State Consumer Disputes Redressal Commission
Hdfc Life Insurance Company Ltd. vs Vivek & Anr on 17 March, 2026
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
(1)
First Appeal No. 84 of 2024
Date of institution : 05.02.2024
Reserved on : 18.02.2026
Date of Decision : 17.03.2026
HDFC Life Insurance Company Ltd. (Formerly known as HDFC
Standard Life Insurance Company Ltd.), 35-B/36/13, 2nd Floor,
Aventura Mall, Mall Road, Amritsar, through its Manager/Person over
all Incharge
Now filed through Sh. Arpit Higgins, Chief Manager-Legal, HDFC Life
Insurance Company Ltd., SCO Nos. 149 to 151, 1st & 2nd Floor,
Sector 43-B, Chandigarh-160022
...Appellant/Opposite Party
Versus
1. Vivek son of Late Sh. Darshan Masih,
2. Smt. Shunila Parveen wife of Late Sh. Darshan Masih,
Both residents of House No. 1227/XV-9, Main Road, Hussain Pura,
Amritsar.
....Respondents/Complainants
(2)
First Appeal No. 85 of 2024
Date of institution : 05.02.2024
Reserved on : 18.02.2026
Date of Decision : 17.03.2026
HDFC Life Insurance Company Ltd. (Formerly known as HDFC
Standard Life Insurance Company Ltd.), 35-B/36/13, 2nd Floor,
Aventura Mall, Mall Road, Amritsar, through its Manager/Person over
all Incharge
Now filed through Sh. Arpit Higgins, Chief Manager-Legal, HDFC Life
Insurance Company Ltd., SCO Nos. 149 to 151, 1st & 2nd Floor,
Sector 43-B, Chandigarh-160022
...Appellant/Opposite Party
First Appeal No. 84 of 2024 2
Versus
1. Vivek son of Late Sh. Darshan Masih,
2. Smt. Shunila Parveen wife of Late Sh. Darshan Masih,
Both residents of House No. 1227/XV-9, Main Road, Hussain Pura,
Amritsar.
....Respondents/Complainants
First Appeals under Section 41 of the
Consumer Protection Act, 2019 against the
orders dated 03.11.2023 passed in C.C. No.
555 of 2019 AND C.C. No. 556 of 2019 by the
District Consumer Disputes Redressal
Commission, Amritsar.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Ms. Simarjot Kaur, Member
Mr. Vishav Kant Garg, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No Present:-
For the appellant : Ms. Monika Thatai, Advocate
For the respondents : Sh. Sukhandeep Singh, Advocate
VISHAV KANT GARG, MEMBER :
By this order of ours, two Appeals i.e. First Appeal No. 84 of 2024 and First Appeal No. 85 of 2024 shall be disposed off as there are common questions of law are involved therein. However, for reference the facts are being extracted from First Appeal No. 84 of 2024. First Appeal No. 84 of 2024 3
2. Appellant/Opposite Party i.e. HDFC Life Insurance Company Ltd., has filed the present Appeal through its Chief Manager- Legal to challenge the impugned order dated 03.11.2023 passed by the District Consumer Disputes Redressal Commission, Amritsar (in short, "the District Commission"), whereby the Complaint filed by the Respondents/Complainants had been allowed.
3. It would be apposite to mention here that hereinafter the parties will be referred, as were arrayed before the District Commission.
4. Briefly, the facts of the case as made out by the Respondent/Complainant in the Complaint filed before the District Commission are that Darshan Masih, the father of Complainant No. 1 and the husband of Complainant No.2 had purchased two insurance policies during his life from OP-Insurance Company i.e. HDFC SL ProGrowth Flexi. First policy No. was 18485183 with sum insured of Rs.8,00,000/- (Rs.28,00,000/-) and 2nd policy No.18140172 was of Rs.7,00,000/-. Both the policies were purchased in the years 2016 and 2017. It was averred that the Proposal Forms of the said policies were filled up by the Agent of the OP and no opportunity was provided to re-verify the contents filled in the same. However, at the time of purchasing the policies, the insured was enjoying good health.
5. Unfortunately, the insured had died on 28.07.2017. Claims were lodged and required documents were supplied to the OP. The OPs had repudiated the said claim on flimsy grounds and informed about the same to the Complainant vide letters dated 04.10.2017. Inspite of paying the whole insurance amount, the OP on its own had transferred Rs.4,30,685/- and Rs.2,36,647/- of Policies No.18485183 and 18140172, First Appeal No. 84 of 2024 4 respectively in the Bank Account of the Complainants, towards unutilized fund value.
6. Stating the act of the opposite party to be a case of 'deficiency in service' and 'unfair trade practice', it was prayed in the Complaint that the OP be directed to pay Rs.3,69,315/- (balance out of Rs.8 lakh policy amount as Rs.4,30,684/- already paid against policy No. 18485183) and Rs.4,63,353/- (balance out of Rs.7 lakh as Rs.2,36,647/- already paid against policy No.18140172). Rs.50,000/- be prayed as compensation amount on account of harassment suffered at the hands of the OP.
7. Upon issuance of notice in the Complaint, the Appellant/ Opposite Party had filed its written statements stating therein that the Insured while purchasing the insurance policies from the OP had willfully and fraudulently given wrong answered to the questions and had wrongly informed that he was having good health. He had concealed the material information regarding his health. It was the duty of both the parties to disclose all the true and correct information to the other party, while entering into contract. It was the duty of the insured to disclose everything affecting his claim, if raised, in future. It had clearly been proved from medical record that the Insured had deliberately gave false answers to the questions relating to his health in the proposal form. It had been established that insured was not having good health prior to obtaining the insurance policy. He had already undergone for major treatment, remained admitted in the Hospital for the same. He had not disclosed all such facts in the proposal form, therefore, there was violation of the terms and conditions of the policy as well as principle of 'Uberrima Fides'. The contract of insurance between the parties is always based on the principle First Appeal No. 84 of 2024 5 of uberrima fides and the party, who approaches the other party with material concealment has no right to get benefits of the same. It was pleaded that there was no "deficiency in service" or "unfair trade practice"
on its part and the claims had rightly been repudiated. It was prayed that the Complaint be dismissed.
8. After considering the contents of the Complaint and the reply thereof filed by the Opposite Party as well as on hearing the oral arguments raised on behalf of both the sides, the Complaint filed by the Complainant was allowed by the District Commission vide order dated 03.11.2023. The relevant portion of said order as mentioned in Para-10 is reproduced as under:
"10. Consequently we allow the complaint with costs and the opposite party is directed to pay the remaining sum assured of Rs.3,69,315/- in policy bearing No.18485183 as well as Rs.4,63,353/- in policy bearing No.18140172 alongwith interest @ 7% p.a. from the date of filing of the complaint till realization to the complainants in equal shares by taking their affidavits, Aadhar cards etc. Opposite party is also directed to pay compensation of Rs.10000/- and litigation expenses of Rs.5000/- to the complainants. Compliance of this order be made within 45 days from the date of receipt of copy of this order; failing which complainant shall be entitled to get the order executed through the indulgence of this commission..."
9. The aforesaid order dated 03.11.2023 passed by the District Commission has been challenged by the Appellant/Opposite Party by way of filing the present Appeal by raising a number of arguments.
10. There was delay of 43 days in filing the Appeal. M.A. No. 173 of 2024 was filed for condonation of delay in filing the Appeal, which was supported by an affidavit. The delay of 43 days in filing the Appeal, was condoned vide order dated 14.02.2024.
First Appeal No. 84 of 2024 6
11. Ms. Monika Thatai, Advocate, learned Counsel for the Appellant has submitted that the Complainants had approached the District Commission with twisted facts to get a favourable order. The Insured had filled online proposal form by selecting the policies of his own choice. He had signed and given the declaration stating therein that he had completely understood the policy terms. The proposals of the Insured had been accepted on the basis of information provided by him on the standard rates. As death of the Insured had occurred within short span after issuance of the policies, therefore on receiving the claim, the matter was investigated. During investigation it was found that the DLA was having past history of CAD and had suffered with heart attack, which had been proved from the medical record. Said material information regarding suffering from pre-existing disease had not been disclosed by the Insured in his proposal forms, therefore, it was proved that the Insured had concealed the material information in his proposal form. In case the said information had been disclosed to the OP at the relevant time, OP could not accept the proposal forms of the Insured. As the Insured had purchased 4 Insurance Policies in a short span, therefore, it is clear that he had obtained these policies with the motive to gain undue monetary benefits for his family by concealing the material information. With regard to personal details regarding health conditions, the insured had replied in 'negative' whereas the medical record clearly revealed that he had suffered with pre-existing disease. It was not denied by the family members of the Complainant that the said medical record did not relate to the Insured. The District Commission after ignoring the medical record and the fact that the insured had deliberately concealed the material information and the expression of material fact, has allowed the Complaint First Appeal No. 84 of 2024 7 on the basis of surmises and conjectures. It was prayed that the impugned order be set aside and the Appeal of the Appellant be allowed.
12. On the other hand, Sh. Sukhandeep Singh, Advocate learned Counsel for the Respondents has submitted that the Insured had purchased two insurance policies from the OP and had paid the due premium. Thereafter, his proposal forms were accepted and the policies had been issued. The Insured had enjoyed good health during the inception of the policy. He had died suddenly and no cause had been shown, which has proved the allegations of the OPs. The OP had failed to prove on record that while purchasing the policies, the insured was suffering from any disease and had taken the treatment for the same from any Hospital. As per instructions of the IRDA only 48 months period had been considered for pre-existing disease and no record relating to treatment taken within 48 months period prior to purchase of the Insurance policy had been produced by the OP. The OPD slips produced by the OP relates to very old period. Said documents cannot be considered as substantive evidence to repudiate the claims of the Complainants. The District Commission in its well-reasoned order had thoroughly considered all these facts and has rightly allowed the Complaint.
13. We have heard the oral arguments of the learned Counsel for the parties and have also carefully perused the impugned order passed by the District Commission, written arguments submitted by the parties and all the relevant documents available on the file. We have also gone through the judgments cited by both the parties.
14. Undisputedly, one Darshan Masih had purchased Insurance Policies, namely, HDFC SL ProGrowth Flexi No. 18485183 having sum First Appeal No. 84 of 2024 8 insured of Rs.8,00,000/- (Rs.28,00,000/-) and another policy No.18140172, having sum insured of Rs.7,00,000/- in the years 2016 & 2017. As the Insured was Punjab Police Official and had retired from the Rank of DSP, having his pension as Rs.12,00,000/- per annum, therefore, DLA was self- sufficient to bear the expenses of these Insurance Premiums during his lifetime.
15. Unfortunately, the insured had died on 28.07.2017. Claims were lodged and required documents were supplied to the OP. The OPs had repudiated the claims on the ground vide letter dated 04.10.2017 that the Life Assured was suffering with Heart Disease prior to issuance of the policies and the said fact was not disclosed in his Proposal Form dated 12.01.2016. It was mentioned in the said letter that had this information provided to the Company, the Company would have declined the application.
16. Now the issue for consideration in the present case is as to whether the life assured had concealed any material information about his health in the Proposal Form or not?
17. The Appellant in the Proposal Forms had asked some information from the Life Assured. The Appellant in the Grounds of Appeal has mentioned some of the Clauses of the Insurance Policy wherein personal details of health of the LA were given. While answering the same, the Life Assured had replied in 'negative'. The same are reproduced as under :-
13 Have you ever suffered from diabetes/high blood sugar/sugar in No urine, high blood pressure/hypertension, heart disease, stroke?
18 Are you currently suffering from any illness, impairment or taking No any medication or pills or drugs?
21 During last five year have undergone or been recommended to No First Appeal No. 84 of 2024 9 undergo hospitalization?
23 During last five years have undergone or been recommended to No undergo X-Ray, any other investigation (including checkups for employment/insurance/foreign visit)?
18. On the basis of these answers, the OP had stated that the Life Assured had concealed the material information regarding past history of CAD and earlier he had suffered heart attack. The basis of this conclusion was the Investigation Report submitted by Renover Business Solutions Pvt. Ltd. Said agency in his overall remarks had submitted as under:-
"This client was having past medical history of coronary artery disease and he had a heart attack in 2002. We have collected medical record and nominee has given the same in writing. The people in the vicinity refused to give any information about the client for obvious reason that client was in police department..."
19. The Investigator has stated that the LA had suffered heart attack in the year 2002. On perusal of the medical record annexed by the OP, it is revealed that it was related from year 2007 till 30.10.2009 but thereafter for approximately 7 years i.e. upto 2016 no medical treatment record of the LA was available. In the absence of any medical record after 2009, it cannot be said that during that period, the LA had taken the treatment of heart problem. If the OP has levelled some allegations that at the time of taking the policy, the LA was suffering from heart problem and had taken the treatment of the same, then the onus was upon the OP to prove such fact with medical record relating to the said period and not on the basis of record relating to very old period of more than 7 years. It was held by the Superior Courts in number of judgments that onus was upon the party, who had levelled the allegations. Hon'ble National Commission in "PNB Metlife Insurance Company Ltd. V. Vinita Devi", 2019 (1) CPJ First Appeal No. 84 of 2024 10 441, had held that 'burden to prove that the life assured was suffering from any pre-existing disease lies with the Insurance Company'. As the OP in the present case had levelled allegations upon the LA regarding concealment of the material fact at the time of taking the policy, it was the duty of it to prove such facts with medical record relating to the same period.
20. Insurance Regulatory and Development Authority of India vide its Circular No. IRDAI/HLT/REG/CIR/225/08/2020 dated 28.08.2020, has specified the period relating to pre-existing disease. Relevant part of the said Circular is reproduced as under:-
"Pre-Existing Disease means any condition, ailment, injury or disease:
(a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
(b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement."
21. The above Circular clearly reflects that any condition, ailment, injury or disease, which was detected within 48 months before taking the policy is called pre-existing disease. It is not appropriate that the OP Insurance Company had taken the benefit of any life-long disease at the time of repudiating the claims of the Insured. Moreover, there was specific question in the Proposal Form that whether "during last five year, insured have undergone or been recommended to undergo hospitalization". Certainly, the answer to that question was 'NO' because no medical record after year 2009 is tendered on record. The IRDA being the supervisory authority of Insurance Companies issues the Circulars from time to time First Appeal No. 84 of 2024 11 after considering the grievances of the public. When the IRDA vide Circular dated 28.08.2020, has fixed the specific period of 48 months as pre- existing disease span prior to the issuance of the policy, then such objections of the OP/Appellant regarding any ailment of more than 7 years old are not applicable in the present case. Moreover, the OPs in its Proposal Form has sought information regarding any ailment within the period of last 5 years. The OP is bound to follow the Instructions/Circulars issued by the IRDA, being the regulatory authority of all Insurance Companies.
22. The Investigator had stated that LA was brought dead in the Hospital but thereafter it was also written that 'no history noted in above hospital'. Therefore, certainly on perusal of the Investigator's Report, it reveals that the said Investigator had changed its stand one after the other. Therefore, under these circumstances, the report of the Investigator cannot be considered as reliable evidence in the present case. In the absence of any concrete proof, no nexus is proved between the cause of death of the Life Assured and his previous heart problem. The exact cause of death has not been proved on record.
23. In the present case, no material concealment on the part of LA had been proved as no record relating to medical treatment taken in last five year (as per OP's own Condition No. 21 in the Proposal Form) was provided by the OPs. Therefore, no material concealment has been proved in the present case. The District Commission had thoroughly dealt with the issue of concealment by citing the law on the subject. The law cited by the District Commission in its judgment is relevant and has supported the case of the Complainant, while allowing the claim of the Complainant. There is no dispute that the judgments cited by the Appellant were based upon the First Appeal No. 84 of 2024 12 law settled by the Hon'ble Supreme Court in the case of "Satwant Kaur Sandhu versus New India Assurance Company Ltd.", 2009(4) CLT 398 wherein the issue of material concealment had been discussed. But as pre-existing time period had elapsed in the present case, in view of the instructions of the IRDA, therefore, no material concealment had been proved on record.
24. The Bench of this Commission comprising Justice Daya Chaudhary, President and Ms. Simarjot Kaur, Member had already dealt with the similar issue in case "Bajaj Allianz General Insurance Limited Versus Parveen Kumar Sood", F.A. No. 25 of 2019, decided on 17.05.2023. In the present case, the allegation of the OPs is that the LA had not disclosed pre-existing disease in the proposal form. After thoroughly discussing all the objections of the OPs and above-mentioned Circular of the IRDA in para 15, this Commission reached to the conclusion that 'any condition, ailment, injury or disease which was detected by the doctor/physician and for which the insured took advice or treatment within 48 months before taking the policy is called pre-existing disease. Further held in the said judgment that Certificate nowhere indicates that the Complainant had taken any treatment of the said ailments from any doctor/physician within a period of four years before issuance of said Insurance Policy. Therefore, the said judgment is fully applicable in the facts and circumstances of the present case because in the said case also, there was no medical record available on file, which shows that within 48 months prior to the purchase of the insurance policy, the Life Assured had taken any medical treatment.
25. No nexus between the cause of death of the LA and any pre- existing disease of the LA had been proved on record. The District First Appeal No. 84 of 2024 13 Commission had rightly appreciated the documents on record and has passed the well-reasoned order. The District Commission had rightly awarded the amount i.e. after deducting the amount already refunded by the Appellant/OP to the Complainants as well as compensation and litigation expenses. The Appellant/OP has failed to make out any ground and material on record for setting aside the impugned order. Therefore, finding no merit in the present Appeal, the same is hereby dismissed and the impugned order dated 03.11.2023 of the District Commission is upheld.
26. The Appellant had deposited a sum of Rs.5,52,464/- at the time of filing of the Appeal. Said amount, along with interest which has accrued thereon, if any, shall be remitted by the Registry to the District Commission forthwith. The Concerned Party may approach the District Commission for the release of the same and the District Commission may pass appropriate order in this regard in accordance with law. First Appeal No. 85 of 2024
27. In the present case, the LA had purchased another two insurance policies from the OP i.e. HDFC SL ProGrowth Flexi. First policy was No. 19074785 having sum insured of Rs.7,00,000/- and in second policy No.18140279 also for Rs.7,00,000/-. It is revealed that all the facts of the case are identical.
28. As the said controversy has already been dealt in F.A. No. 84 of 2024, accordingly, the present Appeal (F.A. No. 85 of 2024), being on the same lines, is also dismissed. The impugned order dated 03.11.2023 is affirmed.
29. The Appellant had deposited a sum of Rs.7,13,152/- at the time of filing of the Appeal. Said amount, along with interest which has accrued thereon, if any, shall be remitted by the Registry to the District First Appeal No. 84 of 2024 14 Commission forthwith. The Concerned Party may approach the District Commission for the release of the same and the District Commission may pass appropriate order in this regard in accordance with law.
30. Since the main case(s) have been disposed off, so all the pending Miscellaneous Applications, if any, are accordingly disposed off.
31. The Appeal(s) could not be decided within the statutory period due to heavy pendency of Court Cases.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (SIMARJOT KAUR) MEMBER (VISHAV KANT GARG) MEMBER March 17, 2026.
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