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DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

SOUTH II

CONSUMER COMPLAINT NO. DC/AB1/670/CC/117/2024

MOIDADIN

PRESENT ADDRESS - H.NO. 19, RATAUL, BAGHPAT-250101SOUTH EAST,DELHI.

.......Complainant(s)

Versus

TATA AIG INSURANCE COMPANY LTD.

PRESENT ADDRESS - 22, 2nd FLOOR, COMMUNITY CENTER, NEW FRIENDS COLONY,

NEW DELHI-110065.SOUTH EAST,DELHI.

.......Opposite Party(s)

BEFORE:

MONIKA AGGARWAL SRIVASTAVA , PRESIDENT

DR. RAJENDER DHAR , MEMBER

RITU GARODIA , MEMBER

FOR THE COMPLAINANT:

NEMO

FOR THE OPPOSITE PARTY:

NEMO

DATED: 22/05/2026

ORDER

CONSUMER DISPUTES REDRESSAL COMMISSION – X

GOVERNMENT OF N.C.T. OF DELHI

Udyog Sadan, C – 22 & 23, Institutional Area

(Behind Qutub Hotel)

New Delhi – 110016

Case No.117/2024

Moidadin

S/o Sh. Maousam,

R/o H. No.19, Rataul,

Baghpat- 250101(U.P.) ……Complainant

VERSUS

TATA AIG Insurance Company Ltd.

Through Its authorized representative

nd

22, 2 Floor, Community Centre,

New Delhi-110065 …… Opposite Party

Date of Institution- 02.04.2024

Date of Order- 22.05.2026

O R D E R

DR. RAJENDER DHAR-MEMBER

1. The complaint pertains to alleged deficiency in service on the part of the OP.

2. Facts as stated in the complaint are that the complainant had taken a home loan of

Rs.23,50,000/- from AU Small Finance Bank Ltd. vide sanction letter dated

23.03.2023. Copy of the sanction letter is annexed as Annexure C-2

3. The complainant further submits that to secure this loan, an insurance master policy

was issued by OP for the period 30.04.2023 to 29.04.2028, with a premium of

Rs.31,723/- paid directly from the loan amount covering risks including Critical

Illness, Accidental Death, and Permanent Total Disability, subject to specific terms

and conditions. Copy of the insurance policy is annexed as Annexure C-3

4. On 24.08.2023, the complainant was admitted to Metro Hospital and diagnosed with

lung cancer, a condition that eventually required the surgical removal of one lung and

left him unable to work. Copy of the treatment documents is annexed as Annexure C-

4

5. Consequently, the complainant filed a claim with OP, requesting they fulfil their

obligations under the policy by repaying the outstanding home loan.

6. The claim was rejected vide email on 15.12.20 23 on the grounds of "non-

declaration of facts about Heart Disease" at the time of proposing the insurance,

leading to an ab-initio cancellation of the policy. Copy of email dated 15.12.2023 is

annexed as Annexure C-5. The complainant alleged this rejection is untenable and

illegal, asserting that while he was treated for heart issues in the past, he was never

diagnosed with the cancer that occurred during the policy tenure.

7. The complainant prayed that OP to comply with the terms and conditions of the

Insurance Policy No.0239503493 and direct OP to pay the sum insured under the said

insurance policy with interest for the date of rejection of the claim i.e. 15.12.2023,

Rs.50,000/- as compensation and cost of litigation.

8. OP in his reply admitted that the complainant had obtained a "Group Credit Secure

Plus Medical Insurance Policy" through AU Small Finance Bank Limited under

Master Policy No. 0239503493. This policy was valid from 30.04.2023 to 29.04.2028

for an insured sum of Rs.23,50,000/-, covering risks including Critical Illness,

Accidental Death, and Permanent Total Disability, subject to specific terms and

conditions.

9. Upon receipt of the complainant's claim (Claim No. 0822607598A) for medical

treatment of "Right Sided Synovial Sarcoma," the OP conducted a scrutiny of the

medical records. It was discovered that the complainant had been admitted to Rajiv

Gandhi Super Specialty Hospital from 08.10.2020 to 09.10.2020 and was diagnosed

with Coronary Artery Disease (CAD), Double Vessel Disease (DVD), and had

undergone PTCA (Percutaneous Transluminal Coronary Angioplasty).

10. The OP contended that the complainant was a known case of heart disease

since 2020, which predated the inception of the policy. Since this material fact was

suppressed and not disclosed in the proposal form, the OP repud