W/o Kishan Singh, Age- 38 years, Resident of Jiwan,
presently at Village Borwa, Tehsil Bhim, District
Rajsamand
...Respondent/Complainant
Before
HON'BLE MR. A.K. AGARWAL - MEMBER
HON'BLE MR. R. N. SARSWAT - MEMBER
Present:
For Appellant: Ms. Shweta Jain &
Mr. Prajjawal Kumar, Advocate
For Respondent: Mr. Gulzar Sindhi, Advocate
Dated: 22.12.2025
Dismissed Page 1 of 10
FA/45/2023
Aegon Life Insurance Co. Ltd. Vs Santosh Devi *Judgment* Authored by: Hon'ble Mr. R. N. Sarswat - Member The appellant-Insurance Company has preferred this appeal against the order dated 09.03.2022, passed by the District Consumer Disputes Redressal Commission, Rajsamand, in Consumer Complaint No. CC/91/2021, whereby the complaint filed by the respondent was allowed.
Complainant's Version The case of the Complainant, Mrs. Santosh Devi, is that her Husband, Mr. Kishan Singh (hereinafter referred to as the Life Assured), obtained a life insurance policy on 12.12.2019 from the Opposite Party, namely Aegon Life Insurance Company Ltd. (hereinafter referred to as the Appellant/Insurer), upon payment of an annual premium of ₹2,236/-. The said policy provided for a basic sum assured of ₹1,500,000/-.
The Complainant further stated that on 27.02.2020, the Life Assured expired due to sudden cardiac arrest.
Upon the demise of the Life Assured, the Complainant, being the nominee, lodged a claim with the Appellant for settlement of the policy benefits. However, the Appellant repudiated the claim on 26.07.2021, on the ground that the Life Assured had allegedly been suffering from Tuberculosis (T.B), before obtaining the insurance policy, and had suppressed the said material fact at the proposal stage. Dismissed Page 2 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi The Complainant contended that the repudiation is causing immense mental agony, harassment, and financial distress.
Proceedings before the DCDRC Aggrieved by the repudiation, the Complainant filed Consumer Complaint No. CC/91/2021 before the District Consumer Disputes Redressal Commission, Rajsamand (hereinafter referred to as DCDRC), on 19.08.2021, seeking the following reliefs:
(i) Payment of ₹1,500,000/- towards the sum assured, along with all the benfits;
(ii) Interest @ 18% per annum from the date of repudiation of the claim till realization;
(iii) Compensation of ₹150,000/- for mental agony, ₹15,000/- towards litigation expenses, and ₹150,000/-
towards advocate's fees; and
(iv) Any other relief deemed just and proper. Despite the due service of notice, the Opposite Party failed to appear before the District Commission and was proceeded against ex parte.
The Complainant supported her case by filing an evidence affidavit, the insurance policy, the death certificate, the repudiation letter, and other relevant documents. Dismissed Page 3 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi The Order of the DCDRC The DCDRC, after considering the pleadings and evidence on record, allowed the complaint vide order dated 09.03.2022, holding the repudiation to be unjustified.
The DCDRC directed the Appellant to:
Pay ₹1,500,000/- to the Complainant; Pay interest @ 9% per annum from the date of 26.07.2021, till realization;
Pay ₹10,000/- as compensation and ₹5,000/- as litigation costs, within 2 months; in default, this amount will attract an interest @ 9% per annum from the date of this order till realization.
Appeal Aggrieved by the said order, the Appellant preferred the present appeal on 20.02.2023, contending inter alia that:
(i) The District Commission erred in proceeding ex parte, thereby violating principles of natural justice;
(ii) The Life Assured deliberately suppressed material facts relating to his health condition;
(iii) Such suppression amounted to misrepresentation and breach of the doctrine of uberrima fides.
(iv) The repudiation was justified in view of Section 45 of the Insurance Act, 1938 (as amended in 2015).
In support of its contentions, the Appellant placed reliance upon the judgment of the Hon'ble Supreme Court in Satwant Kaur Sandhu vs. New India Assurance Co. Ltd. [2009 (9) SCALE Dismissed Page 4 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi 488], as well as the judgment of the Hon'ble National Commissiona in New India Assurance Co. Ltd. vs. Shri Vishwanath Manglunia (Revision Petition No. 164 of 2006), to justify repudiation of the claim on the ground of suppression of material facts.
On the aforesaid premises, the Appellant prayed for the setting aside of the impugned order and permitting them to contest the case.
An affidavit in support of the appeal was filed by Ms. Karishma Mirji, AVP-Legal, Aegon Life Insurance Company Limited.
Points for determination Upon hearing the learned counsel for the parties and on a careful perusal of the record, the following points arise for determination in the present appeal:
1. Whether the DCDRC erred in proceeding ex parte against the Appellant, and if so, whether such proceedings vitiate the impugned order for violation of the principles of natural justice?
2. Whether the Life Assured had suppressed material facts relating to his health condition at the time of obtaining the insurance policy, and whether such alleged suppression has been duly proved by the Appellant?
Dismissed Page 5 of 10
FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi
3. Whether the alleged non-disclosure amounts to misrepresentation and breach of the doctrine of uberrima fides governing contracts of insurance?
4. Whether the repudiation of the insurance claim by the Appellant was justified under Section 45 of the Insurance Act, 1938, as amended by the Insurance Laws (Amendment) Act, 2015?
5. Whether the impugned order dated 09.03.2022 suffers from any legal infirmity or perversity warranting interference by this Commission?
6. What relief, if any, is the Appellant entitled to? Findings of the Commission We have bestowed our anxious consideration on the entire material available on record, the rival contentions advanced by the Appellant, the impugned order passed by the District Commission, and the affidavit filed in support of the appeal. The issues raised in the present appeal are no longer res integra and stand squarely covered by authoritative pronouncements of the Hon'ble Supreme Court and the Hon'ble National Consumer Disputes Redressal Commission.
A. Ex Parte Proceedings:
It is not in dispute that the Appellant was duly served with notice of the proceedings before the District Commission. Despite service, the Appellant failed to enter Dismissed Page 6 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi an appearance or file its written version within the statutory period.
The Hon'ble Supreme Court, in New India Assurance Co. Ltd. vs. Hilli Multipurpose Cold Storage Pvt. Ltd. [(2020) 5 SCC 757], has categorically held that consumer fora are bound by the timelines prescribed under the Consumer Protection Act and that failure to file a written statement within the stipulated time cannot be condoned.
Similarly, the Hon'ble National Consumer Disputes Redressal Commission has consistently held that where due service is established, proceeding ex parte does not amount to a violation of natural justice (LIC of India vs. S. Rajalakshmi, Revision Petition No. 2473 of 2014).
The record reveals that notice was duly served upon the Appellant. Despite service, the Appellant failed to appear or file its written version within the statutory period. In such circumstances, the District Commission was justified in proceeding ex parte.
In view of the above, this Commission finds no illegality or procedural impropriety in the District Commission proceeding ex parte against the Appellant. B. Alleged Suppression of Material Facts:
The burden to establish suppression of material facts squarely lies on the insurer. Mere allegations, without cogent documentary or medical evidence, are insufficient.
Dismissed Page 7 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi In Satwant Kaur Sandhu vs. New India Assurance Co. Ltd (Supra), the Hon'ble Supreme Court held that non- disclosure of material facts would justify repudiation only if the insurer proves that:
The insured knew the ailment,
The fact was material to the risk, and
There was deliberate suppression.
Further, the Hon'ble Supreme Court in Sulbha Prakash Motegaonkar v. Life Insurance Corporation of India [CIVIL APPEAL NO. 8245 OF 2015, Arising out of S.L.P. (C) No. 13589 of 2015] reiterated that every non- disclosure does not amount to suppression. The Court held that unless the insurer establishes that the insured had intentionally withheld a material fact with knowledge of its relevance, repudiation is unsustainable in law. It was further held that if death is due to an independent or unrelated cause, prior ailments cannot be used to deny the claim.
In the present case, except for a bald allegation that the Life Assured was suffering from Tuberculosis before issuance of the policy, no contemporaneous medical records, treatment documents, or hospital records before 12.12.2019 have been produced by the Appellant.
The Hon'ble NCDRC, in ICICI Prudential Life Insurance Co. Ltd. vs. Manish Gupta (RP No. 2156/2017), has held that repudiation cannot be sustained merely on Dismissed Page 8 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi post-claim investigation reports without credible pre-policy medical evidence.
C. Doctrine of Uberrima Fides:
The doctrine of uberrima fides (utmost good faith) indeed governs contracts of insurance. However, its application is not absolute and must be tested against proof of intentional non-disclosure.
In LIC of India vs. Rekhaben Nareshbhai Rathod [(2019) 6 SCC 175], the Hon'ble Supreme Court held that the suppression must be conscious and fraudulent; mere omission without intent cannot vitiate the policy.
In the absence of evidence demonstrating that the Life Assured was aware of Tuberculosis and intentionally concealed it, the charge of misrepresentation cannot be sustained.
The DCDRC rightly held that repudiation based on assumptions and conjectures violates settled principles of insurance law.
D. Justification of Repudiation u/s 45 of Insurance Act:
Section 45, post-amendment, places stringent conditions on insurers seeking repudiation, even within three years of policy issuance. The insurer must prove that the statement was:
Material to the risk, Fraudulently made, and The policyholder knew it to be false. Dismissed Page 9 of 10 FA/45/2023 Aegon Life Insurance Co. Ltd. Vs Santosh Devi In Reliance Life Insurance Co. Ltd. vs. Rekhaben Rathod, (Supra), the Hon'ble Supreme Court clarified that Section 45 is protective in nature and intended to prevent arbitrary repudiation.
E. Relief:
The DCDRC has merely directed payment of the contractual benefits under the policy, along with interest at the reasonable rate of 9% per annum from the date of repudiation. The compensation and litigation costs awarded are nominal and commensurate with the harassment suffered by the Complainant. Conclusion In view of the above discussion and the law laid down by the Hon'ble Supreme Court and the National Commission, we are of the considered opinion that the impugned order does not warrant any interference.
Order Accordingly, the appeal is hereby dismissed. The order dated 09.03.2022, passed by the DCDRC, Rajsamand, in Consumer Complaint No. CC/91/2021 is affirmed in toto. The original record, along with the copy of this order, shall be transmitted back to the DCDRC, Rajsamand, forthwith. (Arun Kumar Agarwal) (Ram Niwas Sarswat) Member (Judicial) Member (Non-Judicial) Dismissed Page 10 of 10