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Late L. Baskaran, a railway employee, took 2 policies of insurance on his life with LIC forRs. 20,000/- and Rs. 25,000/- with effect from 20.2.2000 and 20.5.2000. He nominated hiswife Smt. Malliga under both the policies. He died on 18.9.2001 due to Amoebic Liverabscess-Ruptured and Alcoholic Liver Disease. The claim for policy monies was rejected byLIC for suppression of material information relating to health. The repudiation decision wasupheld by the Zonal Claims Review Committe, giving rise to the present complaint.Parties to the dispute were heard and the case perused. The railway hospital recordsproduced by LIC evidenced that the life assured was a known alcoholic hooked to alcoholfor the past 10 years and used to consume alcohol daily. The life assured was admittedand he underwent treatment for alcoholism and withdrawal seizures and a CT Scan duringpre-proposal period. The cause of death was also related to the alcoholic habit. The lifeassured was also absent from duties on several occasions, as could be gathered from theleave records. The life assured in his proposals for insurance did not disclose his alcoholichabit or the treatment therefor. It was therefore held on the basis of evidence on recordthat there was indeed wilful suppression of material information with knowledge, satisfyingthe provisions of Section 45 of the Insurance Act.The repudiation decision was upheld and the complaint dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2227 / 2004 - 05Smt. P. KarpagamVs.Life Insurance Corporation of IndiaAward Dated 24.10.2004Late C. Pandian proposed for a policy on his life with LIC forRs. 50,000/- on 30.3.2002. The proposal was accepted and the date of commencementbackdated to 28.9.2001 at the request of the life assured. The assured died on 7.9.2003due to Myocardial Infarction and Diabetes Mellitus. The Claim for policy monies wasrejected by LIC starting that the life assured had suffered from TB and Diabetes during preproposalperiod but did not disclose the same at the time of proposing. This repudiationdecision was upheld by the Zonal Claims Review Committee leading to a complaint beforethis Forum.A personal hearing was held and the records of the case perused. The Medical Attendantstated that he had treated the life assured for Diabetes for 10 years and TB since 2000.But the treating Doctor could not furnish any treatment particulars or corroborativeevidence for the treatment given. The complainant denied that her husband ever tooktreatment for TB but accepted that her husband was taking antidiabetic drug for the past 10years only. LIC’s Medical Examiner recorded in his report the urine sugar as nil and alsoclarified that he did not find any symptoms of TB at the time of his examination. Section 45to the Insurance Act was operative. Hence it was held that the Insurer has failed toestablish fraudulent suppression of material information.The complaint was allowed for 50% of the policy sum as Ex-gratia.Chennai Ombudsman CentreCase No. IO (CHN) / 21.01.2286 / 2004 - 05Smt. D. Ravindra BabuVs.Life Insurance Corporation of IndiaAward Dated 28.10.2004Late Smt. Vasundra Kumari insured herself with LIC for a sum of Rs. 50,000/- on 28.2.2002and nominated her husband Shri D. Ravindra Babu. She died on 2.4.2003 due toCarcinoma Gall Bladder. The claim for policy monies was rejected starting that the lifeassured had taken treatment in a hospital for Epigastric pain prior to proposing for
insurance but did not disclose the same in her proposal and thus there was suppression ofmaterial information. On the repudiation decision being upheld by the Zonal claims ReviewCommittee, the claimant has to approach this Forum.A personal hearing was held. The records produced by the Insurer evidenced that the lifeassured had taken treatment for Gastric problem since 1999 after undergoing various testsincluding Ultrasonogram. The records of treatment during terminal stages of illness alsostated that the life assured had history of Epigastric pain and was on medication for thepast 2 years. Thus the insurer could clearly establish that the life assured had sufferedfrom ailments of stomach since 1999 and she continued to be under treatment in varioushospitals till her death due to Cancer. Section 45 of the Insurance Act was not applicableand material suppression was held proved on the basis of documentary evidence.The complaint was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.01.2293 / 2004 - 05Smt. T. MallikaVs.Life Insurance Corporation of IndiaAward Dated 29.10.2004Late M. Thirunathan took a LIC policy on his life for Rs. 1,00,000/- on 29.12.2001. Henominated his wife Smt. T. Mallika under the policy. He died on 27.8.2003 due to heartfailure. The claim for policy monies was repudiated by LIC on ground of suppression ofmaterial information on health. The repudiation decision was upheld by the Zonal ClaimsReview Committee and hence the present complaint before this Forum.Parties to the dispute were granted a personal hearing. The complainant contended thatthe Agent only had filled up the proposal form and that the life assured had also undergonemedical examination. The extensive medical records produced by the Insurer revealed thatthe life assured had an attack of Acute Myocardial Infarction in 1996 and had takentreatment therefor and was also a Diabetic for 12 years on medicines. That materialinformation was not disclosed at the time of taking the policy. The cause of death was alsodue to heart failure. The repudiation of the claim was held valid, the Insurer satisfying thestipulations of Section 45 of the Insurance Act with irrefutable evidence. The contentionthat agent had filled up the proposal was not accepted since the agent while filling up theproposal acts as the Agent of the insured.The complaint was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2287 / 2004 - 05Smt. V. SaraswathiVs.Life Insurance Corporation of IndiaAward Dated 29.10.2004Late V. Venkatesan took a LIC policy on his life for Rs. 1,00,000/- on 30.3.2002. Henominated his mother Smt. V. Saraswathi under the policy. The life assured died on30.1.2003 and the cause of death was stated to be ‘Accident effect Suicide’. The claim forpolicy monies was repudiated by LIC on ground of Suicide which was an exclusion underthe policy. The repudiation decision was upheld by the Zonal Claims Review Committeeand hence a complaint to this Forum.Parties to the dispute were granted a personal hearing. The complainant surmised that herson who was ailing after sustaining severe injuries in a road accident could have consumed
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 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: Smt. Lalitha @ LalliVs.Life Insuran
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
Page 71 and 72: disease with chronic bronchitis and
Page 73 and 74: Decision : I heard the contentions
Page 75 and 76: ii) It was alleged by the insurer t
Page 77 and 78: ii) The insurer repudiated the clai
Page 79 and 80:
The life assured was admitted there
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Award Dated 08.10.2004Facts of The
Page 83 and 84:
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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Decision : I heard the contentions
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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
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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,
Page 227 and 228:
Life Insurance Corporation of India
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Life Insurance - Gbic.co.in

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