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Case No. LIC / 156 / Karnal / Kaithal / 24 - 05Smt. Lalita DeviVs.Life Insurance Corporation of IndiaAward Dated 2.11.2004Facts : Shri Subhash Garg had purchased two Jeevan Mitra policies for sum assured ofRs. 3 and 5 lac for which proposals were submitted on 15.3.2003 and 31.03.2003respectively. He expired on 2.7.03 in the All India Institute of Medical Sciences, New Delhi.The claim filed by his wife was repudiated on 4.9.04 on the ground of suppression ofmaterial information relating to his health at the time of purchase of insurance policies. Shesought intervention of this office for getting the claim amount paid to her on the plea thatthe symptoms of illness viz. fever, breathlessness and vomiting were noticed only threedays before admission in the hospital.Findings : It was established on the basis of hospital record that DLA was admitted inVikram Hospital, Kaithal on 13.5.03 with complaint of congestive heart failure (CHF) anddilated cardio myopathy (DCM) and was discharged on 27.5.03. He was also treated atAIIMS, from 27.6.03 to 2.7.03 and had reported history of Dyspnea for the past fivemonths. He died in AIIMS on 2.7.03. As it was an early claim, investigations undertakenrevealed that the DLA had been having problem since Feb 2003 i.e. prior to proposing forthe policies and was aware of his sickness. As per the case history recorded in AIIMS atthe time of his admission, he reportedly had fever and related symptoms in Feb 2003. Theinsurer contended that such ailments take a long time to reach the terminal stage. Thecause of death in Form No. 3784 issued by AIIMS was stated to be high fever and heartproblem. The history of disease was reported to be prior to the date of insurance.Decision : Held that in view of suppression of material information relating to the state ofhealth at the time of purchase of policies, repudiation of claim was in order. The complaintwas, accordingly, dismissed.Chandigarh Ombudsman CentreCase No. LIC / 81 / Karnal / Sirsa / 21 - 05Smt. Usha DeviVs.Life Insurance Corporation of IndiaAward Dated 2.11.2004Facts : Shri Shyam Lal purchased a policy for sum assured of Rs. 5 lacs on 28.5.02. Hedied on 2.4.03 within less than a year due to renal failure. His wife/nominee Smt. UshaDevi lodged the death claim which was repudiated on 17.4.04 on the ground that DLA hadnot disclosed material information relating to his renal problem.Findings : The complainant contended that her husband was taken ill for 2-3 days onlybefore his death and that he was never put on dialysis. However, investigation conductedby the Branch Manager, Mandi Dabwali revealed that DLA had been suffering from diabetesand renal failure for more than two and a half year. He had reportedly taken treatment atBikaner and Ludhiana hospitals. As per certificate given by the treating doctor DLA hadbeen under dialysis since January’02 and was suffering from renal failure and Type II D.M.As these ailments take long time to reach the terminal stage, it was obvious that DLA wassuffering from the said disease prior to the purchase of policy. Copies of register withdetails of dates on which DLA was put on dialysis at Mohinder Singh Hospital, Bhatindawere also produced.Decision : Held that having regard to the nature of ailment, the treatment taken by the DLAand the terminal stage it had reached, the obvious inference is that he must have been
suffering from the said ailment prior to taking the policy. The contention of the complainantthat DLA was taken ill only 2-3 days before his death was falsified by the documentaryevidence adduced by the insurer about treatment taken by him in Mohinder Singh Hospital,Bhatinda. Hence, the complaint was dismissed.Chandigarh Ombudsman CentreCase No. LIC / 201 / Jalandhar / Faridkot / 21 - 05Smt. Gurmit SinghVs.Life Insurance Corporation of IndiaAward Dated 2.11.2004Facts : Shri Ajit Singh DLA took a policy for sum assured of Rs. one Lac on 28.3.2000 fromBranch Office, Faridkot. He died on 8.3.03. Shri Gurmit Singh his nominee/son filed theclaim. It was repudiated on the ground of concealment of material facts relating to the stateof health of the deceased. Shri Gurmit Singh claimed that his father was not given toexcessive drinking as was alleged. He consumed liquor only on special occasions and thattoo in moderate quantity. The agent was informed about it, but he felt that there was noneed to mention the same in the proposal form. It was admitted that DLA was a diabetic fora year before his death and not for five years as alleged. It was claimed that he died ofjaundice and not because of diabetes or excessive drinking.Findings : The claim was repudiated on the basis of adverse medical history backed bydocumentary evidence. The contention of the complainant that DLA used to drinkoccasionally was not correct since it was reported in form No. 3784 that he was a chronicalcoholic for the last 15 years and diabetic for 5 years. The complainant admitted that hisfather died of jaundice, which was mainly caused by excessive drinking.Decision : Held, that having regard to statement of the relatives of DLA in Shri GuruGobind Singh Medical College and Hospital where he was treated and the diagnosis madeby hospital authorities, it was evident that DLA was a chronic alcoholic and was sufferingfrom diabetes and died of jaundice. The repudiation of claim for suppression of materialinformation was, therefore, justified. The complaint was dismissed.Chandigarh Ombudsman CentreCase No. LIC / 227 / Jalandhar / Nawanshahr / 24 - 05Smt. Anita KumariVs.Life Insurance Corporation of IndiaAward Dated 11.11.2004Facts : Shri Narinder Singh paid initial deposit of Rs. 4096 on 3.7.03 at Branch Office,Nawanshahr against his proposal for a sum assured of Rs. 5 lacs under Table and Term153-10. He died on 7.7.03. Smt. Amarjit Kaur, his nominee (wife) lodged the claimcontending that the premium deposit had been paid. However, the claim was notentertained.Findings : It was noted that the proposal No. 1352 was allotted by B.O. Nawanshahr on3.7.03. However, special reports were called for and the proposal was sent to DivisionalOffice, Jalandhar for underwriting. The proposal could not be underwritten as fresh ECG,medical report and MHR were called for on 16.7.03 by DO Jalandhar. The proposer diedbefore the contract could be completed. The proposal deposit was, therefore, refunded on24.10.03 as the contract of risk was not complete due to non completion of additionalrequirements called for by the Divisional Office.Decision : Held, that proposal deposit is merely an intent or an offer on behalf of theproposer to go in for a specified policy, the contract becomes effective after completion of
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 and 14: produced the father of the assured
Page 15 and 16: Unfortunately, the Assured died on
Page 17: questionnaire in the proposal form.
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
Page 65 and 66: time. This ground of incorrect info
Page 67 and 68: Fact of The Case : One Shri Y. C. M
Page 69 and 70:
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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Page 177 and 178:
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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
Page 225 and 226:
eceived on 12.08.04 by the company,
Page 227 and 228:
Life Insurance Corporation of India
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Life Insurance - Gbic.co.in

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