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Case No. LIC / 344 / Ludhiana / Ludhiana - I / 21 / 05Shri Jatinder KhannaVs.Life Insurance Corporation of IndiaAward Dated 24.01.05Facts : Smt. Muskan Khanna took a policy for sum assured of Rs. 6 lacs on 31.03.03. Shedelivered a baby on 24.2.03 by caesarean operation. Subsequently, she developedjaundice and remained under treatment of Dr. Pritpal Singh. Medical Superintendent,Jeevan Hospital, Ludhiana and died on 6.7.03 due to some complications. The death claimfiled by her husband/nominee Shri Jatinder Khanna was repudiated on 19.2.04 on theground that the deceased had made false statement in the proposal form as she failed todisclose about her caesarean operation and treatment taken in the hospital from 23.2.03 to4.3.03. It was asserted that pregnancy was not an ailment, rather a natural process ofchildbirth and its disclosure may not be necessary. It was however, admitted that she haddelivered the baby on 23.02.03 through caesarean operation. The complainant alleged thatthe proposal forms were changed cleverly by some official to cause him damage, as thesignature of the agent, his wife and doctor do not appear to be genuine.Findings : In reply to question 13 (a) of the proposal form, DLA had stated that her lastdelivery was on 23.02.03 while the date of last menstruation was indicated to be 28.03.03.The representative of insurer stated that it was medically incorrect. Further she failed toinform that she had undergone a caesarean operation on 23.2.03. As per rules of theCorporation, she was uninsurable on account of delivery through caesarean operation on23.2.03 and had to wait for three months. The complainant urged that DLA had filled up theproposal form on 31.3.03. She developed jaundice on 18.6.03, which led to her death on6.7.03. The allegation that the state of health of DLA was not good at the time sheproposed for the policy, was unfounded as inference to this effect has been drawn on thebasis of report received from Chopra Nursing Home where she remained admitted from23.2.03 to 4.3.03 for delivering a baby. Admission in the hospital for delivery of babycannot be construed to be an illness. In the proposal form, the date of childbirth and thefact that it was a stillborn child was duly disclosed. She was not admitted in any hospitalfor treatment of any serious disease other than for delivery. However, information withregard to the baby having been delivered through caesarean operation was inadvertentlynot given. Besides, the proposal form was filled up by the agent.Decision : It is not disputed that DLA had undergone a caesarean operation. Had this beendisclosed, she would not have been eligible for insurance for sometime and would havebeen required to produce a report from a gynaecologist in Form No. 3341 to determine hersuitability for insurance. Held that as DLA had not disclosed these facts in the proposalform, the decision to repudiate the claim was in order.Chandigarh Ombudsman CentreCase No. LIC / 229 / Shimla / Nahan / 21 / 05Shri Vinod Kumar GuptaVs.Life Insurance Corporation of IndiaAward Dated 31.01.05Facts : Late Smt. Asha Gupta wife of Sh. Vinod Kumar Gupta purchased two policies forsum assured of Rs. One Lac and Rs. 40,000 each from the branch office Nahan. Shereportedly slipped in her house on 21.9.03 and became unconscious. She was operatedupon for brain haemorrhage on 22.9.03 at PGI, Chandigarh where she remained admittedupto 17.12.03. The Medical Board, Nahan issued a Permanent Disability Certificate on31.1.04. Her husband applied to the Branch Manager, Nahan for PDB on 9.2.04, but theclaim remained unsettled. In the meantime, she expired on 24.4.04. Her husband lodged