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Life Insurance - Gbic.co.in

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suicide. S<strong>in</strong>ce the same was exclusion under the policy for <strong>co</strong>nsider<strong>in</strong>g Accident Benefit,the Insurers decision not to settle Accident Benefit was upheld.The <strong>co</strong>mpla<strong>in</strong>t was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2304 / 2004 - 05Shri G. RamakrishnanVs.<strong>Life</strong> <strong>Insurance</strong> Corporation of IndiaAward Dated 3.11.2004Shri G. Ramakrishnan took a Children’s Moneyback policy on the life of his m<strong>in</strong>or childMaster Manikandan on 31.1.1998. The risk under the policy was to <strong>co</strong>mmence with effectfrom 28.1.2004. The m<strong>in</strong>or life assured died on 3.10.2003 <strong>in</strong> a road accident. LIC refusedto settle the full sum assured s<strong>in</strong>ce the risk under the policy did not <strong>co</strong>mmence. LIChowever offered to return the premiums paid under the policy <strong>in</strong> terms of policy <strong>co</strong>nditions .The <strong>co</strong>mpla<strong>in</strong>ant not satisfied with the decision of LIC approached this Fourm forsettlement of full sum assured.Parties to the dispute were heard. The <strong>co</strong>mpla<strong>in</strong>ant <strong>co</strong>ntended that he was not aware oftechnical <strong>in</strong>tricacies, that the exact date of <strong>co</strong>mmencement of risk was not <strong>in</strong>formed to himby the Agent, that other <strong>in</strong>surers provided risk <strong>co</strong>ver even from age 0 to 4 and that hedeserved sympathetic <strong>co</strong>nsideration as he has lost his dear son. The re<strong>co</strong>rds of the casewere perused. The special type of plan provided risk <strong>co</strong>ver even dur<strong>in</strong>g the m<strong>in</strong>ority of thechild from the policy anniversary follow<strong>in</strong>g <strong>co</strong>mpletion of 7 years of age of the child and <strong>in</strong>case of death before <strong>co</strong>mmencement of risk a return of the entire premium paid. The dateof birth of the child was 5.2.1996 and he <strong>co</strong>mpleted age 7 on 5.2.2003. S<strong>in</strong>ce the policy<strong>co</strong>mmenced on 28.1.1998, the risk under the policy <strong>co</strong>mmenced with effect from 28.1.2004,which was the immediate policy anniversary follow<strong>in</strong>g <strong>co</strong>mpletion of age 7 on 5.2.2003.However the child died on 3.10.2003, before <strong>co</strong>mmencement of risk on 28.1.2004. Hencethe decision of the Insurer to refund the premiums paid was held to be <strong>in</strong><strong>co</strong>nformity withthe policy <strong>co</strong>nditions. AS for the <strong>co</strong>ntention of the <strong>co</strong>mpla<strong>in</strong>ant that other <strong>Insurance</strong> offeredpolicies on which risk <strong>co</strong>mmenced even before age 4, each Insurer offered policies withdifferent <strong>co</strong>ndition and the specific terms stated under the policy are applicable withdifferent <strong>co</strong>ndition and the specific terms stated under the policy are applicable. Hisanother <strong>co</strong>ntention that Agent filled up the proposal form was not acceptable s<strong>in</strong>ce it is wellsettled <strong>in</strong> law that Agent acted as the Agent of the Insured while fill<strong>in</strong>g up the proposalfrom.LIC’s decision to refund the premiums paid under the policy was upheld. The <strong>co</strong>mpla<strong>in</strong>t forpayment of full sum assured was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2292 / 2004 - 05Smt. S. ChandraVs.<strong>Life</strong> <strong>Insurance</strong> Corporation of IndiaAward Dated 3.11.2004Late A. Selvarasu took a LIC policy for Rs. 34,000/- as per his proposal dated 31.3.1997.He nom<strong>in</strong>ated his wife Smt. S. Chandra thereunder. The policy lapsed due to default ofpremium and was revived on 20.10.2001 on the strength of a declaration of good health.The assured died on 23.12.2001 with<strong>in</strong> a few months of revival and the cause of deathac<strong>co</strong>rd<strong>in</strong>g to the claimant was Heart Attack. LIC set aside the revival and repudiated theclaim for suppression of material <strong>in</strong>formation on health at the time of revival. That decisionwas upheld by the Claims Review Committee lead<strong>in</strong>g to the present <strong>co</strong>mpla<strong>in</strong>t.

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