4 min readNew DelhiJun 11, 2026 12:59 PM IST
First published on: Jun 11, 2026 at 12:59 PM IST
The National Consumer Disputes Redressal Commission has allowed the plea of a man who underwent angioplasty in 2018 but was denied Rs 5 lakh mediclaim on the ground that he had a ‘pre-existing’ condition. The ruling held that a health insurance claim cannot be rejected merely on an allegation of pre-existing hypertension without proof of suppression.
Justice A P Sahi (president) and member Bharatkumar Pandya were hearing a revision petition filed by Religare Health Insurance Co Ltd challenging an April 2022 order of the Punjab State Consumer Disputes Redressal Commission, which had upheld the complainant’s claim.
“The findings recorded by the district commission and the state commission that, in our opinion, are well reasoned, and in the absence of any cogent evidence to support the allegation of suppression of the alleged disease of hypertension, the contentions raised by Mr Seth, learned counsel for the insurance company, are unsustainable,” the June 9 order read.
Justice A P Sahi (president) and member Bharatkumar Pandya noted that the complainant had a medical risk covered under a group health insurance policy acquired from the insurance company.
‘Disease not hidden’
- It was placed on record that the complainant, one Jarnail Singh, had a medical risk covered under a group health insurance policy acquired from the petitioner for which an annual premium of Rs 15,391 had been paid.
- The policy for the period in question was valid from December 12, 2017 till December 11, 2018, subject to the terms and conditions for the sum assured at the rate of Rs 5 lakh each.
- According to the complainant, on May 27, 2018, the complainant started sweating and vomiting with dizziness, and therefore he went to a local hospital where the ECG was found to be unstable.
- Accordingly, the complainant was referred to Fortis Hospital where he was admitted on the same day and remained there till June 2, 2018, for the treatment of his heart problem and angioplasty was performed.
- Since the said claim, according to the complainant, was covered under the policy, the insurance company was requested to reimburse the same.
- However, the claim was repudiated on the ground of non-disclosure of the disease of hypertension from which the complainant was alleged to be suffering 10 to 15 years ago.
- Aggrieved by the same, the complainant moved to the district commission, which allowed the complaint, directing the payment of Rs 5 lakh with 18 per cent interest from the date of admission in hospital.
- Then, the insurance company moved to the state commission.
- However, the state commission found that no authentic evidence was produced to show that the complainant had undergone treatment for hypertension before the policy period or was even aware of such a condition.
- It therefore upheld the district commission’s findings, while reducing the rate of interest from 18 per cent to 9 per cent per annum.
- Aggrieved by the same, the insurance company moved to the National Consumer Disputes Redressal Commission challenging the state commission’s order.
Arguments
Appearing for the insurance company, advocate Pankaj Seth urged that such suppression amounts to a violation and, consequently, the complainant’s negative answer in the proposal form clearly amounts to non-disclosure; hence, the claim was not indemnifiable.
He also urged that the terms of the contract are sacrosanct and therefore the answer given amounts to a breach of the terms of the contract.
He has also relied on the decision of the Supreme Court in other cases to urge that non-disclosure or suppression disentitles the claimant to any indemnification.
On the other hand, advocate Humraz Bir Singh, appearing for the complainant, argued that the concurrent findings of the district and state commissions did not warrant interference in the commission’s limited revisional jurisdiction.
The National Consumer Disputes Redressal Commission found that no authentic evidence was produced to show that the complainant had undergone treatment for hypertension before the policy period or was even aware of such a condition. (AI-generated image) 
Justice A P Sahi (president) and member Bharatkumar Pandya noted that the complainant had a medical risk covered under a group health insurance policy acquired from the insurance company.
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