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Parties to the dispute were heard and the records of the case perused. The medicalrecords produced by the Insurer revealed that the life assured had suffered from heartailments, underwent hospitalisation and was advised surgery, before reviving the policy.The leave records also stated the assured was on leave during the period of his treatment.The revival was effected 5 days after discharge from the hospital without disclosing thesame at the time of revival. The life assured died of post operative complications. Therewas therefore clear intentional suppression of material information on the basis ofindisputable evidence placed on record, satisfying the stipulations of Section 45 of theInsurance Act.The complaint was dismissed.Chennai Ombudsman CentreCase No. (CHN) / 21.04.2315 / 2004 - 05Smt. S. GomathiVs.Life Insurance Corporation of IndiaAward Dated 3.11.2004Shri M. Sekar (since deceased) took a LIC policy for RS. 75,000/- vide his proposal dated11.12.2000 and the risk therein was backdate to commence from 4.12.2000 as per request.He nominated his wife Smt. S. Gomathi thereunder. He died on 12.3.2002 due to Cancer ofStomach operated. The claim for payment of policy monies was repudiated for suppressionof material information relating to his health at the time of proposal, which decision wasupheld by the Zonal Claims Review Committee, leading to the present complaint.Parties to the dispute were heard and the records of the case perused. The CancerHospital’s case sheets revealed that the life assured underwent Total Gastrectomy in 1998and was undergoing periodical checkups. Various diagnostic tests were also done. The lifeassured was also on leave on medical grounds during the period of his treatment, as perthe leave records. These details were not disclosed at the time of proposing for insurance.There, therefore, was clear suppression of material information with full knowledgesatisfying the stipulations of Section 45 of the Act. The contention of the complainant thather husband was suffering from stomach pain and that Cancer came to knowledge onlyduring terminal illness was not accepted since the Cancer Institute’s records clearlyevidenced that the life assured was diagnosed to be suffering from Carcinoma in 1998itself.The repudiation decision was upheld and the complaint dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2295 / 2004 - 05Smt. P. JohnsyVs.Life Insurance Corporation of IndiaAward Dated 4.11.2004Shri B. Rosari (Late) took a LIC policy for Rs. 1 lakh for a term of 20 years with effect from22.2.2002 and nominated his mother Smt. P. Johnsy under the policy. The premiums underthe policy were being deducted from the salary of the assured under Salary SavingsScheme. Since premiums were paid only upto the premium due 22.3.2003 and furtherpremiums not being paid, the policy remained lapsed with effect from 22.4.2003. The lifeassured died on 27.6.2003. LIC rejected the claim since the policy was in a lapsedcondition. The Zonal Claims Review Committee upheld the decision.The records of the case received from LIC were perused. It is clear that the policy was in alapsed condition on the date of death of the life assured. Moreover the policy did notacquire any paid up value, as premiums were not paid thereunder for a minimum period of
3 years as per policy conditions. Therefore, the contention of LIC that nothing was payablewas upheld. Since policy conditions were clear, no hearing was held and the complaintdismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.02.2321 / 2004 - 05Smt. SamundeeswariVs.Life Insurance Corporation of IndiaAward Dated 4.11.2004Shri Srinivasan (Late) took a LIC policy for Rs. 30,000/- for a term of 20 years with effectfrom 28.3.2003 and nominated his daughter Smt. Samundeeswari under the policy. The lifeassured died on 25.5.1993. The claimant preferred the claim in 2003, nearly 10 years afterthe death of her father. LIC rejected the claim as time barred invoking Article 44 (a) of theLimitation Act, 1963 and the decision was upheld by the Zonal Claims Review Committee.Hence the present complaint.The records of the case received from LIC were perused. The complainant contended thatthe claim was preferred late since the family came to know of the policy only in 2003 ongoing through his belongings. Article 44 (a) of the Limitation Act set a limit of 3 years forpreffering a claim under policy of insurance. Hence the contention of LIC was upheld andthe complaint was dismissed. Personal hearing was not felt necessary, in view of the clearnature of the case.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2326 / 2004 - 05Smt. C. RamalakshmiVs.Life Insurance Corporation of IndiaAward Dated 5.11.2004Shri U. Chellamuthu (since deceased) took a LIC policy for Rs.35,000/- on 28.11.1992, nominating his wife Smt. C. Ramalakshmi thereunder. The policylapsed due to discontinuance of premiums and was revived on 2.1.2003 on the strength ofPersonal Statement regarding Health. The assured died on 12.11.2003 due to MyocardialInfarction and Hypertension. LIC repudiated the claim citing suppression of materialinformation at the time of revival, since they held proof to show that the life assured wassuffering from Hypertension and had taken treatment therefor before reviving the policy.LIC had however settled paid up value acquired before revival. On appeal, Zonal ClaimsReview Committee upheld the repudiation decision, leading to the present complaint.Parties to the dispute were heard and the records of the case perused. The MedicalAttendant’s Certificate did state that the life assured was suffering from Hypertension since1999. But the case records stated that the life assured was not a diabetic or hypertensive.Moreover, BP readings were not available in the case records, suggesting thatHypertension on a solitary occasion could not be of pathogenic origin. The Insurer hadfailed to prove material suppression as cast upon him by the stipulations of Section 45 ofthe Act.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2237 / 2004 - 05Smt. G. RaniVs.Life Insurance Corporation of India
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 and 28: Smt. Lalitha @ LalliVs.Life Insuran
Page 29 and 30: insurance but did not disclose the
Page 31: suicide. Since the same was exclusi
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
Page 81 and 82: 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
Page 87 and 88:
22/7069); 09.08.2002 (S. No. 5/7897
Page 89 and 90:
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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Page 177 and 178:
Page 179 and 180:
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
Page 217 and 218:
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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