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2026 Supreme(Online)(SCDRC) 3223
IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Sangita Dhingra Sehgal, President, Bimla Kumari, Member
MS. MENKA – Appellant
Versus
ICICI LOMBARD GEN. INSURANCE – Respondent
FIRST APPEAL NO.- 297/2024
For the Appellants/Petitioners: Shripal
For the Respondents: Praveen Kumar Shahi
A consumer's claim should not be dismissed due to technical drafting errors in affidavits if documentary evidence exists. Furthermore, an insurance company cannot repudiate a claim as "fraudulent" without providing cogent evidence to support such an allegation.
Headnote:(A) Consumer Protection - Evidence - Technicalities in Affidavit - Omission of material facts in an evidence affidavit should not lead to the dismissal of a genuine claim, especially when documentary evidence, such as a repudiation letter, confirms the existence of the claim. (Para 8, 10)
(B) Insurance Law - Repudiation of Claim - Burden of Proof - A claim cannot be rejected on the grounds of being "fraudulent" based on bald averments; the insurer bears the heavy onus to provide cogent evidence to substantiate allegations of fraud or misrepresentation. (Para 15)
Issues: Whether the District Commission erred in dismissing the complaint on technical grounds regarding the evidence affidavit and whether the repudiation of the insurance claim as fraudulent without supporting evidence constitutes a deficiency in service.
| Table of Content |
|---|
| 1. case background and lower court's dismissal based on affidavit omissions. (Para 1 , 2 , 3 , 4 , 5) |
| 2. technical errors in affidavits should not defeat genuine claims under welfare legislation. (Para 6 , 7 , 8 , 9 , 10 , 11) |
| 3. insurer must provide cogent evidence to justify repudiation of a claim as fraudulent. (Para 12 , 13 , 14 , 15) |
| 4. award of treatment costs, compensation for mental agony, and litigation expenses. (Para 16 , 17 , 18 , 19 , 20) |
CORAM:
HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)
HON’BLE MS. BIMLA KUMARI, MEMBER (FEMALE)
Present:
Mr. Shripal , counsel for the Appellant
Mr. Praveen Kumar Shahi, counsel 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:
“ The complainant has filed the complaint under section 12 of Consumer Protection Act, 2019 (hereinafter referred to as Act) with the allegations that on 04.06 2019 she has taken online health policy 110 41281/IH/17257440/00/000 for a sum insured of Rs 3 lakh from OP 1 which was valid from 04.06 2019- 03.06.2020 On 16.09.2019 she was admitted to Parth Hospital. New Delhi and remained hospitalized till 18.09.2019. A bill of Rs. 23992/ was raised and paid by her She lodged the claim with OP-1 which was rejected on 21.10.2019 being fraudulent claim. A legal notice dated 01.04.2021 was given to OP-1 to pass the claim but in vain. Hence, this complaint.
2. OP-2 was duly served OP-2 did not put the appearance despite was service as a result proceeded ex-parte on 14.10.2022
3. OP-1 did not file the reply as a result defence was closed vide order dated 10.02.2023.
4. The complainant was directed to lead the evidence
5.The complainant has filed her own affidavit in evidence wherein she stated that on 04.06.2019 she has taken online health policy no 41281/IH/17257440/00/000 for a sum insured of Rs 3 lakh from OP-1 which was valid from 04.06.2019-03.06 2020 On 16.09.2019, she was admitted to Parth Hospital, New Delhi and remained hospitalized till 18.09 2019. A bill of Rs. 23,992/- was raised and paid by her.”
2. The District Commission after taking into consideration the material available on record passed the order dated 13.03.2024, whereby it held as under:
“6. We have heard AR of the complainant and perused the entire material on record
7. The complainant has filed her own affidavit in evidence in support of the allegations as set out in the complaint. The affidavit shows that she has taken the policy from OP-1 On 16.09.2019, she was admitted to Parth Hospital and remained hospitalized till 18.09.2019which is clear from discharge summary dated 18.09 2019 She has wd the bill of Rs 23992/- These are the entire facts in the affidavit.
8.She has nowhere stated in the affidavit that she has lodged a claim with the OP-1 which was rejected under clause 12 of the Terms and Conditions of the Policy on the grounds of fraudulent claim/false statement/declaration
9. The material part of the complaint is missing in the evidence led by the complainant. The case is decided on the basis of evidence led by the parties. The evidence regarding rejection of claim by OP-1 is missing from the evidence so it cannot be said that there is deficiency of service on the part of OP-1
10. In view of the above stated discussion, we do not find any merit in the complaint of the complainant and accordingly the complaint of the complainant is dismissed without any order as to the cost. A copy of this order is to be sent to all the parties as per rule File be consigned to record room”
2. Aggrieved by the aforesaid order of the District Commission, the Appellant has preferred the present Appeal contending that the Impugned Order is illegal, wrong, perverse and based on conjectures and surmises. The impugned Order is liable to be set aside as the same has been passed without appreciating the material facts and documents on record while
