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2026 Supreme(Online)(SCDRC) 3225
IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Sangita Dhingra Sehgal, President, Pinki, Judicial Member
MRS. REENA – Appellant
Versus
FUTURE GEN. INDIA INS. CO. LTD. – Respondent
FIRST APPEAL NO.- 296/2024
For the Appellants/Petitioners: Shripal
For the Respondents: Praveen Kumar Shahi, Amrita Singh
Technical omissions in an evidence affidavit should not defeat a genuine claim under welfare legislation if documentary evidence exists. Furthermore, insurance claims cannot be repudiated based on unsubstantiated allegations of fraud without cogent evidence.
Headnote:(A) Evidence - Technical Omissions - Mere absence of a specific submission in an evidence affidavit cannot be the sole ground for rejecting a claim when sufficient documentary evidence exists, especially under welfare legislation. (Para 9, 10)
(B) Insurance Claim - Repudiation - Allegation of Fraud - Repudiation of a claim based on bald averments of fraud without cogent evidence is arbitrary and illegal; discrepancies in hospital records cannot be attributed to the insured unless proven. (Para 14)
Issues: Whether the District Commission erred in dismissing the complaint on technical grounds and whether the repudiation of the insurance claim was justified.
| Table of Content |
|---|
| 1. summary of original complaint and lower court's dismissal based on evidence gaps. (Para 1) |
| 2. arguments regarding the illegality of the impugned order and the validity of the lower court's decision. (Para 2 , 3 , 4) |
| 3. technicality of affidavit omissions versus documentary evidence in welfare legislation. (Para 5 , 6 , 7 , 8 , 9 , 10 , 11) |
| 4. validity of claim repudiation based on unsubstantiated fraud allegations. (Para 12 , 13 , 14) |
| 5. final order for reimbursement, compensation, and litigation costs. (Para 15 , 16 , 17 , 18 , 19) |
CORAM:
HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)
HON’BLE MS. PINKI, MEMBER (JUDICIAL)
Present:
Mr. Shripal, counsel for the Appellant
Ms. Amrita Singh, 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:
“1. The complainant has filed the complaint under section 12 and 35 of Consumer Protection Act, 2019 (hereinafter referred to as Act) with the allegations that on 25.07.2021 she has taken online health policy no.HTO-33-21-7050460-00-000 dated 25.07.2021 for a sum insured of Rs.3 lakh from OP which was valid from 25.07.2021 to 24.07.2022.
On 04.03.2022, she was admitted to Mahavir Multispecialty Hospital, New Delhi and remained hospitalized till 07.03.2022. A bill of Rs.35,503/- was raised by hospital and paid by her. She lodged the claim with OP which was rejected on 20.04.2022 being full of discrepancies etc. A legal notice dated 04.10.2022 was given to OP to pass the claim but in vain. Hence, this complaint
2 OP was duly served. OP did not put the appearance. OP did not file the reply as a result defence was struck off vide order dated 13.03.2023.
3. The complainant was directed to lead the evidence.
4. The complainant has filed her own affidavit in evidence wherein she stated that on 04.06.2019 she has taken online health policy no.HTO-33-21-7050460-00-000 dated 25.07.2021 for a sum insured of Rs.3 lakh from OP which was valid from 25.07.2021 to 24.07.2022. On 04.03.2022, she was admitted to Mahavir Multispecialty Hospital, New Delhi and remained hospitalized till 07.03.2022. A bill of Rs.35,503/- was raised and paid by her.”
2. The District Commission after taking into consideration the material available on record passed the order dated 19.03.2024, whereby it held as under:
“5. We have heard AR of the complainant and perused the entire material on record.
6. 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. On 04.03.2022, she was admitted to Mahavir Multispecialty Hospital and remained hospitalized till 07.03.2022 which is clear from discharge summary dated 07.03.2022. She has paid the bill of Rs.35,503/-/-. These are the entire facts in the affidavit.
7. She has nowhere stated in the affidavit that she has lodged a claim with the OP which was rejected.
8. 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 submission of claim and its rejection by OP is missing from the evidence so it cannot be said that there is deficiency of service on the part of OP.
9. 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 re
