IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution: 15.02.2021 Date of Hearing: 12.09.2025 Date of Decision: 17.10.2025 FIRST APPEAL NO.-11/2021 IN THE MATTER OF SHRI A.M. TEWARI HUSBAND OF THE DECEASED POLICY HOLDER R/O. 5-B, SFS FLATS, HIGHWAY APARTMENT, GHAZIPUR, DELHI – 110096.

(Through: Mr. Mahmood Alam, Advocate)

…Appellant VERSUS

1. TATA AIA LIFE INSURANCE COMPANY UNIT-302, BUILDING NO. 4, INFINITY IT PARK, FILM CITY ROAD, DINDOSHI MALAD EAST, MUMBAOI-400097.

2. CEO, MANAGING DIECTOR, TATA AIG LIFE INSURANCE CO. LTD.

DELPHI-B WING, ND

2 FLOOR, ORCHA’D AVENUE, HIRANANDANI BUSINESS PARK, PAWAI, MUMBAI-400076.

(Through : Avanish Kumar, Advocate )

…Respondent CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MS. PINKI, MEMBER (JUDICIAL)

Present : Mr. Mahmood Alam, Counsel for the Appellant None for the Respondent.

JUDGMENT

1. The facts of the case as per the District Commission record are as under:

“The present complaint has been filed by Shri AM Tewari, the complainant, against, TATA AIG Life Insurance Co. Ltd (OP-1) and CEO, MANAGING DIRECTOR, TATA AIG Life Insurance Co. Ltd., (OP-2) under Section 12 of the Consumer Protection Act, 1986.

Briefly stated the facts necessary for the disposal of present complaint are in the month of February, 2009, the authorized agent of TATA AIG life insurance approached the deceased wife of the complainant, Smt. Raj Laxmi Tewari and convinced her to purchase an insurance policy by misleading and playing fraud on the pretext that medical test would be conducted before the issuance of policy. Payment of Rs. 50,000/- was made towards the premium however, no medical test was conducted despite reminders.

The policy was issued by OP and the second premium was paid vide Cheque no. 452525 dated 19.03.2010. The reminder for the annual thin premium of Rs. 50,000/- was received by the complainant which was due in the month of March, 2011 but unfortunately the insured expired on 15.02.2011.

Claim was filed with OP alongwith original policy and other document. On 28.04.2011, the complainant received a cheque of Rs. 65,105.38 from OP as full and final settlement without any reason. The complainant was shocked to received the said amount as the sum insured was Rs. 10,00,000/-, for which the premium was being paid.

The complainant visited the office of OP and requested for the copy the insurance application and proposal form, where he came to know the part II of the policy document had not been signed by the deceased policy holder. On 09.02.2012., the complainant requested the OP to settle the claim which is duly replied. In another letter dated 06.08.2012 addressed to customer care cell of OP,, the complainant requested for the medical certificate pertaining to the medical done before the issuance of policy. Despite, several reminders the complainant's grievance remain un-addressed. Claim before insurance ombudsman was also filed 24.12.2013, whereby the same was dismissed vide order dated 23.02.201 On 16.12.2014, again a cheque of Rs. 65,105.385 was sent to complainant, which has not been encashed by him. Feeling aggrieved by act/ omission on the part of OP, the complainant has prayed for directions to OP to pay Rs. 10,00,000/- as claim alongwith interest 18% per annum.

The complainant has annexed the application form general amendment form, sales benefit illustration, letter dated 04.09.2009, endorsement, first premium receipt, policy information, death claim, letters dated 09.02.2012. 07.06.2012. 05.07.2012, 06.08.2012, 09.11 2012 and 15.03.2013, copy of the complaint to ombudsman, claim payment letter, award of ombudsman have been annexed with the complaint OP have filed Written Statement upon service of summons. They have taken several pleas in their defence such as, there was no deficiency in services as the claim of the complainant had been repudiated vide letter dated 03.05.2011 on the ground that the life assured had suppressed material facts regarding the condition of her