Gauhati High Court
Page No.# 1/5 vs Rina Kalita And Anr on 3 November, 2025
Page No.# 1/5
GAHC010255352023
2025:GAU-AS:14850
THE GAUHATI HIGH COURT
(HIGH COURT OF ASSAM, NAGALAND, MIZORAM AND ARUNACHAL PRADESH)
Case No. : WP(C)/300/2024
BHARTI AXA LIFE INSURANCE COMPANY LIMITED
THROUGH ITS AUTHORIZED REPRESENTATIVE MS. SNEHAL SAWANT
HAVING ITS REGISTERED OFFICE AT UNIT NO. 1904, 19TH FLOOR,
PARINEE CRESCENZO, G BLOCK, BANDRA KURLA COMPLEX, BKC ROAD,
BEHIND MCA GROUND, BANDRA (EAST), MUMBAI-400051,
MAHARASHTRA ALS HAVING ITS OFFICE AT 2ND FLOOR, MILESTONE
BUILDING, SIX MILE, G.S. ROAD, GUWAHATI-781022, ASSAM.
VERSUS
RINA KALITA AND ANR
ADULT, INDIAN INHABITANT, VILL- BARANGHATI, P.O.-BARANGHATI,
DIST- KAMRUP, PIN-781350, ASSAM
2:OFFICE OF THE INSURANCE OMBUDSMAN
(ASSAM
MEGHALAYA
MANIPUR
MIZORAM
ARUNACHAL PRADESH
NAGALAND AND TRIPURA) THROUGH ITS REGISTRAR
JEEVAN NIVESH
5TH FLOOR
NR. PANBAZAR OVER BRIDGE
S.S. ROAD
GUWAHATI-781001
ASSA
Advocate for the Petitioner : S BORA, MR. C TALUKDAR
Advocate for the Respondent : MR. A MANNAF (r-1), MD A S ALI (r-1)
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BEFORE
HON'BLE MR. JUSTICE RAJESH MAZUMDAR
ORDER
03.11.2025
Heard Ms G Swamy, learned counsel appearing for the petitioner. Also heard Mr A
Mannaf, learned counsel appearing for the respondent No. 1.
2. This writ petition has been preferred invoking the powers of this Court under
Article 226 and Article 227 of the Constitution of India, to assail the Award No.
IO/GUW/A/LI/ /2022-2023 in Complaint Reference No. 1) GUW-L-008-2223-0201,
passed by the Insurance Ombudsman, State of Assam, Meghalaya, Manipur, Mizoram,
Arunachal Pradesh, Nagaland and Tripura. The Award was issued on 6 th of December,
2022.
3. The husband of the respondent No. 1 had taken an insurance policy with the
petitioners herein and based on the information furnished in the proposal form, he was
given insurance cover under Policy No. 502-9697066 with a cover start on 25.02.2021.
The Company received the claim intimation under the insurance cover on 12.04.2022,
since the husband of the respondent had expired on 29.04.2021, due to cardiac arrest, as
mentioned in the hospital death summary. The respondent No. 1 had, thereafter, placed a
claim before the Company to pay the insured amount and the insurer having conducted
an investigation into the cause of death of the life assured, the claim was repudiated. The
Insurance Company claimed that it was revealed during investigation that the deceased
life assured was a known case of diabetes since 2019 and also suffered left ventricular
hypertrophy since 2007 and was under treatment for the same. The Insurance Company,
therefore, claimed that it would repudiate the claim made for the death of the husband of
the respondent No. 1. The respondent No. 1, thereafter, approached the learned
Insurance Ombudsman through a complaint and by the award published on 6 th day of
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December, 2022, the learned Ombudsman took note of the claim of the petitioner herein
that the representative of the insurer had stated that the deceased insured was suffering
from PED, as per submitted medical documents, which pertained to a period prior to
issuance of the policy and these were not declared in the proposal form.
4. The Insurance Company, therefore, had submitted that such suppression constituted
violation of utmost good faith under Clause-N, hence, the repudiation was in order. The
learned Ombudsman, thereafter, took note of the medical records of the deceased life
insured as submitted by the insurer for the years- 2006, 2007 and 2019, and also took
into note the pre-acceptance medical examination report submitted by the
Insurer/petitioner herein. In none of these reports, there was evidence of such PED,
which warranted any disclosure on the part of the insured. Hence, it was held by the
learned Ombudsman that the repudiation of the claim, relying upon the documents, did
not appear to be in order. Accordingly, it was awarded that the respondent/insurer was to
settle the claim by payment of death benefit of the amount insured to the complainant.
Assailing such an Award, this writ petition has been filed.
5. Ms G Swamy, learned counsel appearing for the petitioner has referred to Page-64
of the writ petition, where the blood glucose level of the husband of the respondent No.
1 has been shown to be more than that of the higher range as on 02.09.2009, and further
has referred to Page-65, where the blood glucose level again on 25.11.2019 has been
shown to be on the higher side, beyond the normal range. The learned counsel has,
thereafter, referred to the referral summary of the husband of the respondent No. 1,
which is available at Page-68 to show that on 28.04.2021, the provisional diagnosis of
the husband of the respondent No. 1 was shown to be fever with metabolic acidosis with
hyperkalemia with AKI with Type 2 Diabetes Mellitus with ACC Hypertension. She has,
therefore, submitted that in view of the documents available on record, the husband of
the respondent No. 1 had not disclosed the fact that he was suffering from PED in his
disclosure form, and, therefore, the rejection of the claim of the wife of deceased was
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lawful and did not require interference of the learned Ombudsman.
6. Mr A Mannaf, learned counsel for the respondent No. 1, on the other hand, has
submitted that the diagnosis of the husband of the respondent No. 1, which has been
referred to by the learned counsel for the respondent No. 1 itself shows that those dates
are after the date on which the proposal form have been submitted and the period of
coverage had started. Relevant to note here that the period of coverage had started in
March, 2021.
7. The learned counsel for the petitioner has placed reliance upon the Judgment and
Order, passed in Reliance Life Insurance Company Limited & Another -Vs-
Rekhaben Nareshbhai Rathod; reported in (2019) 6 SCC 175, more specifically,
Paragraph-30 thereof, to impress upon this Court that when the proposal forms suppress
information which would be material for the insurer to come to a finding regarding the
health status of a person proposed to be insured, a later claim would be liable to be
repudiated on the basis of the materials suppressed. She has also relied upon the
Judgment passed by the Apex Court in the case of Satwant Kaur Sandhu -Vs- New
India Assurance Company Limited; reported in (2009) 8 SCC 316, where at Paragraph-
25, the Apex Court held that in a contract of insurance, any fact which would influence
the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a
material fact and any suppression thereof, may lead to repudiation of the claim of the
person insured.
8. From the records, it is seen that the documents relied upon by the
petitioner/Insurance Company itself reveal that the fact of the insured having been
diagnosed to be suffering from PED etc. had come only on his hospitalization in the
month of April, 2021, and no documents have been shown before this Court to indicate
that he had any indication of such diseases pre-existing at the time when he filled up the
proposal form. In any case, such findings would require pleading of evidence, which this
Court will not enter into, in exercise of its writ jurisdiction.
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9. This Court has observed that it is not sitting in appeal over an Award of the learned
Ombudsman. Since the powers under Article 226 and Article 227 of the Constitution of
India are sought to be invoked by the learned counsel for the petitioner, and no
procedural lapse or perversity has been shown in the observations, recommendations or
final conclusion arrived at by the learned Ombudsman, this Court does not find this to be
a fit case to interfere.
10. Since the writ petition has not pointed out any procedural law or perversity in the
order, the prayer made in the same, stands rejected. The writ petition, accordingly, stands
dismissed.
11. No costs.
JUDGE
Comparing Assistant
