State Consumer Disputes Redressal Commission
Reliance Health Insurance Co. Ltd vs Subhash Chand Gupta on 9 April, 2026
FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA
IN THE DELHI STATE CONSUMER DISPUTES
REDRESSAL COMMISSION
Date of Institution: 25.07.2023
Date of hearing: 02.02.2026
Date of Decision: 09.04.2026
FIRST APPEAL NO. 356/2023
IN THE MATTER OF
RELIGARE HEALTH INSURANCE CO. LTD.,
(NOW CARE HEALTH INSURANCE LTD.)
D-3 P3B DISTRICT CENTRE, SAKET,
NEW DELHI - 110017.
ALSO AT:
VIPUL TECH SQUARE, TOWER C, 3RD FLOOR,
GOLF COURSE ROAD, SECTOR - 43,
GURUGRAM - 122009 (HARYANA).
(Through: Mr. Pankaj Seth, Advocate)
...Appellant
VERSUS
MR. SUBHASH CHAND GUPTA,
S/O LATE MR. MAM CHAND GUPTA,
R/O H. NO. 1/7 GALI NO.5,
VISHWASH NAGAR, SHAHDARA,
DELHI - 110032.
(Through: Sanjeev Kedwal & Associates)
...Respondent
DISMISSED PAGE 1 OF 15
FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)
HON'BLE BIMLA KUMARI, MEMBER (FEMALE)
Present: Ms. Vijay Laxmi, proxy counsel for the Mr. Pankaj Seth, Counsel
for the appellant.
None for the respondent.
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 complainant has filed the present complaint praying for Rs.3,00,000/- towards cost of treatment and medicines spent in Max Hospital for the treatment of his wife and on account of physical and mental torture and harassment, litigation expenses.
2. It is stated by the complainant that he had taken a Mediclaim policy from the OP vide policy no. 10233187 for a period of two years and paid the amount of Rs. 49,783/- as premium.
3. It is stated by the complainant that the policy was given to him by the OP, after getting medical examination conducted. In the proposal form, the wife of the complainant had clearly disclosed that she was suffering from Hypothyriodism.
4. The wife of the complainant suffered from pain in chest and was admitted to the hospital on 25.06.2015 and was rushed to Max hospital Patparganj where the doctor after considering her stage, advised her to be admitted in the hospital.
5. Clinical examinations were conducted by the hospital particularly for heart disease and angiography was also done and she was discharged on 29.06.2016 in a stable condition. It is stated by the complainant that no pre-existing disease of any kind was found by the doctors and it was realised that the pain was sudden. In this regard, all the documents pertaining to the hospital have been annexed as Annexure 2.
6. It is further stated by the complainant that the total amount incurred by him on the expenditure of treatment of his wife was Rs. 74,219.84/-. It is also stated that after being discharged he spent huge amount on the medicines as advised, by the doctors DISMISSED PAGE 2 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA which is also within the purview of post hospitalization expenses in terms of insurance policy provided by the OP.
7. It is stated by the complainant that he requested the OP several times to pass his claim however, his claim wast rejected on 27.08.2015 vide letter annexed as Annexure 6 on the ground of disease, pre-existing.
8. It is the case of the complainant that dishonest and malafide intention of the OP is clear from the repudiation letter as they have fabricated grounds by taking the shield of clause 6.1 of the policy which states that the policy shall be cancelled or claims shall be repudiated if the policy holder has concealed or withheld any information maliciously or with dishonest intention.
9. It is stated by the complainant that there has been no withholding of information or concealment from his side at the time of taking the policy which is evident from the fact that the wife of the complainant had fully disclosed that she was suffering from thyroid at the time of taking of insurance policy and this fact is also substantiated by the medical examination conducted by the OP on the complainant and his wife at the time of taking the policy.
10. The complainant has stated that in case there was any pre- existing disease at the time of taking of the policy then it would have detected at the medical examination which was got conducted by the OP at the time of taking of policy. Therefore, it is stated that the policy has been wrongly repudiated.
11. Per contra, the OP in their reply have stated that the complaint is not maintainable as there has been no deficiency in service on the part of the OP in rejecting the claim of the complainant
12. It is stated by the OP that the claim was rightly repudiated as there was a non-disclosure of chronic obstructive pulmonary disease (COPD) and dyspnea on exertion (DOE) for last 6 months for Ms. Bala Gupta. It is stated that the following non- disclosure came to the notice of the OP from the documents of OPD consultation sheet dated 06.12.2014 from Garg hospital, Delhi wherein it is mentioned that the patient is suffering from dyspnea on exertion (DOE) chronic obstructive pulmonary disease (COPD) along with hypothyroidism and obesity.
13. It is also stated that as per the IAS cardiology history sheet of Max hospital dated 25.06.2015 it is mentioned that the patient has a history of dyspnea on exertion (DOE) Class Il for DISMISSED PAGE 3 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA last 6 months. The OPD consultation sheet and the IAS cardiology history sheep is annexed as Annexurel along with the reply.
14. It is stated by the OP that accordingly the claim was not payable as per policy's terms and conditions and was duly repudiated by the vide letter dated 27.08.2015. It is stated that in furtherance of its interest the OP vide letter dated
02.11.2015 issued notice of cancellation of policy and that vide letter dated 23.12.2015 informed the complainant that his case cannot be considered because of non-disclosure of material information at the time of proposal and had it been disclosed at the time of proposal, OP would not have issued the policy. The claim rejection letter is Annexure 2 and the Cancellation documents are Annexure 3.
15. It is stated that it is visible from the document submitted to the company that the wife of the complainant had severe health problems prior to taking the policy from the company and only thyroid was disclosed at the time of taking the policy, the complainant has failed to disclose the rest of the diseases about the patients history of COPD and dyspnea at the time of proposal while procuring the policy.
16. It is further stated that had the complainant made correct disclosures at the time of the proposal, different set of medical test would have been conducted on his wife. It is stated that the present complaint is not maintainable as the insurance policy in question was obtained by the complainant by concealment / suppression of material facts.
17. It is further stated by the OP that the complainant has not challenged the contents of policy cancellation letter dated 23.12.2015 therefore they are deemed to be admitted to be correct by the complainant.
18. It is also stated that the complaint is bad in law for non- joinder of Ms. Bala Gupta as party. It is also stated that disputed and complicated question of facts are involved which cannot be decided in a summary trial and which can only be decided by leading it detailed evidences and cross examination in a civil court therefore, it is not maintainable before this Commission.
19. The OP has also relied on the judgment of the Hon'ble Supreme Court passed in Satwant Kaur Sandhu vs New India Assurance and Life Insurance Corporation of India vs Smt. Neelam Sharma passed by Hon'ble National Commission.
DISMISSED PAGE 4 OF 15 FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA
20. In his rejoinder, the complainant has stated that the said OPD slip of Garg hospital dated 06.12.2014 and the IAS cardiology history sheet dated 25.06.2015 of Max hospital but was only for initiating medical examination on doubts created in mind of the doctor but physical and laboratory examination of the patient showed different result.
21. It is stated that doctor did not find any dyspnea on exertion (DOE) or COPD after laboratory test. It is stated that the insurer has given the policy after taking a huge amount of premium and after getting all the tests done, nowhere it has been recorded that his wife has any medical condition. It is stated that the onus to prove that the insured had a pre-existing disease is on the OP.
22. The complainant has placed his reliance on National Insurance Company vs Raj Narayan judgment of the Hon'ble NCDRC when it is stated that most of the people are totally unaware of the symptoms of the disease that they suffer and hence they cannot be made liable to suffer because the insurance company relies on their clause... in a malafide manner to repudiate all the claims.
23. It is stated that pre-existing disease is one for which the insured would have undergone hospitalization or undergone long treatment or operation. It is stated that the pre-existing disease is one which is in the knowledge of the insured and he places reliance on the judgment of the Hon'ble National Commission passed in New India Assurance us Vishwanath Manglunia (2006).
24. It is stated that though in the morning on 25.06.2015 Max hospital took the patient with symptoms of hypothyroidism acute coronary syndrome, dyspnea on exertion II, severe LV dysfunction but laboratory test and coronary angiography revealed that no such disease existed.
25. It is further stated that there is nothing on record to show that before taking the policy on 18.03.2015 the wife of the complainant had the knowledge that she was suffering from the above disease therefore there is no question of suppression of material facts.
26. Placing reliance on the judgment ,It is stated that a disease should not only be existing at the time of taking the policy but also should have existed in the near proximity if the insured had been hospitalised or operated upon for the said disease in the near past say 6 months or an year. He is supposed to disclose DISMISSED PAGE 5 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA the said fact to rule out the failure of his claim on the ground of concealment of information as to pre-existing disease. It is stated that if the insured had been otherwise living normal and healthy life and attending to his duties and daily chores, like any other person he cannot be declared as diseased person......
27. It is stated that insurance company cannot take advantage of its act of omission and Commission as it is under obligation to ensure before issuing mediclaim policy to enquire whether a person is fit to be insured or hot.
28. Both the complainant and the OP have filed their respective evidence affidavits as well as written arguments, oral arguments have been heard."
2. The District Commission after taking into consideration the material available on record passed the judgment dated 14.12.2022, whereby it held as under:
"29. It is seen that that the complainant has been forth right in filling up the proposal form and declaring that his wife was suffering from hypothyroidism. The report of the doctor also categorically states that the weight of the wife of the Complainant was 80 kgs. It is also noticed that the medical tests conducted by the OP or the doctor who had conducted the physical examination of the complainant or his wife has nowhere stated that she was suffering from any disease. Nothing amiss is found by the doctor in the medical tests conducted on the complainant or his wife.
30. The only document on which the OP, repudiated the claim of the Complainant and placed its reliance is OPD slip from Garg hospital and IAS cardiology history sheet of Max hospital. It seems that the OP has missed the question mark on the slip. This Commission is of the view that those were symptoms with which the wife of the complainant was presented and nothing was found in the tests conducted on her. The OP has not placed on record anything to sufficiently conclude that the wife of the complainant was actually suffering from any such disease.
31. The Hon'ble Supreme Court in the matter of SGS India Limited vs Dolphin International A 2021 SC 4819 has held the following:
"The onus of proof that there was deficiency in service is on the complainant. If the complainant is able to discharge its initial DISMISSED PAGE 6 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA onus, the burden would then shift to the Respondent in the complaint."
32. In this case the complainant has discharged its onus to prove that there was deficiency in service on the part of OP. This Commission has gone through the pleadings and documents filed by the parties and find that OP has not been able to discharge its onus to prove the allegations on the basis of which the claim of the complainant was repudiated.
33. Therefore, the claim of the complainant is allowed and the OP is directed to pay a sum of rs.74,219.84/- to the complainant within two months from the receipt of this order failing which the OP would be liable to pay this sum along with interest @5% p.a till realisation. The OP is liable to pay sum of Rs.25,000/- as compensation for the wrongful repudiation to the complainant within two months from the receipt of this order.
3. Aggrieved by the aforesaid order, the Appellant has filed the present appeal on the ground that the impugned order passed by the District Commission is based merely on surmises and conjectures, without proper appreciation of the documents placed on record by the Appellant. The counsel for the Appellant contended that the District Commission failed to appreciate that the claim of the Respondent was rightly repudiated due to non-disclosure of Chronic Obstructive Pulmonary Disease (COPD) and dyspnea on exertion for six months by the Respondent at the time of submission of the proposal form. He further contended that the repudiation of the claim of the Respondent was in accordance with Clause 6.1 of the terms and conditions of the policy, which is binding upon both the parties.
4. The counsel for the Appellant further contended that a contract of insurance is a contract of uberrimae fidei (utmost good faith) and there is a clear breach of this principle when correct and accurate information is not disclosed. He also submitted that the District Commission failed to appreciate the provisions of the Insurance Regulatory and Development Authority of India (IRDAI) Regulations, 2017, particularly Clause 19(4), DISMISSED PAGE 7 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA which enumerates the general principles and casts an absolute duty upon the policyholder to disclose all material facts to the insurer to enable proper assessment of risk. Pressing the aforesaid submissions, the Appellant prayed for setting aside the impugned order.
5. The Respondent has filed reply to the present Appeal and denied all the contentions of the Appellant. Moreover, the Respondent 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 Appellant has filed written arguments and reiterated the contentions raised in the present appeal. The Appellant has also relied upon the following judgments:
a. Export Credit Guarantee Corporation of India Ltd. vs. M/s Garg Sons International, 2013 (1) SCALE 410.
b. General Assurance Society Ltd. vs. Chandumull Jain & Anr., (1966) 3 SCR 500.
c. Oriental Insurance Co. Ltd. vs. Sony Cherian, I (1999) CPJ 13 (SC).
d. Oriental Insurance Co. Ltd. vs. Sony Cherian, II (1999) CPJ 13 (SC).
e. Oriental Insurance Co. Ltd. vs. Mahendra Construction, 2019 (7) SCALE 187; Reliance Life Insurance Co. Ltd. & Anr. vs. Rekhaben Nareshbhai Rathod, SLP (C) No. 14312/2015. f. Life Insurance Corporation of India vs. Manish Gupta, SLP (C) No. 5001/2019.
7. The Respondent has also filed written arguments and denied all the contentions of the Appellant.
8. We have perused the material before us.
9. The main question that falls for our consideration is whether the District Commission erred in holding the Appellant deficient in service.
10. The fact that the Respondent had purchased Health Insurance Policy No. 10233187 from the Appellant in the joint names of himself and his wife for DISMISSED PAGE 8 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA two years commencing 18.03.2015 against the premium of Rs.49,783/- is not disputed by the contesting parties.
11. The counsel for the Appellant submitted that there is no deficiency in service on the part of the Appellant as the claim of the Respondent was rightly repudiated due to non-disclosure of Chronic Obstructive Pulmonary Disease (COPD) and dyspnea on exertion for six months by the Respondent at the time of submission of the proposal form in accordance with Clause 6.1 of the terms and conditions of the policy.
12. We are of the view that insurance documents are invariably standard-form contracts and it is common for the insured to sign them without reading every clause. It is extremely tenuous to expect a layperson to read and comprehend each clause before signing. On many occasions, a person obtaining insurance has no choice but to accept the clauses as presented, as they are non-negotiable. Since insurance is primarily obtained for unforeseen medical conditions, policies ought to be honoured where there has been no fraud, concealment, or suppression of facts at the time of obtaining the policy. It is unfortunate that claimants must run from pillar to post to secure medical reimbursement from insurance companies.
13. In the present case, the insurance policy was issued to the insured person only after a medical examination. This obviously means that the contested clause was applied by the Insurance Company mechanically, not based on the specific findings of that examination. Such an application lacks a factual foundation and is untenable.
14. On the concept, meaning and import of word disease, pre-existing disease in reference to medical insurance this commission has drawn following ten conclusions in a highly extensive, dissecting manner in their decision Pradeep Kumar Garg v. National Insurance Co. Ltd., FA-482/2005 decided on 01.08.2008. These are as:
DISMISSED PAGE 9 OF 15 FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA "a. Disease means a serious derangement of health or chronic deep-seated disease frequently one that is ultimately an insured must have been hospitalized or operated upon in the near proximity of obtaining the mediclaim.
b. Such a disease should not only be existing at the time of taking the policy but also should have existed in the insured had been hospitalized or operated upon for the said disease in the near past, say, six months or to disclose the said fact to rule out the failure of his claim on the ground of concealment of information as to.
c. Malaise of hypertension, diabetes, occasional pain, cold, headache, arthritis and the like in the body are normal modern day life which is full of tension at the place of work, in or out of the house and are controllable on standard medication and cannot be used as concealment of pre-existing disease for repudiation of the insurance insured in the near proximity of taking of the policy is hospitalized or operated upon for the treatment of these other disease.
d. If insured had been even otherwise living normal and healthy life and attending to his duties and daily chores person and is not declared as a diseased person as referred above he cannot be held guilty for concealment medical terminology of which is even not known to an educated person unless he is hospitalized and operated particular disease in the near proximity of date of insurance policy say few days or months.
e. Disease that can be easily detected by subjecting the insured to basic tests like blood tests, ECG etc. the insured to disclose such disease because of otherwise leading a normal and healthy life and cannot be branded as diseased.
f. Insurance company cannot take advantage of its act of omission and commission as it is under obligation to issuing mediclaim policy whether a person is fit to be insured or not. It appears that insurance companies obligation as half of the population is suffering from such malaises and they would be left with no or very little .
DISMISSED PAGE 10 OF 15 FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA Thus, any attempt on the part of the insurer to repudiate the claim for such non-disclosure is not permissible, exclusion clause invokable.
a. Claim of any insured should not be cannot be repudiated by taking a clue or remote reference to any so called discharge summary of the insured had concealed his hospitalisation or operation for the said disease undertaken reasonable near proximity as referred above.
b. Day to day history or history of several years of some or the other physical problem one may face occasionally landed for hospitalisation or operation for the disease cannot be used for repudiating the claim. For instance suffered from a particular disease for which he was hospitalised or operated upon 5, 10 to 20 years ago and living healthy and normal life cannot be accused of concealment of pre-existing disease while taking mediclaim being cured of the disease, he does not suffer from any disease much less the pre-existing disease while taking as after being cured of the disease, he does not suffer from any disease much less the pre-existing disease.
c. For instance to pay that insured has concealed the fact that he was having pain in the chest off and on for years diagnosed or operated upon for heart disease but suddenly lands up in the hospital for the said purpose and disentitled for claim bares dubious design of the insurer to defeat the rightful claim of the insured on flimsy are not rare where people suffer a massive attack without having even been hospitalised or operated upon years or so.
d. Non-instance of hospitalisation/or operation for disease that too in the reasonable proximity of the date of the only ground on which insured claim can be repudiated and on no other ground."
15. From the above, it is clear that unless and until a person is hospitalised or undergoes operation particular disease in the near proximity of obtaining insurance policy or any disease for which he has never undergone operation is not a pre-existing disease. If a person conceals the factum of his hospitalisation of an operation undergone by him in the near proximity DISMISSED PAGE 11 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA of obtaining the insurance policy, only then it can be termed factum of disease and doctrine of good faith under Section 45 of the Insurance Act can then alone be pressed company and not otherwise. Doctrine of good faith is two-way traffic and not a one-way traffic. If the Insurance benefit of doctrine of good faith, then they have to accept whatever the insured declares and should not subject medical test and get certificate from the doctor on the panel that the insured possesses sound and good health mediclaim insurance policy. Such a certificate will be meaningless and of no relevance as to the state of health.
16. Furthermore, the issue of pre-existing disease has been dealt with by the Hon'ble NCDRC in the matter of Tarlok Chand India Insurance Co. Ltd. in RP-686/2007 decided on 16.08.2011 holding as under:
"Infact, the onus to prove that she had a pre-existing disease was on the respondent who failed to file or credible evidence in support of its case. Further, the deceased had been taking he mediclaim insurance the respondent right from 1996 and she had also as per the practice, been examined by the doctor respondent/insurance company who has nowhere recorded that she had any medical problem relating."
17. The Hon'ble NCDRC is yet another judgment in National Insurance co.
Ltd. vs. Rai Narain-2008 NCT 559 NCDRC held as under:
"Most of the people are totally unaware of the symptoms of the disease that they suffer and hence they liable to suffer because the Insurance Company relies on their clause 4.1 of the policy in a mala-fide repudiate all the claims. No claim is payable under the medi-claim policy as every human being is diseases are perhaps pre-existing in the system totally unknown to him which he is genuinely unaware Hindsight everyone relies much later that he should have known from some symptom. If this is so every medical studies and further not take any insurance policy."
18. The Hon'ble NCDRC in the matter of Praveen Damani vs. Oriental Insurance Co. Ltd., reported as IV (2006) CPJ 189(NC) has held as under:
DISMISSED PAGE 12 OF 15 FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA "....If this interpretation is upheld, the Insurance Company is not liable to pay any claim, whatsoever, person suffers from symptoms of any disease without the knowledge of the same. This policy is not just a contract entered only for the purpose of accepting the premium without the bona fide intention benefit to the insured under the garb of pre-existing disease. Most of the people are totally unaware the disease that they suffer and hence they cannot be made liable to suffer because the Insurance Company their clause 4.1 of the policy in a mala fide manner to repudiate all the claims. No claim is payable policy as every human being is born to die and diseases are perhaps pre-existing in the system totally which he is genuinely unaware of them. Hindsight everyone relies much alter than he would have known symptom. If this is so every person should do medical studies and further not take any insurance policy facts on record, there is no material to show that the petitioner had any symptoms like chest pain etc. 11.08.2000."
19. The fact that the onus to prove that insured was suffering from pre-existing disease is on the Insurance Company the orders of the Hon'ble NCDRC in the matter of LIC of India v. Priya Sharma and Ors. in Revision Petition No. 2615 of 2011, decided on November 2, 2012. Secondly, if the policy was issued by the insurance company without proper verification, they cannot the claim at the later stage, as per the view held by the Hon'ble NCDRC in the matter of Oriental Insurance Co. Ltd. vs. Dipender Kaur in [I (2016) CPJ 603 (NC)].
20. In the present case, the Appellant has primarily relied upon the OPD slip dated 06.12.2014 from Garg Hospital and the IAS cardiology history sheet dated 25.06.2015 of Max Hospital, to substantiate its allegation of pre- existing disease and non-disclosure. However, a careful scrutiny of the aforesaid documents reveals that these records merely indicate symptoms or provisional history noted at the time of initial examination. Also, the District Commission has rightly observed that the presence of a question mark in the Max Hospital history sheet clearly reflects that the conditions DISMISSED PAGE 13 OF 15 FA/356/2023 D.O.D: 09.04.2026 RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA mentioned therein were only suspected or put forth as differential diagnoses and not confirmed ailments. Therefore, the aforesaid documents do not conclusively establish that the insured was suffering from COPD or dyspnea on exertion as a diagnosed pre-existing disease prior to the inception of the policy.
21. Furthermore, it is pertinent to note that the subsequent clinical and diagnostic tests, including angiography conducted at Max Hospital did not confirm the existence of any such disease. Rather, the insured was discharged in a stable condition without any conclusive diagnosis of COPD or DOE.
22. Consequently, the allegation of suppression of material facts cannot be sustained in the absence of any cogent evidence that shows the insured was suffering from the alleged diseases prior to obtaining the policy. Moreover, the burden of proving that there was a deliberate concealment or non- disclosure of material facts lies upon the insurer. In the present case, the Appellant has failed to discharge this burden by placing on record any medical evidence showing prior diagnosis or treatment of the alleged conditions.
23. Consequently, we are of the view that the District Commission has appreciated the evidence on record and has rightly held that the Appellant failed to substantiate the grounds on which the claim was repudiated.
24. In light of the aforesaid discussion, we find no reason to interfere with the order dated 14.12.2022 passed by the District Consumer Disputes Redressal Commission- II Udyog Sadan, C-22 & 23, Qutub Institional area (behind Qutub Hotel), New Delhi - 110016.
25. Consequently, the present Appeal stands dismissed with no order as to costs.
DISMISSED PAGE 14 OF 15 FA/356/2023 D.O.D: 09.04.2026
RELIGARE HEALTH INSURANCE CO. LTD. VS. MR. SUBHASH CHAND GUPTA
26. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
27. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986. The judgment be uploaded forthwith on https://e-jagriti.gov.in for perusal of the parties.
28. File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (BIMLA KUMARI) MEMBER (FEMALE) Pronounced On:
09.04.2026 LR-ZA DISMISSED PAGE 15 OF 15