NCDRC upholds Tata AIG Life's rejection of death claim over undisclosed heart condition

The National Consumer Disputes Redressal Commission (NCDRC) on 12 October 2026 ruled in favour of Tata AIG Life Insurance Co. Ltd. in a death claim, holding that the policyholder had not disclosed a serious heart condition in the proposal form. The commission set aside orders of a district forum and the Rajasthan State Commission that had directed the insurer to pay Rs 4.4 lakh with interest to the family.

What Happened

According to the order, the policyholder filled the proposal form on 30 September 2011 and died on 5 April 2012 at a hospital in Jaipur. The family filed a claim, but the insurer paid only the unit value of Rs 92,297 as a full and final settlement, saying the policyholder had concealed his health history. The family sought the full benefit of Rs 9.4 lakh.

The District Forum in Sri Ganganagar ordered the insurer to pay Rs 4.4 lakh with 9% simple interest, plus the death benefit and Rs 5,000 as litigation costs. The State Commission dismissed the insurer's appeal in October 2017.

The NCDRC held that the hospital's death summary, whose authenticity was not disputed, recorded that the policyholder was a known heart patient and had undergone cardiac resynchronisation therapy, a heart procedure, in 2008, about three years before the proposal. He had answered "no" to the specific health questions in the form. The commission said both lower forums failed to consider this entry, and that the family did not produce any evidence to show it was wrong.

What It Means

The NCDRC said insurance is a contract of utmost good faith, so a buyer must give a full and true answer to every specific health question in the proposal form. It noted that the insurer bears the burden of proving concealment, but held that an undisputed hospital record showing earlier treatment can meet that burden without proof of the exact date the illness began. Because the non-disclosure was material, the commission held the insurer's repudiation of the claim was not a deficiency in service and dismissed the complaint. No costs were awarded.

For policyholders, the ruling underlines that past treatment must be disclosed when a proposal form asks about it. The NCDRC's order may be appealed.

Source: Consumer commission order