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2026 Supreme(Online)(SCDRC) 3226
IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Sangita Dhingra Sehgal, President, Pinki, Judicial Member
REENA – Appellant
Versus
FUTURE GENERAL HEALTH INS. CO . LTD – Respondent
FIRST APPEAL NO.- 37/2025
For the Appellants/Petitioners: Shripal
For the Respondents: Vanshika Jaiswal, Amrita Singh
Technical omissions in an evidence affidavit should not override documentary evidence in consumer disputes, as the Consumer Protection Act is welfare legislation; arbitrary repudiation of insurance claims without considering available clarifications constitutes a deficiency in service.
Headnote:(A) Consumer Protection - Evidence - Technical omissions in affidavit - Mere absence of specific submissions in an evidence affidavit cannot be the sole ground for rejecting a claim when sufficient documentary evidence exists, as the Consumer Protection Act is welfare legislation. (Para 9, 10)
(B) Insurance Claim - Repudiation - Arbitrariness - Repudiation of a claim without considering clarifications provided by the hospital or furnishing cogent reasons for rejection constitutes a deficiency in service. (Para 14, 15)
Issues: Whether the District Commission erred in dismissing the complaint on technical grounds and whether the repudiation of the insurance claim by the respondent amounted to a deficiency in service.
| Table of Content |
|---|
| 1. summary of original complaint and its dismissal by the district commission. (Para 1) |
| 2. arguments regarding the legality of the dismissal and the merits of the appeal. (Para 2 , 3 , 4 , 5) |
| 3. technical omissions in affidavits should not defeat genuine claims under welfare legislation. (Para 6 , 7 , 8 , 9 , 10) |
| 4. arbitrary repudiation of claims despite available clarifications constitutes deficiency in service. (Para 11 , 12 , 13 , 14 , 15) |
| 5. granting of reimbursement, compensation, and litigation costs to the appellant. (Para 16 , 17 , 18 , 19 , 20) |
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:
“ The complainant has filed the complaint under section 35 & 36 of Consumer Protection Act, 2019 (hereinafter referred to as Act) with the allegations that she has taken online health insurance policy no.HTO-33-21-7050460-00-000 dated 25.07.2021 from OP valid from 25.07.2021-24.07.2022 for a sum insured of Rs.3 lakh. On 20.05.2022, she was admitted to Highland Care Multispecialty Hospital, New Delhi for treatment and discharged on 22.05.2022. She has paid a bill of Rs.40069/- to the hospital. The claim was raised with OP which was rejected on 25.09.2022 without any reason. Hence, this complaint.
2. The OP was duly served. The defence of OP was struck off vide order dated 15.09.2023.
3. The complainant has filed her own affidavit evidence wherein she has corroborated the version of complaint.”
2. The District Commission after taking into consideration the material available on record passed the order dated 22.01.2025, whereby it held as under:
“4. We have heard AR of the complainant and perused the entire material on record.
5. The affidavit in evidence filed by the complainant shows that on 25.07.2021 she has taken online health policy no. по.НТО-33-21-7050460-00-000 dated 25.07.2021 from OP which was valid from 25.07.2021 24.07.2022. On 20.05.2022 she was admitted to highland care multispecialty hospital and discharged on 22.05.2022 and paid a sum of Rs.40,069/- for the charges of medical bill.
6. The affidavit in evidence nowhere shows that she was admitted to hospital for the treatment of a particular disease. The affidavit is silent to the effect that claim was lodged by her with the OP which has been rejected without any rhyme or reason. The material particular are missing from the affidavit. The complainant has failed to lead the evidence that claim was lodged and rejected by the OP. No document has been exhibited by the complainant. This is a case no evidence,
7. Hence, the complainant has failed to show that there is any deficiency of service on the part of OP in rejecting the claim. Hence, the complaint of the complainant is dismissed. A copy of this order is to be sent to all the parties as per rule. File be consigned to record room. Announced in the open court on 22.01.2025”
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 miserably ignoring the principle of natural justice. It is further submitted that the provisions of the law of the land have been ignored by the District Commission. It is further submitted that the District Commission has failed to apply its judicial mind to the pleadings and has also failed to apply its judicial mind to relevant documents. Therefore, it is submitted that the Order is liable to be set aside because it suffers from error apparent on the face of the record and reasons given by the D
