The District Consumer Disputes Redressal Commission (DCDRC) in Karnal has mandated Tata AIG General Insurance Company Ltd. to pay a policyholder over ₹60,000. The ruling comes after the insurer rejected a health insurance claim, alleging non-disclosure of a pre-existing illness, an accusation the commission found unsubstantiated.
Commission Finds Insurer's Evidence Lacking
In its order dated June 23, 2026, the commission directed Tata AIG to reimburse ₹40,246 for medical expenses, plus 9% interest per annum from the date of repudiation until payment. Additionally, the insurer must pay ₹20,000 as compensation for mental agony, harassment, and litigation costs. The DCDRC criticized the growing trend of insurance companies denying genuine claims, noting that some appear primarily interested in collecting premiums.
The Genesis of the Dispute
The case was initiated by Bhag Singh, a Karnal resident, who purchased a Group Medicare Health Insurance Policy from Tata AIG via Axis Bank on January 7, 2020, with a sum insured of ₹5 lakh. The policy was subsequently renewed for the period between January 7, 2022, and January 6, 2023.
On August 5, 2022, Bhag Singh suffered multiple injuries to his right leg and knee after an accidental fall at his home. He underwent surgery at Virk Hospital Pvt. Ltd., Karnal, incurring approximately ₹45,000 in medical expenses. Following his discharge, Singh submitted all necessary documents to Tata AIG for reimbursement under his policy. However, the insurer rejected the claim.
Tata AIG's Grounds for Rejection
Before the commission, Tata AIG argued that Bhag Singh had a history of polio residual paralysis predating the policy's inception in January 2020. The insurer claimed Singh had not disclosed this condition in his proposal form. Based on this alleged non-disclosure, Tata AIG cancelled the policy and repudiated the claim on September 5, 2022.
Policyholder's Stance and Commission's Scrutiny
Bhag Singh maintained that his claim stemmed from an accidental fall, not a pre-existing condition, and that his treatment was legitimate and covered. The commission meticulously examined the evidence and concluded that Tata AIG failed to prove any deliberate concealment of illness by Bhag Singh.
A critical point highlighted by the commission was that Tata AIG's entire case rested on a mere photocopy of Virk Hospital's treatment records. The insurer neither presented the original document nor provided an affidavit or testimony from the doctor who prepared the record. Consequently, the commission ruled that the medical record held no evidentiary value in law, deeming Tata AIG's rejection based on assumptions rather than admissible evidence.
The commission also relied upon previous rulings of the National Consumer Disputes Redressal Commission (NCDRC), which held that insurers cannot rely upon unproved photocopies of medical records without examining the treating doctor to establish concealment of disease.
Final Order and Implications
While Bhag Singh had sought reimbursement of nearly ₹45,000, the commission restricted the medical expense reimbursement to ₹40,246, aligning with the actual documented bills and the amount Singh initially claimed. The ruling underscores the legal burden on insurance companies to provide robust, admissible evidence when denying claims based on alleged non-disclosure.
- Reimbursement: ₹40,246 for medical expenses.
- Interest: 9% per annum from September 5, 2022, until payment.
- Compensation: ₹20,000 for mental agony, harassment, and litigation expenses.