Life Insurance - Gbic.co.in

Smt. Lalitha @ LalliVs.Life Insurance Corporation of IndiaAward Dated 21.10.2004Late Manokaran took policy for Rs. 50,000/- with effect from 15.3.1998 and nominated hiswife Smt. Lalitha @ Lalli. The policy lapsed due to non-payment of premiums and wasrevived thrice - once in 2000 and twice in 2001 on the strength of declaration of goodhealth by the life assured. The life asured died on 11.4.2002 due to HIV. The claim wasrepudiated by LIC for wilful suppression of material information at the time of revivals,which decision was also upheld by Zonal Claims Review Committee on appeal by theclaimant. Hence the present complaint.Parties of the dispute were heard in person and the records perused. The MedicalCertificates issued by the Doctors of a Govt. Sanatorium produced by the life assured tohis employer did evidence that the life assured had undergone almost continuous treatmentfor Pulmonary Tuberculosis since 2000. The Medical Attendant’s Certificate certifying thecause of death as HIV confirmed that the life assured had received certifying the cause ofdeath as HIV confirmed that the life assured had received treatment at TB Sanatorium. Thedetails of treatment underwent prior to revival, were not disclosed to the Insurer at the timeof revival and hence it was held that there was suppression of wilful material informationwith knowledge on the basis of evidence on record. Evidence was also placed on theprinciples laid down by Courts of law that revivial of a lapsed policy was a privilegeaccorded to the policyholder subject to certain limitations.The decision to repudiate the claim setting aside the revivals was upheld and the complaintdismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.05.2282 / 2004 - 05Smt. SanthiVs.Life Insurance Corporation of IndiaAward Dated 21.10.2004Late K. Raju took a LIC policy for Rs. 20,000/- on 28.2.2003 and nominated his wife Smt.Santhi thereunder. He died on 10.4.2003 due to Bronchial Asthma and Heart Disease. Theclaim for policy monies was repudiated by LIC. giving rise to the present complaint.Parties to the dispute were heard and the records of the case perused. The complainantmainly contended that LIC had failed to consider a letter of the treating Doctor obtainedand produced to LIC correcting the duration of illness to Asthma from one year to onemonth. The treating Doctor did issue a certificate that he was the usual medical attendantand that he had been treating him for Asthma the past one year. But no supporting recordsevidencing treatment for Asthma for the past one year could be produced by the Insurer.Even Accepting that the life assured had an attack of Acute Bronchial Asthma, it couldhave been only an isolated attack and the chronicity of the ailment was not held proved, inthe absence of full particulars of the treatment underwent. The leave records of the lifeassured were clear in that there was no medical leave availed. It was held that the Insurerhad failed to prove material suppression with irrefutable evidence.The repudiation decision was interfered with and the complaint allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.05.2199 / 2004 - 05Smt. B. MalligaVs.Life Insurance Corporation of IndiaAward Dated 21.10.2004