NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. NC/FA/10/2022 (Against the Order dated 23rd November 2021 in Complaint 479/2013 of the State Consumer Disputes Redressal Commission Delhi)

BAJAJ ALLIANZ LIFE INSURANCE CO. LTD. & ANR.

PRESENT ADDRESS - 909-911, 9TH FLOOR,PRAGATI TOWER, RAJENDRA PLACE,NEW DELHI-110008 THE BAJAJ ALLIANZ LIFE INSURANCE CO.LTD.

PRESENT ADDRESS - GE PLAZA, AIRPORT ROAD,YEWADA, PUNE-411006 .......Appellant(s)

Versus GURPREET KAUR & ANR.

PRESENT ADDRESS - W/O LATE SH.S.GURPREM SINGH, R/O H.NO.178, G.F.STATE BANK NAGAR, PASCHIM VIHAR, NEW DELHI-110063 PUNJAB AND SIND BANK PRESENT ADDRESS - THROUGH ITS CHAIRMAN, PUNJAB AND SIND BANK HOUSE, 21, RAJENDRA PLACE, NEW DELHI-110008 .......Respondent(s)

BEFORE:

HON'BLE MR. SUBHASH CHANDRA , PRESIDING MEMBER HON'BLE AVM J. RAJENDRA, AVSM VSM (RETD.) , MEMBER FOR THE APPELLANT:

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FOR THE RESPONDENT:

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DATED: 29/04/2025

ORDER

For the Appellant Ms Shweta Singh Parihar, Advocate For the Respondent Mr Manoj Tomar, Advocate with Mr Sunil Kumar, Advocate for R 1

ORDER

PER SUBHASH CHANDRA

1. This First Appeal under the Consumer Protection Act, 1986 (in short, the “Act”) is in challenge to order of the Delhi State Consumer Disputes Redressal Commission, Delhi (‘the State Commission’) in Complaint no. 429/2013 dated 23.11.2021 allowing the complaint alleging deficiency in service on part of the Appellant herein in allowing a claim under a life insurance policy obtained by the Respondent’s late husband and directing payment of the balance amount with interest @ 6% p.a. from the date of repudiation of claim (12.02.2013) till the date of judgment, within 2 months failing which with interest @ 9% p.a. till realization along with Rs 1,00,000/-

towards mental agony and harassment and Rs 40,000/- as litigation costs.

2. The delay of 12 days in the filing of this appeal was condoned in the interest of justice for the reasons stated in the application for the same.

3. We have heard the learned counsel for both the parties and have carefully perused the material on record.

4. The relevant facts of the case, in brief, are that the Respondent’s late husband had obtained two life insurance policies for Rs 10,00,000/- and one for Rs 5,00,000/- from the Appellant under the Master Policy “Sarve Shakti Suraksha Policy” with the commencement date of 25.06.2012. The Policies were issued on the basis of a Declaration of Good Health which included specific replies in the negative to previous medical conditions, diseases, disorders or surgeries. The Policy Administrator for the Group Policy was Respondent No. 2. On 12.10.2012 the life assured suffered a heart attack and expired. Claim forms were submitted by the Respondent as the nominee and legal heir of the Deceased Life Assured (DLA). Being an early claim (within 3 months and 25 days), Appellant undertook an investigation as per the Insurance Act and found out that the DLA had undergone treatment from 24.11.2010 to 27.11.2010 for alcoholic liver disease portal hypertension, ascites with Spontaneous Bacterial Peritontis (SBP) in 2010 at the Institute of Liver & Biliary Science, New Delhi. It was also learnt that he had been a known case of alcoholic liver disease for two years and a habitual alcoholic for 18-20 years. The claims were repudiated by the Appellant on the ground of concealment of pre-existing diseases at the time of obtaining the Policies and the premium amount of Rs 66,471/- was refunded. The Respondent approached the State Commission alleging deficiency in service and on contest, the State Commission upheld the complaint and directed payment of the assured sum with interest. This order is impugned before us.

5. According to the Appellant, the State Commission heard in its conclusion and failed to appreciate that the proposal form categorically contained a declaration by the DL A with regard to a declaration of good health the deliberate concealment of pre-existing diseases by the appellant respondent was violated of sect