Delhi District Court
Asha Rani vs Cholamandalam Ms General Insurance Co ... on 24 December, 2025
IN THE COURT OF SH. AJAY PANDEY
DISTRICT JUDGE (COMMERCIAL COURT-10) CENTRAL,
TIS HAZARI COURTS, DELHI
CS Comm 1276/2024
Smt. Asha Rani
W/o late Sh. Vinod Kumar
R/o A-45, 46, Gandhi Vihar,
Delhi-110009 Plaintiff
Vs
Cholamandalam MS General Insurance Co. Ltd
Plot no. 39,
2nd Floor, Samyak Tower,
Pusa Road,
Opposite Pillar No. 120,
New Delhi-110005 Defendant
Date of Institution : 20.11.2024
Date of Arguments : 28.11.2025
Date of Judgment : 24.12.2026
JUDGMENT:-
SUIT FOR RECOVERY FOR AN AMOUNT OF RS.6,32,827/- (RUPEES SIX LAKHS THIRTY TWO THOUSAND EIGHT HUNDRED TWENTY SEVEN ONLY)
1. The present suit for recovery of Rs.6,32,827/- has Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed by Page no. 1 of 26 CS Comm 1276/2024 AJAY AJAY PANDEY PANDEY Date: 2025.12.24 15:42:53 +0530 been filed by the plaintiff against the defendant.
2. PLAINT It is inter-alia stated in the plaint that:-
2.1 Plaintiff is a senior citizen and cancer survivor.
2.2 Defendant is a well known General Insurance Company.
2.3 Since the year 1998, plaintiff has been insuring herself with National Insurance Company for a sum assured of Rs.50,000/- only. For a period of 20 years no claim was ever lodged by plaintiff, hence the sum assured became Rs.75,000/-.
2.4 Plaintiff has her savings bank account with erstwhile Oriental Bank of Commerce (now Punjab National Bank).
2.5 Bank Manager of that bank offered mediclaim policy from defendant company to plaintiff as they had tie-up with defendant.
2.6 In the year 2019 the plaintiff had insured herself with the defendant insurance company vide policy/certificate number 2842/00178812/0001/000/22 for the period commencing from 02.05.2019 to 01.05.2020 for a sum insured of Rs.5.00 lakhs. Against such a cover an amount of Rs.14,316/- was paid as premium to the defendant company from the saving bank account no. 02805011000951 of then Oriental Bank of Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 2 of 26 CS Comm 1276/2024 Digitally signed by AJAY AJAY PANDEY PANDEY Date:
2025.12.24 15:42:58 +0530 Commerce now Punjab National Bank. Since then the insurance policy with the defendant is continuing year by year without any break.
2.7 In July 2019, plaintiff was hospitalized in Sant Parmanant Hospital, Civil Lines. The claim for hospitalization was honoured by National Insurance Company and the sum insured with the said company was exhausted.
2.8 On 01.08.2019 at Fortis Hospital, Shalimar Bagh, plaintiff was diagnosed as suffering from multiple myeloma- a form of blood cancer.
2.9 Treatment of plaintiff started at Fortis Hospital. Plaintiff's health however deteriorated.
2.10 Plaintiff then consulted Sr. Oncologist Dr. K.K. Saxena at Sant Parmanand hospital and on his recommendation was admitted in hospital.
2.11 A claim was initiated with the defendant claiming expenses for pre-hospitalization, hospitalization and post-hospitalization. Plaintiff supplied all required information and documents to the defendant.
2.12 Since the plaintiff was detected with blood cancer, process of hospitalization for sessions of chemotherapy remained continued. Plaintiff shared all information with defendant.
2.13 Defendant kept repeating its demand for information and documents which were already supplied to them without bothering to peruse the already Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 3 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:04 +0530 submitted documents.
2.14 Defendant company refused to honour the claims of plaintiff.
2.15 Plaintiff filed a recovery suit in respect of expenses incurred during the period August 2019 to November 2020 vide suit CS DJ No.768 of 2020 which was decreed in favour of plaintiff on 25.03.2023 by the Commercial Court presided over by learned Sh. Umed Singh Grewal.
2.16 Since treatment of plaintiff continued, plaintiff lodged further claim for the period December 2020 to April 2022 for an amount of Rs.4,02,870/-.
Defendant released an amount of Rs.20,131/- and Rs.6110/- on 02.08.2022 and 15.09.2022 respectively.
2.17 For remaining amount of Rs.3,76,629/-, plaintiff filed a suit no. 994 of 2023 for recovery which was decreed by this court on 07.08.2024.
2.18 In the meantime, treatment of plaintiff remained continued. Therefore, plaintiff had to incur expenses towards treatment/hospitalization/medicines.
2.19 Plaintiff lodged claim of these medical expenses for an amount of Rs.5,64,527/- for the period from May 2022 to October 2023 and supplied all requisite documents to the defendant.
2.20 Defendant released only a partial amount of Rs.40,069/- vide cheque dated 30.03.2024 and made erroneous unreasonable deductions from the payable Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 4 of 26 CS Comm 1276/2024 AJAY Digitally signed by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:08 +0530 claim.
2.21 The present suit has been filed for these medical expenses from May 2022 to October 2023.
2.22 Plaintiff wrote repeated letters to the defendant to release the whole claim amount but to no avail.
2.23 Plaintiff initiated pre-suit mediation process, however despite service of notice, defendant did not appear in those proceedings and proceedings were closed as non-starter.
2.24 By denying and delaying the claim of plaintiff, defendant acted in contravention of policy contract and is therefore liable to pay interest @ 12% per annum from 13.11.2023.
2.25 Value of suit for pecuniary jurisdiction and court fees is calculated in table in para no.27 of plaint as follows :-
Relief Value C. Fee
For Recovery of Money Rs.564527.00 8541.00
For Interest at the rate Rs.68300.00 of 12% per annum from date of submission of all document i.e. 13.11.2023 till filing of suit Total of Total Rs.632827.00 Rs.8541.00 2.26 Value of suit for the purpose of jurisdiction Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 5 of 26 CS Comm 1276/2024 Digitally signed AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:14 +0530 is thus stated to be Rs.6,32,827/- and advalorem court fees of Rs.8541/- has been paid.
2.27 Suit is within limitation period. Hence, present suit for recovery of Rs.6,32,827/- with pendentelite and future interest along with cost of suit.
3. WRITTEN STATEMENT 3.1 Summons for settlement of issues were served upon the defendant. Defendant filed its written statement.
3.2 Defendant took preliminary objections that present suit is false, frivolous and abuse of judicial process; that there is no liability on the part of defendant as plaintiff never lodged any claim with the defendant for her admission in hospital as per discharge summary though it was duty of the plaintiff to lodge the claim for each and every admission based on her discharge summary and even each and every claim had to be decided by the defendant on its merits in accordance with terms and conditions of the policy.
3.3 It is further preliminary objected that defendant has not erred in offering service to the plaintiff and claim indemnification has following 04 essentials :-
i) Utmost good faith,
ii) Insurable interest,
iii) Valid consideration,
iv) Actual damages.
Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 6 of 26
CS Comm 1276/2024
AJAY by AJAY PANDEY
PANDEY Date: 2025.12.24
15:43:19 +0530
Unless all above requirements are met with, insured cannot seek any indemnification from the insurer. Plaintiff is guilty of violation of said ingredients and do not deserve any indulgence from this court.
3.4 It is further preliminary objected that plaintiff failed to produce any evidence or averments for claim admissible under the insurance policy and has suppressed material facts.
3.5 It is further stated that being customer of Punjab National Bank, plaintiff obtained Group Health Insurance policy no.2876/00205940/000/00 from the defendant for sum insured of Rs.5.00 lakhs from 02.05.2022 to 01.05.2023 subject to terms and conditions of policy provided in the policy certificate. It is further stated that plaintiff renewed the same policy for the 5th time and defendant issued policy no.2876/00247005/003/00 valid for the period from 02.05.2023 to 01.05.2024.
3.6 It is further stated that plaintiff lodged two claims i.e. claim no. 2876165604 against policy no.2876/00205940/000/00 for claim of Rs.1,22,317/- and claim no. 2876166176 against policy no.2876/00247005/003/00 for claim of Rs.93,048/- with the defendant for two hospitalizations and both the claims were processed by the defendant and defendant released the payments for both the claims i.e. Rs.40,069/- vide cheque/NEFT no. 944263 dated Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 7 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date:
2025.12.24 15:43:24 +0530 30.03.2024 against claim no. 2876165604 and Rs.48,295/- vide cheque/NEFT no. IN1ON240207070E6 dated 07.02.2024 against claim no. 2876166176 respectively.
3.7 It is further stated that plaintiff has not lodged any other claim with the defendant against the above noted policies, though she is well aware of the procedure to be followed and she ought to have lodged separate claims with the defendant for each and every hospitalization based on discharge summary and medical bills with prescriptions even if she was under continuous treatment.
3.8 It is further stated that plaintiff failed to comply with the procedure for reimbursement of claim amounting to breach of warranty under the policy.
Therefore the suit is not maintainable for want of cause of action.
3.9 It is further stated that Hon'ble Supreme Court while dealing with the issue in United India Insurance Vs. M/s Harchand Rai Chanda Lal, JT 2004(8) SC 8 held that the terms of the contract has to be read strictly. The Hon'ble Supreme Court in Vikram Greentech India Ltd. & Anr. Vs New India Assurance Co. Ltd reported in (2009) 5 SCC 599 in para no.18 held that the insured cannot claim anything more than what is covered by the insurance policy. The Hon'ble Supreme Court in the case of Sikka Papers Ltd. Vs National Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed by AJAY Page no. 8 of 26 CS Comm 1276/2024 AJAY PANDEY PANDEY Date:
2025.12.24 15:43:29 +0530 Insurance Co. Ltd & Ors reported as (2009) 7 SCC 777, in para no.21 held that it is true that the surveyor's report is not the last word but then there must be legitimate reasons for departing from such report.
3.10 It is further stated that plaintiff filed the present suit claiming payment for her various hospitalizations on various occasions, period and under different policies to create confusion and to take reimbursement benefits of the amount in bulk which is not possible in such a manner, as all the claims are to be specified with proper documentation, claim form and questionnaire to be filled by treating doctor which need to be submitted with the defendant for verification as per the policy and its terms and conditions. Thus the bulk and bundled various claims as made by the plaintiff and one claim was found admissible under this policy, consequently the claim was paid by the defendant but no other claims were lodged by plaintiff. Therefore, the present suit without giving an opportunity to the defendant to decide the claims on merits, is premature and not maintainable and is liable to be dismissed.
3.11 In reply on merits, issuance of medical policies to the plaintiff is admitted. Detection of blood cancer, requirement of chemotherapy sessions, medicines, hospitalization etc. of the plaintiff is stated to be matter of record. It is denied that plaintiff had shared required information and documents to the defendant Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 9 of 26 Digitally signed CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:34 +0530 company and the defendant kept repeating its demand for already supplied information and documents. It is denied that defendant refused to honour claim of plaintiff for unreasonable reasons.
3.12 It is stated that claim for the amount of Rs.5,64,527 in respect of medical expenses for the period from May 2022 to October 2023 lodged by plaintiff with the defendant was for various admissions and discharges under different policies and for different periods, whereas the proper procedure to lodge the claim was that she ought to have lodged different claims for each and every admission and discharge, so that each claim could have been decided properly without any confusion. There is no procedure for deciding various claims in a single bulk claim for continuous treatment.
Therefore, the present suit is not maintainable unless the plaintiff lodged different claims for each admission and each and every claim is decided by the defendant on merits. All the documents and letters as annexed with the present suit for various different admissions/hospitalizations for various different period and under different polices are stated to be totally creating confusions as the defendant can consider only one claim for one admission/hospitalization. Accordingly, an amount of Rs.40,069/- was released to the plaintiff considering her 1st admission in the hospital for which the medical bills were released. Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 10 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:39 +0530 3.13 It is denied that defendant has violated any of its contractual obligations or that plaintiff is entitled to recovery of any amount or interest from the defendant. Dismissal of suit is prayed.
REPLICATION
4. Plaintiff filed replication to the written statement stating inter-alia that on one hand in para no.2 page 2 of written statement, defendant stated that plaintiff never lodged any claim but in contrast in para no.9 of page no.3 of written statement states about lodging claim by plaintiff, which shows that defendant has raised flimsy defence which is full of contradictions.
4.1 It is further stated that defendant has disclosed about payment of Rs.48,295/- on 07.02.2024. It is further stated that it has come to the notice of plaintiff on checking that this payment was credited directly in bank account and since no communication from defendant was received, therefore, the same could not be mentioned. Whereas, the other payment of Rs.40,069/- was sent through cheque, therefore same came to notice and it was mentioned while filing the plaint. The plaintiff, therefore, restricts its claim to the amount arrived after deduction of aforementioned amounts.
4.2 It is further stated that vide letter dated 13.11.2023 plaintiff sent bunch of original documents Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 11 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:44 +0530 comprising 830 pages elaborating therein reasons for sending all documents together and that defendant cannot state that each and every claim has to be lodged separately because there is no such condition existing in insurance policy and it is only after treatment is concluded, claim is lodged. It is further stated that defendant was well aware of the ongoing treatment of plaintiff. The defendant had denied request for cashless treatment on various occasions and were not paying the claim amount for reimbursement. It is further stated that plea raised by the defendant is without any basis and is an after thought as the defendant never communicated such requirement of lodging different claims, besides the plaintiff cannot assume how the defendant treat claims lodged by her and the defendant could not give any reason for such massive deduction in claim amount. It is further stated that in para no.9 of written statement defendant mentioned about lodging two claims by the plaintiff and in para no.12 it further mentioned that one claim was found admissible, however defendant opted to keep mum about the reasons for non-payment of the remaining amount or claims.
4.3 Contents of written statement are stated to be misleading and against the guidelines/circular issued by Regulator IRDAI i.e. IRDA/RegJ14n2/2013 which deals with a situation where claim falls within two policies. It is mentioned in the said circular "iv. If the Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 12 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:51 +0530 claim even falls within two policy period, the claims shall be paid taking into consideration the available sum insured in the two policy period, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received earlier".
4.4 Contents of plaint are reiterated and contrary allegations of written statement are denied.
AFFIDAVIT OF ADMISSION/DENIAL
5. Both the parties filed their respective affidavits of admission/denial of documents.
ISSUES
6. Vide order dated 27.03.2025, following issues were framed:-
1) Whether the plaintiff failed to lodge separate claims of insurance with the defendant, if so its effect ? OPD
2) Whether the plaintiff has concealed material facts? OPD
3) Whether the claims of the plaintiff are beyond insurance policy? OPD
4) Whether the plaintiff is entitled for recovery of the suit amount or of any other amount ? OPP Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 13 of 26 Digitally signed CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:43:56 +0530
5) Whether the plaintiff is entitled to interest, if so, at what rate or for which period? OPP
6) Relief.
EVIDENCE
7. PW1 Sh. Amit Kumar Maihan AR of the plaintiff was examined as PW-1 and proved following documents:-
1) Special Power of attorney as Ex.PW1/1.
2) Copy of Aadhar card of plaintiff as Mark PW1/2.
3) Insurance policies issued by defendant in the name of plaintiff as Ex.PW1/3.
4) Office copy of letter dated 13.11.2023 along with postal receipts and prescriptions by Dr. K.K. Saxena as Ex.PW1/4.
5) Copies of documents obtained by Investigator deputed by defendant as Ex.PW1/5.
6) Copies of letter dated 30.11.2023, 16.12.2023, 02.02.2024 and 22.07.2024 sent by plaintiff to defendant with proof of disptaches as Ex.PW1/6.
7) Certificate under section 63 (4) (C ) of BSA as Ex.PW1/7.
8) Certificate issued by DLSA as Ex.PW1/8.
8. PW-1 was cross-examined by learned counsel for Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 14 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:03 +0530 defendant. In his cross-examination he stated that he had followed procedure mentioned in the policy Ex.PW1/3 and lodged claims accordingly vide letter Ex.PW1/4. He further stated that since the treatment was continuing and defendant was apprised about ongoing treatment, therefore collective documents were sent to the defendant vide Ex.PW1/4. He admitted that no claim was lodged for the admission and discharge of the plaintiff since May 2022 till 13.11.2023.
9. He denied the suggestion that he did not regularly supply available information to the defendant. A document i.e. claim computation sheet was put to him as Ex.PW1/D1. He stated "I have gone through the claim computation sheets filed by defendant which are denied by me as the reason given in the computation sheets are not agreeable to me." He further volunteered that these computation sheets were never supplied to plaintiff. He denied the suggestion that any explanation or reasons were given by the defendant for releasing only partial payment amount from total claim of Rs.6,04,596/-.
10. PW-2 Sh. Rahul Rawat, Deputy Manager, HDFC Bank was called to prove bank statement of Dr. Krishan Kumar Saxena Ex.PW2/1 to show that payments were made by the plaintiff in the account of Dr. Krishan Kumar Saxena.
11. PW-3 Sh. Saneep Singh, Relationship Manager Wealth and Trade, ICICI Bank was called to prove the Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 15 of 26 Digitally signed CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:08 +0530 bank statement of Dr. Krishan Kumar Saxena for the period 01.01.2022 to 25.05.2025 as Ex.PW3/1.
12. DW-1 Ms. Jenika Chopra, is AR of defendant company as well as Deputy Legal Manager. She proved the special power of attorney as Ex.DW1/1 and health claim computation sheet as Ex.DW1/2 which was already exhibited as Ex.PW1/D1.
13. DW-1 was cross-examined by learned counsel for plaintiff. She stated that she had not dealt personally with the claim of plaintiff. She further stated that Ex.PW1/3 is complete policy document. She further admitted Ex.PW1/D1 i.e. claim computation sheets was prepared during pendency of present suit. She denied that this document was created belatedly to mislead the court. She admitted that no letter was written to the plaintiff for explaining the reasons of not releasing balance claim amount. She admitted that no letter was sent to the plaintiff stating breach of any warranty or terms or conditions. She admitted that the payments of Rs.40,069/- and Rs.48,295/- mentioned in para no.9 of affidavit were released to the plaintiff after receiving the documents from her. She stated that pre and post hospitalization expenses are not covered by the policy and denied the suggestion of learned counsel for plaintiff that such expenses are covered. She was confronted with IRDAI circular Ref-IRDA/HLTH/MISC/CIR/2016/09/2011 dated 20.09.2021 Ex.DW1/P1 and she admitted that as per Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 16 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:16 +0530 the said document insurance company cannot reject any claim only on the basis of delay in intimation of claim. She further admitted that defendant company did not sent any letter or email disowning the liability of plaintiff's claim. She failed to show any letter or email whereby it was intimated to the plaintiff that each and every claim has to be lodged separately or within 30 days from the date of discharge from the hospital. She gave similar reply in respect of letter intimating to the plaintiff that separate claim need to be filed for each claim/admission.
ARGUMENTS
14. learned counsels for parties argued the matter in detail. Learned counsels for parties have also filed their respective written submissions.
15. Learned counsel for plaintiff argued that plaintiff has duly proved its case through the testimony and documents proved on record.
16. Learned counsel for defendant argued that the suit filed by the plaintiff is not maintainable as plaintiff was well aware of the procedure to be followed while lodging the claims and she ought to have lodged separate claims with the defendant for each and every hospitalization based on discharge summary and medical bills with prescriptions even if she was under continuous treatment. It is further argued that plaintiff failed to comply with the procedure for reimbursement of claim Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed by AJAY Page no. 17 of 26 CS Comm 1276/2024 AJAY PANDEY PANDEY Date: 2025.12.24 15:44:22 +0530 amounting to breach of warranty under the policy.
17. Arguments considered. Record perused.
FINDINGS
18. Issue wise findings of the court are as under :-
Issue no. 1 :- Whether the plaintiff failed to lodge separate claims of insurance with the defendant, if so its effect ? OPD
19. Onus to prove this issue was upon the defendant.
In his written statement defendant has stated that there is no procedure for deciding various claims in a single bulk claim for continuous treatment and therefore the claims lodged by the plaintiff were not maintainable.
20. Court is in agreement with the submissions of learned counsel for plaintiff that denial of the medical claims of the plaintiff could have been only in accordance with the terms and conditions of the policy. The present suit has been filed by plaintiff for medical expenses for the period with effect from May 2022 to October 2023. Plaintiff was diagnosed a form of blood cancer in August 2019. Since then the plaintiff is under continuous medication and treatment. Plaintiff has to undergo chemotherapy. Previously also the defendant did not clear the medical expenses bills of the plaintiff and the plaintiff had to file different suits against the defendant which were decreed by different courts.
21. During the course of arguments no condition has Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 18 of 26 CS Comm 1276/2024 Digitally signed AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:28 +0530 been pointed out on behalf of defendant that claims are liable to be rejected just because separate claims were not made for each admission or discharge. DW-1 in his cross-examination has categorically admitted that no letter was written to the plaintiff by the defendant company explaining reasons for not releasing balance payment of the claimed amount of medical expenses by plaintiff. She could not show any email or letter intimating the plaintiff that each and every claim has to be lodged separately or within a specified period of 30 days or that the expenses of each visit or admission need to be filed through separate claim. The continuous ongoing treatment of the plaintiff justifies the filing of a combined claim. Meanwhile the defendant was well aware of the ongoing treatment of the plaintiff. It is important to mention here that as many as 830 documents were filed along with the claim. It was not feasible for the plaintiff or for the treating doctor to verify the bills on day to day basis and to lodge separate claim for each visit, bill or admission. In the absence of any requirement in the policy to do so and in the absence of any letter or intimation by the defendant to this effect, this objection of the defendant is not tenable.
22. This issue is accordingly decided against the defendant and it is held that not lodging separate claim for each visit or admission does not entitle the defendant to deny the medical expenses/treatment claims lodged by Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 19 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:34 +0530 her.
Issue no. 2:- Whether the plaintiff has concealed material facts? OPD
23. Onus to prove this issue was upon the defendant.
Defendant has not disclosed in the written statement as to what material information was concealed by the plaintiff and even during the proceedings it has not been disclosed by the defendant. It is important to mention here that defendant had even deputed an investigator to collect documents and/or to investigate the case of plaintiff. However, defendant has failed to prove that the plaintiff did not cooperate with the investigator or did not provide him any material information. This issue is accordingly liable to be decided against the defendant. Held accordingly.
Issue no. 3:- Whether the claims of the plaintiff are beyond insurance policy? OPD
24. Onus to prove this issue was again upon the defendant. While deciding issue no.1, the court has already held that absence of separate claims for different admissions/visits do not entitle the defendant to deny medical expenses claim of the plaintiff. Apart from this the defendant could not have denied the claims of the plaintiff on the ground that the same are not filed within a period of 30 days or so. Even if there is such procedure Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 20 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:39 +0530 followed by the defendant, the same is not in accordance with IRDA Circular no.
Ref-IRDA/HLTH/MISC/CIR/2016/09/2011 dated 20.09.2021 Ex.PW1/D1 which was admitted by DW-1 during his cross-examination. DW-1 further admitted that as per the said circular, the insurance company cannot reject any claim only on the basis of delay in intimation of claim. Apart from this the claims could not have been rejected because they were falling within two policy periods. As per the notification dated 16.02.2023 from IRDA published in The Gazette of India : Extraordinary, Part-III Section 4 regulation 8d it was duty of the defendant to not to call for unnecessary documents and to call for all documents at one time and to not call them in piecemeal manner. The defendant has not intimated to the plaintiff about non-submission of any necessary document before rejection of the claims. The said notification even perceives making of claims falling within two policy periods. For the purpose of convenience, said regulation 8d is hereby extracted below:-
d. Settlement/Rejection of claim by insurer:
i. An insurer shall settle claims, including its rejection, within thirty days of the receipt of the last 'necessary' document.
ii. Except in cases where a fraud is suspected, ordinarily no document not listed in the policy terms and Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 21 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:44 +0530 conditions shall be deemed 'necessary'. The insurer shall ensure that all the documents required for claims processing are called for at one time and shall nor call for the documents in a piece meal manner.
iii. The information that the insurer has captured in the proposal form at the time of accepting the proposal, the terms & conditions offered under the policy, the medical history as revealed by earlier claims, if any, and the prior claims experience shall all be maintained by the insurer as an electronic record and shall not be called for again from the policyholder/insured at the time of subsequent claim settlements. If called, for such information will not be deemed 'necessary.' iv. If the claim event falls within two policy periods, the claims shall be paid taking into consideration the available sum insured in the two policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received earlier.
v. Insurer may stipulate a period within which all necessary claim documents should be furnished by the policyholder/insured to make a claim. However, claims filed even beyond such period should be considered if there are valid reasons for any delay.
25. From the record, preponderance of probabilities Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 22 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:49 +0530 lies in favour of plaintiff and against the defendant and it appears that the defendant has failed to prove that the claims of plaintiff were beyond insurance policy rather preponderance of probabilities suggest that defendant has acted beyond or in violation of insurance policy.
26. This issue is liable to be decided against the defendant. Held accordingly.
Issue no.4:- Whether the plaintiff is entitled for recovery of the suit amount or of any other amount ? OPP.
27. Onus to prove this issue was upon the plaintiff.
PW-1 has specifically proved that the claims of the plaintiff were sent to defendant through letter dated 13.11.2023 Ex.PW1/4. In his cross-examination also this witness categorically stated that he had lodged claims vide letter Ex.PW1/4. He further explained that since the treatment was continuing and defendant was apprised about ongoing treatment, therefore collective documents were sent to defendant vide Ex.PW1/4. There is no counter suggestion to this witness that the claim was not lodged through Ex.PW1/4 dated 13.11.2023. A computation sheet Ex.PW1/D1 was put to this witness during his cross-examination. Witness stated that the said sheet was never supplied to the plaintiff. A perusal of the said computation sheet reflects that the same was prepared on 17.02.2025. DW-1 also admitted that this document Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 23 of 26 CS Comm 1276/2024 AJAY Digitally signed by AJAY PANDEY PANDEY Date: 2025.12.24 15:44:54 +0530 was prepared during pendency of the present suit. As per regulation 8d (i) of IRDA Regulations published on 16.02.2023, defendant was supposed to settle the claims of plaintiff within 30 days of receipt of documents. The computation sheet Ex.PW1/D1 was prepared after more than a year and three months of submission of documents by the plaintiff. The same was never intimated to the plaintiff. This document therefore prima facie appears to be an afterthought and cannot be relied to deny just claims of the plaintiff.
28. Plaintiff is therefore entitled to reimbursement of the claim of medical expenses and treatment lodged by her.
29. As per para no.19 of the plaint, plaintiff lodged the claim for an amount of Rs.5,64,527/-. This fact of lodging claim for Rs.5,64,527/- was admitted by the defendant in corresponding paragraph of the written statement. As per para no.20 of the plaint, defendant released partial amount of Rs.40,069/- on 30.03.2024. In addition thereto, in the replication plaintiff admitted another payment of Rs.48,295/- on 07.02.2024.
30. Thus, out of the claimed amount of Rs.5,64,527/-, even prior to filing of suit, plaintiff had received an amount of Rs.40,069/- + Rs.48,295/- = Rs.88,364/-. The computation table in para no.27 of the plaint appears to be not correct as it has added entire claim amount of Rs.5,64,527/- plus interest with effect from 13.11.2023. Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 24 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:45:00 +0530 The plaintiff is however entitled to the remaining claim amount after deducting already received amount of Rs.88,364/- (Rs.564527-Rs.88364 = Rs.4,76,163/-). Plaintiff is thus held entitled to recovery of the principal amount of Rs.4,76,163/- (Rupees four lakhs seventy six thousand one hundred and sixty three only). This court is not inclined to add pre-suit interest in this amount because the correct calculation of the same has not been made in the plaint.
31. This issue is accordingly decided partly in favour of plaintiff.
Issue no. 5:- Whether the plaintiff is entitled to interest, if so, at what rate or for which period? OPP.
32. While deciding issue no.4, this court has already held that this court is not inclined to add pre-suit interest. However, in its prayer clause, plaintiff has also prayed for pendentelite and future interest.
33. The transactions between the parties was commercial and the defendant has wrongly deprived the plaintiff from its legitimate money. The payment has been delayed by the defendant without any justifiable reason. In the facts and circumstances, it would be just and proper that plaintiff be granted pendentelite and future interest @ 12% per annum on the principal amount of Rs.4,76,163/- (Rupees four lakhs seventy six thousand one hundred and sixty three only). This issue is Asha Rani Vs Cholamandalam MS GIC Ltd Digitally signed Page no. 25 of 26 CS Comm 1276/2024 AJAY by AJAY PANDEY PANDEY Date: 2025.12.24 15:45:05 +0530 accordingly decided.
Relief:-
34. Accordingly, suit of the plaintiff is decreed with cost for recovery on the principal amount of Rs.4,76,163/- (Rupees four lakhs seventy six thousand one hundred and sixty three only) with pendentelite and future interest @12% per annum.
35. Decree sheet be prepared accordingly.
36. File be consigned to record room.
Announced in the open court
on the 24th day of December, 2026 Digitally signed
by AJAY
AJAY PANDEY
PANDEY Date:
2025.12.24
(Ajay Pandey)15:45:13 +0530
District Judge
(Commercial Court-10)
Central, Tis Hazari Courts, Delhi.
Asha Rani Vs Cholamandalam MS GIC Ltd Page no. 26 of 26
CS Comm 1276/2024