State Consumer Disputes Redressal Commission
Mrs. Tanuja Gupta vs Future Generali India Life & Ins. Co. ... on 5 January, 2026
FA/73/2021 D.O.D: 05.01.2026
MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL
COMMISSION
Date of Institution: 15.12.2021
Date of Hearing: 13.10.2025
Date of Decision: 05.01.2026
FIRST APPEAL NO.-73/2021
IN THE MATTER OF
MRS. TANUJA GUPTA
W/O LATE MR. VIMAL GUPTA,
RESIDENT OF H. NO. 4604,
DEPUTY GANJ, SADAR BAZAR,
DELHI - 110006.
(Through: Mr. Rajan Bhatia & Mr. Girraj Singh, Advocate)
...Appellant
VERSUS
1. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.,
THROUGH ITS GENERAL MANAGER,
9TH FLOOR, ROOTS TOWER, LAXMI NAGAR,
DELHI - 110092.
(Through: Law Veritas North )
...Respondent no.2
2. AU SMALL FINANCES BANK LTD.,
THROUGH ITS GENERAL MANAGER,
B - 11E, MALVIYA NAGAR INDUSTRIAL AREA,
JAIPUR - 302017.
(Through: Mr. Rajiv Ranjan Dwivedi,
Mr. Vishal & Mr. Kapil Chaturvedi, Advocates)
...Respondent no.2
DISMISSED PAGE 1 OF 18
FA/73/2021 D.O.D: 05.01.2026
MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)
HON'BLE MS. PINKI, MEMBER (JUDICIAL)
Present: Mr. Girraj Singh, Counsel for the appellant (Enrl. No. D/1419/25,
Email:[email protected])
Ms. Avantika Chaturvedi, Counsel for the Respondent No. 1,
(Email: [email protected])
Mr. Vishal, Counsel for the Respondent No. 2 appeared through VC
PER: HON'BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT
JUDGMENT
1. The facts of the case as per the District Commission record are as under:
"1. The brief conspectus of facts as alleged in the present complaint are that Sh. Vimal Gupta, husband of the Complainant obtained a loan for Rs.55,00,000/- from AU Small Finance Bank Ltd., OP-2 herein, vide Loan Agreement dated 02.02.2018 and Loan Account No. L9001060714170625 wherein the Complainant and her son Sh. Akash Gupta, were the co- applicants. Property bearing House No. 4605, Sadar Bazaar, Delhi - 110006 was mortgaged as a collateral property against the said loan. The rate of interest under the Loan Agreement was 11% p.å,. and the loan amount was payable in 123 monthly installments @ 75,763/- per month. The date of payment of first installmant was 10.03.2018 and last installment was to become due on 10.05.2028. Sh. Vimal Gupta purchased a Future Generalli Loan Suraksha Group Life Policy with Policy No. DISMISSED PAGE 2 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
ML000003 from OP-1, valid for a period of 05 years from 08.02.2018 to 07.02.2023 to cover the loan amount of Rs.55,00,000/-. In the said Group Policy, OP-2 is the policyborder. As per the said policy, in case of death of any one of the joint borrowers where both borrowers are insured on the entire loan amount, the death benefit is directly payable to the master policyholder to the extent of the outstanding loan amount subject to the terms & conditions of the policy and the death benefit amount in excess of the outstanding loan amount, if any, is payable to the nominee/appointee/legal heirs/insured member. Sh. Vimal Gupta was regularly paying the premium to OP- 1 until his death on 25.10.2019 at Ram Manohar Lohia Hospital, New Delhi. Alter the death of the husband of the Complainant, a claim was submitted by her in the office of OP-1 but the same was rejected vide letter dated 31.01.2020 on the ground that Sh. Vimal Gupta was a known case of retroviral disease and was on anti-retroviral medication since 2013 and the said history is prior to the date on which proposal/application for the insurance of the loan amount was signed. Consequent to this, Complainant submitted her petition before the Claims Review Committee of OP-1 vide letter dated 17.02.2020. Vide letters dated 22.10.2020 and 12.03.2020, OP - 1 gave assurance that the admissions of the Complainant have been put before the Claims Review Committee. Vide Letter dated 24.03.2020 OP No.1 conveyed to the Complainant the decision of the Claims Review Committee reaffirming its decision. On 01.07.2000, the DISMISSED PAGE 3 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
complainant lodged her complaint with the Insurance Ombudsman against the rejection of her claim under the said Policy by OP No.1. Demand Notice dated 24.08.2020 issued u/s 13(2) SARFARSI Act, 2002 was issued by OP No2 for the recovery of Rs. 57,45,837/- towards the said loan within 60 days from the date of the said notice. Subsequent to the receipt of the Letter dated 17.02.2020 from OP No 2; the complainant sent a letter dated 08.09.2020 to the Claims Review Committee for delay in reconsideration of the claim under the said Policy. Vide Letter dated 16.09.2020 OP No.1 informed the complainant again its decision of rejection of her claim. The petitions made to the Insurance Ombudsman and IRDAI were also not considered. Alleging deficiency in service and unfair trade practice on the part of the OPs, the complainant has prayed for directions to the OP No.1 to pay Rs.57,45,837/- to OP No.2 towards the Loan Account in question, Rs.2,00,000/- as compensation for harassment and mental agony, and Rs.1,00,000/- as the cost of the present litigation.
2. Arguments advanced by the Ld. Counsel for the complainant on the admissibility of the present complaint.
2. The District Commission after taking into consideration the material available on record passed the judgment dated 24.08.2021, whereby it held as under:
"...4. On a threadbare scrutiny of the record, it is not in dispute that Sh. Vimal Gupta, husband of the complainant, had availed DISMISSED PAGE 4 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
loan facility of Rs.55,00,000/- Rupees Fifty Five Lakhs only) vide Loan Account No: L9001060714170625 from AU Small Finance Bank Limited wherein Sh. Vimal Gupta was the Borrower alongwith Smt. Tanuja Gupta and Sh. Akash Gupta as the Co-borrowers. Sh. Vimal Gupta had mortgaged his Property bearing H. No.4605, Sadar Bazar, District North Delhi admeasuring 40 sq. yds. with OP No. 2 as a collateral security to ensure the repayment of loan. The said loan was sanctioned on 07.02.2018 for tenure of 123 months from 10.03.2018 to 10.05.2028. It is also not in dispute that the borrower Sh. Vimal Gupta insured the loan in question under a Future Gererali Loan Suraksha Group Policy of OP No.1 bearing No. ML000003 for a period of five years from 08.02.2018 to 07.02.2023 wherein OP No.2 was the Insurance Policy Holder and the complainant herein was nominated by Sh. Vimal Gupta as his nominee under the said policy. On 25.10.2019 Sh. Vimal Gupta died, following which the complainant lodged a claim under the said policy with the insurer i.e., OP No.1, which was repudiated by it vide its letter dated 31.01.2020, copy of which has been placed on record by the complainant. From the perusal of the said letter, it is observed that in the Proposal Form dated 28.01.2018 submitted by Sh. Vimal Gupta he had replied to certain questions pertaining to the health and medical history of the proposer that required a specific disclosure on whether any ailment, hospitalization or treatment had been undergone by the proposer. Section: 6 Medical Questionaire Q.1(g), Q.2 & Q.3 DISMISSED PAGE 5 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
and the replies thereto as given in the application form and mentioned to in the said letter are being reproduced as hereunder:
Section 6 Medical Questionnaire Q.1(g), Q.2 & Q.3 Q. No. 1 Have you ever been diagnosed Answers with, treated for, or advised to seek treatment from any of the following conditions? (a to h) if answers to any of the following is "Yes"
please provide details.
1. (g) Kidney problem, Liver problems, No Hepatitis B or C or HIV/AIDS infection or diseases of reproductive organ.
2. Have you consulted any doctor for No surgical operations or have been hospitalized for any disorder or been advised to undergo any medical investigation / treatment for any medical conditions other than for minor cough, cold or flu during last 5 years.
3. Are you currently taking or in the No. past 5 years have taken any treatment or medications for any condition for continuous period more than 14 days? (except for minor cough, cold, flu, appendix typhoid)
5. The questions in the medical Questionaire have been answered by Sh. Vimal Gupta in the negative. Question 1(g) in the Medical Questionnaire has been answered in the negative, DISMISSED PAGE 6 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
indicating thereby that he had never been diagnosed with, treated for, or advised to seek treatment for Kidney problem, Lives problems, Hepatitis B or C or HIV/AIDS infection or disease of reproductive organ. Question 2 inquiring as to whether he (i.e. the life proposed to be insured) has consulted any doctor for surgical operations or have been hospitalized for any disorder or been advised to undergo any medical investigation/ treatment for any medical condition other than minor cough, cold or flu during last 5 years was also responded in the negative. Even the Question 3 making a query as to whether he is currently taking or in the past 5 years have taken any treatment or medications for any condition for continuous period more than 14 days? (except for minor cough, cold, flu, appendix, typhoid) was answered in the negative. It is also mentioned in the letter dated 31.01.2020 of OP No.1 that the claim was evaluated and medical records as received by the insurer revealed, according to it, that the Deceased Life Assured ( i.e., Sh. Vimal Gupta) was a known case of Retro Viral Disease and was on anti-retroviral medications since 2013 and that the said history is prior to the date on which proposal/application for insurance was signed. While repudiating the claim of the complainant under the said policy vide its letter dated 31.01.2020, on account of non-disclosure of material facts within two years from the date of commencement of the роlicy i.e., 08.02.2018, it is mentioned in the said letter that though these facts were in the knowledge of the Deceased DISMISSED PAGE 7 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
Life Assured but they were not disclosed by him at the time of taking the Insurance policy in question.
6. A policy of insurance is a contract of insurance which is governed by the Principle of Uberrimae Fidei (i.e., the Principle of Utmost Good Faith). A proposer who seeks to obtain a policy of insurance is duty bound to disclose all material facts bearing upon the issue as to whether the insurer would consider it appropriate to assume the risk which is proposed. It is with this principle in view that the proposal form requires a specific disclosure of Pre-Existing Diseases, so as to enable the insurer to arrive at a considered decision based on actuarial risk. Coming to the facts of the present complaint, it is evident on reading- through the copy of the Death Summary issued by Dr. Ram Manohar Lohia Hospital, New Delhi confirming the death of Sh. Vimal Gupta on 25.10.2019 at 05:30 am, that Sh. Vimal Gupta was diagnosed with PLHA in 2013 and was continuing with ART (TLE) regime since 2013 from RML Centre. The Deceased Life Assured was duty bound to make full disclosure of material facts in his knowledge in response to the queries in the insurance proposal form, which he failed to do. This brings the ground for repudiation squarely within the principles which have been formulated by the Hon'ble Apex Court in its judgments given in Life Insurance Corporation of India vs. Asha Goel (2001) 2 SCC 160, P.C. Chacko vs. Chairman, Life Insurance Corporation of India (2008) 1 SCC 321 and Satwant Kaur Sandlu vs. New India Assurance Company Limited DISMISSED PAGE 8 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
(2009) 8 SCC 316. The Hon'ble Supreme Court in Life Insurance Corporation of India vs. Asha Goel, has held:
"12... The contracts of Insurance Including the contract of life assurance are contacts uberrima fides and every fact of material (sic material fact) must the disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of risk which may take place between the proposal and its acceptance. If there is any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person."
The principle of law as laid down in Life Insurance Corporation of India vs. Asha Goel (supra) has been reiterated in its judgments in PC Chacko vs Chairman, Life Insurance Corporation of India and Satwant Kaur Sandhu vs. New India Assurance Company Limited mentioned supra In Satwant Kaur Sandhu vs. New India Assurance Company Ltd. (supra), at the time of obtaining the Mediclaim policy, the insured suffered from chronic diabetes and renal failure, but failed to disclose the details of these illnesses in the policy proposal form. Upholding the repudiation of liability by the insurance company, this Court held:
"25. The upshot of the entire discussion is that in a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept DISMISSED PAGE 9 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
the risk is a "material fact". If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form. Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance."
7. While disposing of an Appeal in Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and Others vs. Dalbir Kaur, Civil Appeal No. 3397 of 2020 vide its judgment dated 09.10.2020 the Hon'ble Apex Court has referred to its earlier decisions in Life Insurance Corporation of India vs. Asha Goel, P.C. Chacko vs. Chairman Life Insurance Corporation of India and Salwant Kaur Sandhu vs. New India Assurance Company Limited mentioned supra.
8. Even otherwise, the suppression of material facts by the Deceased Life Assured which were well within his knowledge since 2013 entitles the insurer to repudiate the policy in view of Section 45 of the Insurance Act, 1938 which stipulates that an insurer is restricted from calling into question a life insurance policy after an expiry of two years from the date on which it was effected on the ground that a false or inaccurate statement has been made in the (1) proposal; (ii) report of a medical officer, referee or a friend of the insured; or (ii) in any other document leading to the issue of policy. On the expiry of two years, the burden of proof shifts to the insurer who has to establish that the false or inaccurate statement was a material matter or related to DISMISSED PAGE 10 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
material facts. It is pertinent to mention here that in the present case, the claim in question was repudiated vide letter dated 31.01.2020, within two years from the date of commencement of the policy on 08.02.2018, on the ground of non-disclosure of material information which was available with the Deceased Life Assured at the time of taking the insurance policy in question as every facet of materiality must be disclosed otherwise there is good ground for rescission.
9. For the reasons which we have adduced and fortified by the Judgments afore-mentioned, we are of the considered view that the insurance company was justified in repudiating the claim of the complaint. The present complaint, thus, deserves to be dismissed and it is accordingly dismissed in limine.''
3. The Appellant has preferred the present appeal against the impugned order on the ground that the District Commission erred in applying the principle of utmost good faith, as the understanding of a "material fact" is subjective and depends upon the prudence of the insured person. The counsel for the Appellant submitted that the insured was a small-time vendor; therefore, cannot be presumed to possess the same level of prudence or understanding as that of a well-educated person. Moreover, the obligation to disclose material facts depends upon the information sought and explained by the insurance agent and the responsibility to explain which facts were material for disclosure squarely rested upon the insurance agent.
DISMISSED PAGE 11 OF 18 FA/73/2021 D.O.D: 05.01.2026
MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
4. The counsel for the Appellant further contended that the District Commission failed to appreciate that the Review Committee of Respondent No. 1 repudiated the claim based on a superficial evaluation. He submitted that the legal burden to prove suppression of material facts rests squarely upon the insurer. However, Respondent No. 1 failed to place any cogent evidence on record to establish that the insured had acted with mala fide intent in withholding any information. He further contended that an Respondent/insurance agent is required to exercise due diligence to ensure that the proposer is not deliberately concealing material facts as the Claims Review Committee repudiated the claim vide letter dated 31.01.2020 solely on the ground that the insured was a known case of a retroviral disease and was undergoing medication since 2013. However, a disease of such seriousness could not have been deliberately concealed if the insurer had exercised proper due diligence, as it could have been detected through a simple blood test. Pressing the aforesaid submissions, the Appellant prayed for the impugned order to be set aside.
5. The Respondent no.1 has filed reply to the present appeal and denied all the contentions of the Appellant. He further submitted that there is no error in the impugned order as the entire material available on record was properly scrutinized before passing the said order.
6. The Respondent No. 2 has also filed reply to the present appeal and has raised objections regarding the maintainability of the same. The counsel for the Respondent No. 2 submitted that no cause of action has arisen against the Respondent No. 2. He further submitted that the Appellant has not approached this Commission with clean hands, as she has concealed material facts that there exists an arbitration clause between the parties, DISMISSED PAGE 12 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
wherein all matters, questions, and disputes arising between them are required to be settled by arbitration under the Arbitration and Conciliation Act, 1996. He further submitted that the Appellant failed to adhere to financial discipline and did not fulfil her financial commitments. He also submitted that the present appeal is not maintainable in view of Section 34 of the Securitisation and Reconstruction of Financial Assets and Enforcement of Security Interest Act, 2002. Pressing the aforesaid objections, the Respondent No. 2 prayed for dismissal of the present appeal with costs.
7. The Appellant has filed written arguments and reiterated the contentions raised in the present appeal.
8. Respondent No. 1 has also filed written arguments and denied the contentions raised in the present appeal. The counsel for Respondent No. 1 further argued that the impugned order has been rightly passed by the District Commission.
9. The Respondent No. 2 has also filed written arguments and reiterated the preliminary objections raised in the reply to the appeal.
10. We have perused the material available on record and heard the counsel appeared on behalf of all the parties.
11. The first issue to be adjudicated is whether the Appellant has cause of action to approach this commission against the Respondent no.2. It is imperative to refer to Section 69 of the Consumer Protection Act, 2019 wherein it is provided as under: -
"(1) The District Commission, the State Commission or the National Commission shall not admit a complaint DISMISSED PAGE 13 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
unless it is filed within two years from the date on which the cause of action has arisen.
(2) Notwithstanding anything contained in sub-section (1), a complaint may be entertained after the period specified in sub-section (1), if the complainant satisfies the District Commission, the State Commission or the National Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period:
Provided that no such complaint shall be entertained unless the District Commission or the State Commission or the National Commission, as the case may be, records its reasons for condoning such delay."
12. Analysis of Section 69 of the Consumer Protection Act, 2019 leads us to the conclusion that this commission is empowered to admit a complaint if it is filed within a period of 2 years from the date on which cause of action has arisen. In the present case, it is evident from the record that the Appellant had availed a loan facility of Rs.55,00,000/- from Respondent No. 2 vide Loan Account No. L9001060714170625, for a tenure of 123 months commencing from 10.03.2018 and ending on 10.05.2028. It is further clear from the record that the said loan was insured under a Group Loan Insurance Policy issued by Respondent No. 1. However, the grievance of the Appellant arises solely from the repudiation of the insurance claim by Respondent No. 1 vide letter dated 31.01.2020. Furthermore, it is not the case of the Appellant that Respondent No. 2 committed any deficiency in service in relation to the sanction or DISMISSED PAGE 14 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
disbursement of the loan. More so, the Respondent No. 2 was merely the lender and the master policyholder under the group insurance policy and the repudiation of the claim was exclusively carried out by Respondent No. 1. In view of the above, we are of the considered view that Respondent No. 2 has no role in the repudiation of the insurance claim and no cause of action has arisen against it in the present matter.
13. The main question for consideration before us is whether the impugned order dated 24.08.2021 passed by the District Commission suffers from any infirmity.
14. The Appellant has contended that the District Commission erred in applying the principle of utmost good faith, on the ground that the understanding of a "material fact" is subjective and depends upon the prudence of the insured person. He further submitted that the insured had no mala fide intention to deliberately suppress any material fact at the time of obtaining the insurance policy.
15. The fact that the husband of the Appellant i.e. Sh. Vimal Gupta had taken a Future Generali Loan Suraksha Group Life Policy bearing Policy No. ML000003 for the period from 08.02.2018 to 07.02.2023 is not disputed by the parties. It is further clear from the record that the insured unfortunately expired on 25.10.2019 at Dr. Ram Manohar Lohia Hospital, New Delhi. Pursuant to his death, the Appellant lodged a claim under the said Group Loan Insurance Policy. However, the Respondent No. 1 vide letter dated 31.01.2020, repudiated the said claim on the ground of non- disclosure of a pre-existing disease at the time of obtaining the insurance policy.
DISMISSED PAGE 15 OF 18 FA/73/2021 D.O.D: 05.01.2026
MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
16. On perusal of the record, it is noted that Dr. Ram Manohar Lohia Hospital, New Delhi issued the Death Summary, wherein it is explicitly mentioned that the insured was a known case of Retro Viral Disease and was on anti-retroviral medication since the year 2013. Moreover, the Appellant has failed to place on record any material or document to controvert the said medical record. Moreover, it is pertinent to note that the husband of the Appellant i.e. the insured (deceased), obtained the insurance policy in question in the year 2018, whereas he was suffering from Retro Viral Disease and was on anti-retroviral medication since the year 2013. Therefore, the insured was fully aware of his medical condition at the time of filling up the proposal form. However, the insured concealed from Respondent No. 1 the fact that he was suffering from the aforesaid disease.
17. Furthermore, the insured failed to disclose the said fact in response to the specific questions contained in the medical questionnaire. Accordingly, the contention of the Appellant that there was no deliberate suppression of the illness is devoid of any merit. Thus, we are of the view that the insured was suffering from the said illness much prior to the issuance of the insurance policy.
18. Additionally, we are in agreement with the findings of the District Commission that the contract of insurance is governed by the principle of uberrima fides i.e., utmost good faith. The District Commission has rightly relied upon the judgments of the Hon'ble Supreme Court in Life Insurance Corporation of India vs. Asha Goel (2001) 2 SCC 160, P.C. Chacko vs. Chairman, Life Insurance Corporation of India (2008) 1 SCC 321 and Satwant Kaur Sandhu vs. New India Assurance Company DISMISSED PAGE 16 OF 18 FA/73/2021 D.O.D: 05.01.2026 MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
Limited (2009) 8 SCC 316, wherein it has been consistently held that non-disclosure of material facts having a direct bearing on the risk undertaken by the insurer entitles the insurer to repudiate the claim.
19. The Appellant further contended that Respondent No. 1 or the insurance agent was required to exercise due diligence to ensure that the proposer was not deliberately concealing material facts, as the Claims Review Committee repudiated the claim vide letter dated 31.01.2020 solely on the ground that the insured was a known case of a retroviral disease. We are of the view that when a proposer has been suffering from a serious illness and undergoing treatment for several years, he is expected to disclose such information while answering the specific questions in the proposal form. Non-disclosure of such a material fact cannot be justified on the ground of lack of understanding or absence of deliberate intention. Once a material fact is concealed, the insurer cannot be faulted for repudiating the claim as the very basis of the insurance contract stands vitiated. Therefore, we are of the view that the District Commission rightly held that there is no deficiency on the part of Respondent No. 1.
20. In light of the aforesaid discussion, we find no reason to interfere with the order dated 24.08.2021 passed by the District Consumer Disputes Redressal Commission - I, North, Room No. 2 & 3, Ground floor, Annexe Building, Tis Hazari Court Complex, Delhi-110054.
21. Consequently, the present Appeal stands dismissed with no order as to costs.
22. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
DISMISSED PAGE 17 OF 18 FA/73/2021 D.O.D: 05.01.2026
MRS. TANUJA GUPTA VS. FUTURE GENERALI INDIA LIFE & INSURANCE CO. LTD.
23. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
24. File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (PINKI) MEMBER (JUDICIAL) Pronounced On:
05.01.2026 LR-ZA DISMISSED PAGE 18 OF 18