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Life Insurance - Gbic.co.in

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the Doctor and undergo treatment. The cause of death was also the same heart ailmentsfor which she underwent treatment. Section 45 of the <strong>Insurance</strong> Act was not applicable andit was held that the <strong>in</strong>surer has proved material suppression.The <strong>co</strong>mpla<strong>in</strong>t was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2198 / 2004 - 05Shri C. ChellappanVs.<strong>Life</strong> <strong>Insurance</strong> Corporation of IndiaAward Dated 15.10.2004Late C. Ramu took a LIC policy for a sum assured of Rs.50,000/- as per his proposal dated 30.3.1999 and the risk under the policy was dated backby LIC to <strong>co</strong>mmence from 20.4.1998 as per his request. The policy lapsed due to nonpaymentof premium and the same was revived on 14.1.2003. He also took another policyfor a sum of Rs. 1,00,000/- under Bima Kiran plan, a high risk policy. The assured died on27.4.2003 and the cause of death was Suicide by hang<strong>in</strong>g. LIC repudiated the claim underboth the policies for furnish<strong>in</strong>g <strong>in</strong><strong>co</strong>rrect statement relat<strong>in</strong>g to his occupation and that hewas unemployed on the date of sign<strong>in</strong>g the proposals. LIC had however settled claimsunder 7 earlier policies of the life assured. The repudiation decision was also upheld by theZonal Claims Review Committee and hence the present <strong>co</strong>mpla<strong>in</strong>t.The parties to the dispute were heard and the re<strong>co</strong>rds of the case perused. The lettersobta<strong>in</strong>ed from the employers of the deceased, produced before this Forum, did evidencethat the life assured had quit their jobs and was not <strong>in</strong> their employment establish<strong>in</strong>g falsityof <strong>in</strong>formation furnished by the life assured <strong>in</strong> his proposals for <strong>in</strong>surance with regard to hisemployment. Howeve the same was not viewed very material s<strong>in</strong>ce the life assured was aneng<strong>in</strong>eer<strong>in</strong>g graduate who had the potential to get employed. Therefore it was decided toallow the claim under the first policy. However, s<strong>in</strong>ce the Agent was the father of the lifeassured himself who was a lead<strong>in</strong>g Agent of LIC and also the beneficiary under both thepolicies, LIC was directed to take action aga<strong>in</strong>st him for his misrepresentation about hisson’s employment <strong>in</strong> his <strong>co</strong>nfidential report.The life assured did not mention <strong>in</strong> his proposal for se<strong>co</strong>nd policy that his earlier policywas <strong>in</strong> a lapsed <strong>co</strong>ndition. Had that <strong>in</strong>formation been furnished LIC would not haveundertaken to grant that policy and <strong>in</strong>stead would have advised the life assured to revivehis earlier policy before apply<strong>in</strong>g for fresh <strong>in</strong>surance. That there was deliberatesuppression of material <strong>in</strong>formation lead<strong>in</strong>g to repudiation s<strong>in</strong>ce opportunity to properlyassess risk was denied to LIC was held valid. Here, the Agent was the mother of the lifeassured who has misrepresented <strong>in</strong> her <strong>co</strong>nfidential report that his son’s previous policywas <strong>in</strong> force, though re<strong>co</strong>rds evidenced that the previous policy was <strong>in</strong> a lapsed <strong>co</strong>ndition.LIC was advised to take action aga<strong>in</strong>st her for her misrepresentation.On the whole, it was held that both the Agents (who were the father and mother of lifeassured and the father be<strong>in</strong>g the beneficiary under both the policies) were guilty of grossbreach of good faith reposed on them by LIC and LIC was directed to take str<strong>in</strong>gent actionaga<strong>in</strong>st them for their misrepresentations. The Claim under the first policy was allowed andthe <strong>co</strong>mpla<strong>in</strong>t under the subsequent policy was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2263 / 2004 - 05Smt. K. B<strong>in</strong>niammalVs.<strong>Life</strong> <strong>Insurance</strong> Corporation of IndiaAward Dated 19.10.2004

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