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Bhubaneswar Ombudsman CentreCase No. I.O.O. / BBSR / 24 - 234Shri Prakash Kumar SahooVs.Life Insurance Corporation of IndiaAward Dated 27.01.2005Happened that Shri Bula Sahoo had obtained a life insurance Policy on 15.11.1988 bearingNo. 580216816 under Table & Term 73-12 for an assured sum of Rs. 30000/- from CuttackDist branch of Life Insurance Corportion of India nominating his wife Smt. Santi Sahoo asthe beneficiary in the event of his death. Unfortunately, the life assured died on 3.11.90.His widow (the nominee) gave information of his death & lodged claim in prescribed form.On 30.3.93 the Insurer repudiated the claim on the ground interalia that the policy hadlapsed due to non - payment of premium and the assured while reviving the lapsed policyhad suppressed material facts relating to preexisting disease. The nominee died in themeantime. On 11.3.04 the complainant (son of the deceased) made a representation to theinsurer for payment of death claim to the legal heir of both Assured & Nominee. But theInsurer stood by the repudiation for which the Complainant moved this forum for redressal.Complained that he was not aware of the repudiation. Since the claim lodged by hermother was not settled by the Insurer during her life time, he made a representation to theInsurer on 11.3.2004.Countered by LIC that the Policy had lapsed without acquiring Paid-up value for nonpayment of premium on 15.11.89 & it was revived on 4.10.90 on the strength of PersonalStatement regarding health. The assured, who was then suffering from hepaticencephalopathy died of it one month after revival of the policy. The assured haddeliberately suppressed the material facts relating to pre-existing disease while furnishingpersonal declaration of health for reviving the policy.Observed that the repudiation letter was issued to the nomiee on 30.3.93. It is stated bythe insurer that no representation from nominee was received thereafter. The complainanthas not produced any communication made by the nominee to the insurer after repudiation.The only document produced by him is his representation dt. 11.03.04. The complainant isnot a minor. He drew a blank when asked why he remained silent for about 11 years. Threeyears period of limitation is prescribed under Article 44(a) of the limitation Act 1963 forfiling a suit relating to contract on policy of insurance. In the the present caserepresentation having been made 11 years after repudiation of death claim, the complaintis hopelessly barred by law of limitation.Held that repudiation action by the insurer is correct and proper and complaint is disposedof without any relief.Bhubaneswar Ombudsman CentreCase No. I.O.O. / BBSR / 21 - 142Smt. Jyotshna SahooVs.Life Insurance Corporation of IndiaAward Dated 22.02.2005Happened that Late Purna Chandra Sahoo had taken a Life Insurance policy bearing no.583281784 from Bhubaneswar Branch -I on 28.7.99 under Table & term 75-20 for anassured sum of Rs. 25,000/- with Qly mode of payment nominating his wife Smt. JyotshnaSahoo as beneficiary (nominee) in the event of his death. The policy lapsed w.e.f. January,2001 but it was revived on 28.7.2001 on payment of arrears premium with interest and dulyexecuted personal statement regarding health form.
Unfortunately, the Assured died on 12.1.2002 out of Diabetic Mellitus, Chronic RenalFailure and Cardio Respiratory Failure . The claim was repudiated by the Insurer on15.9.03 on the ground that the Assured had suppressed material facts relating to preexistingdisease in the Personal Statement regarding Health while reviving the policy.Complained that the Assured was not suffering from any disease at the time of revival ofpolicy and pointed out certain discrepancies in claim form B1 relating to date of admissionof the Assured to the hospital.Countered by LIC that the Assured was suffering from Diabetic Mellitus for last 7 1/2 yearsand was taking treatment as an outpatient in S.C.B. Medical College, Cuttack vide O.P.D.No. 10185 dated 18.9.99.Observed that the Assured was admitted in S.C.B. Medical College & Hospital on 4.1.2002for treatment of Diabetic Mellitus & CRF. The copy of BHT received from the hospitalreveals 71/2 years history of Diabetic Mellitus and treatment as on outpatient since18.9.1999. It is evident that the Assured had the Knowledge that he was suffering fromDiabetic Mellitus by the time of revival, which he did not disclose in personal StatementRegarding Health form. The repudiation therefore, can not be dubbed as unjust.The assured was in good health at the time of mooting proposal. Unfortunately he cameunder grip of Diabetic Mellitus by the time of revival. He was a poor rustic person & has leftbehind his widow & three minor children.Held that this is a fit case to be considered under ex-gratia. Recommended an ex-gratiaaward of Rs. 10,000/- in favour of the Complainant & directed the Insurer to make paymentwithin 15 days from the date of receipt of consent letter.Bhubaneswar Ombudsman CentreCase No. I.O.O / BBSR / 21 - 149Smt. Chinmayee MishraVs.Life Insurance Corporation of IndiaAward Dated 17.03.2005Happened that deceased life assured Rabindra Kumar Mishra was a policy holder underCuttack Branch of LIC of India, Cuttack Division, owning the policy bearing No. 584165238,which was commenced on 19.12.2001 for an assured sum of Rs. 5,00,000/- under Table &Term 112 - 25 (16) with Hly mode of payment. The Complainant was nominee under thepolicy. The assured died on 15.3.2003 during currency of the policy due to Cancer. Thedeath claim lodged by the nominee (Complainant) was repudiated by the Insurer on27.11.2003 on the ground interalia that the assured while mooting the proposal hadsuppressed materieal facts relating to pre-existing disease. Being aggrieved thecomplainant moved this forum for redressal.Complained that the deceased assured was neither a smoker nor an alcoholic nor sufferedfrom any such disease.Countered by LIC that prior to obtaining the policy he was suffering from Asthama for 3years. He was also a Chronic Smoker and alcohol consumer. These facts were mentionedin copy of BHT dtd. 29.5.2002 of TMH, Mumbai.Observed that the Assured was treated in TMH, Mumbai vide BHT No. BS 08107 wardSPW “B” dtd. 29.5.2002 and it is mentioned in the said BHT that the Assured had 3 yearshistory of Asthma and was also a Chronic Smoker and Alcohol consumer. According toInsurer’s underwriting, a proposer with history of Asthma is required to submit variousspecial reports viz. Asthma Questionnaire, X-Ray of Chest, CBC / ESR, SPQ 001 Part I andattending Physician’s Report stating number of attacks per year with details of treatment.Non - disclosure of this Pre-existing disease amounts to suppression of material facts.Held that repudiation action taken by the Insurer can not be faulted on any score.
Page 3 and 4: of treatment for urinary tract infe
Page 5 and 6: Mr. Ramesh D. MakwanaVs.Life Insura
Page 7 and 8: Case No. 21 - 001 - 0249Mr. K. D. D
Page 9 and 10: Complainant’s husband took a Poli
Page 11 and 12: Life Insurance Corporation of India
Page 13: produced the father of the assured
Page 17 and 18: questionnaire in the proposal form.
Page 19 and 20: suffering from the said ailment pri
Page 21 and 22: Case No. LIC / 344 / Ludhiana / Lud
Page 23 and 24: Findings : The complainant asserted
Page 25 and 26: the Doctor and undergo treatment. T
Page 27 and 28: Smt. Lalitha @ LalliVs.Life Insuran
Page 29 and 30: insurance but did not disclose the
Page 31 and 32: suicide. Since the same was exclusi
Page 33 and 34: 3 years as per policy conditions. T
Page 35 and 36: suppression of material information
Page 37 and 38: Smt. C. AnnapooraniVs.Life Insuranc
Page 39 and 40: was placed on the decisions of the
Page 41 and 42: Case No. IO (CHN) / 21.08.2405 / 20
Page 43 and 44: Life Insurance Corporation of India
Page 45 and 46: Shri K. Perumal, the nominee under
Page 47 and 48: The repudiation decision was upheld
Page 49 and 50: The complaint under all 3 policies
Page 51 and 52: Case No. IO (CHN) / 21.08.2509 / 20
Page 53 and 54: Smt. K. Tamilselvi took a LIC polic
Page 55 and 56: In short, LIC has no valid ground a
Page 57 and 58: Smt. Lakshi DeviVs.Life Insurance C
Page 59 and 60: Findings : It appears that on the s
Page 61 and 62: proposal for assurance, the opposit
Page 63 and 64: Life Assured was guilty of any brea
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time. This ground of incorrect info
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Fact of The Case : One Shri Y. C. M
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Fact of The Case : Shri G. Prabhaka
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disease with chronic bronchitis and
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Decision : I heard the contentions
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ii) It was alleged by the insurer t
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ii) The insurer repudiated the clai
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The life assured was admitted there
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Award Dated 08.10.2004Facts of The
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I heard the contentions of both and
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admitted with diabetic pulmonary ed
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22/7069); 09.08.2002 (S. No. 5/7897
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date of birth as 05.07.1946 at the
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established beyond all doubt that t
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x) Therefore, for the reasons as af
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Decision : I have carefully perused
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it was a very early claim, the insu
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Hyderabad Ombudsman CentreCase No.
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Finding the life assured to be guil
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6. In the result the complaint is c
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ecords, the insured underwent werth
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ix) Therefore, I have to hold, for
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suppression of material facts relat
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particulars like father’s name an
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solemn obligation to make full disc
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ix) Having regard to the facts and
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y 13 years at the timeof taking the
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from this hospital in the form of d
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iv) In support of their repudiation
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cause of death was reported to be c
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assured was sleeping in his cot, he
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months and 11 days and hence the in
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having a bearing upon the acceptanc
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above. The insured died on 27.04.20
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Shri Cherukuri RajeshwariVs.Life In
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(iii) In support of their repudiati
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AFFECTIVE DISORDER AND ASPIRATION P
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Severe LV dysfunction, Cognestive C
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Award Dated 12.2.2005Facts of the C
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of this act after expiry of two yea
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initiated by them. In any considere
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that the life assured, while submit
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value of the policy, as ex-gratia b
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indisputable proof to show that eve
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Case No. L / 21 - 001 - 0267 - 2004
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insured to make a full disclosure o
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vii) According to the same dictiona
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justice and also give fair opportun
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Decision : I have carefully perused
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insurer in the claim form no. 5152
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Tetralogy. This admission and the t
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insured did not declare any income
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case on hand, the insurance policy
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not fulfill all the three ingredien
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not been heard of for seven years,
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The duration of the claim for risk
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eviewing the decision of the respon
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Even if the Life Assured were alive
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The complainant under Rule No. 12(1
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Award Dated 22.2.2005Facts / Submis
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Award Dated 07.10.2004Shri Chandray
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view of this, the claimant approach
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was conveyed to the claimant by the
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Employer’s Certificate and leavel
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Vs.Life Insurance Corporation of In
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normally develops in childhood. Thu
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Certificate dated 3.3.03 issued by
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were not disclosed. Under the circu
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the deceased life assured withheld
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his health at the time of effecting
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history of Appendectomy 15 years ba
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Mumbai Ombudsman CentreCase No. LI
Page 215 and 216:
Shri Raju Shankar Makadwale took tw
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life assured withheld material info
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Respiratory Arrest” and the secon
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epudiated by Nagpur DO of LIC stati
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Therefore, there was suppression of
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eceived on 12.08.04 by the company,
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Life Insurance Corporation of India
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