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Award Dated 18.11.2004Shri A. Gopalakrishnan (Late) took 3 LIC policies each for Rs.50,000/- with effect from 20.2.2000, 19.3.2001 and 15.2.2002 and nominated his wife Smt.G. Rani under the policies. He died on 19.4.2002 due to Myocardial Infarction. The claimunder the policies was repudiated for suppression of material information relating to thehealth condition of the assured. The repudiation decision was also upheld by the ZonalClaims Review Committee giving rise to the present complaint.Records of the case were duly perused. A personal hearing of the parties to the disputewas also held. The medical records produced by LIC evidenced that the life assured wassuffering from chronic pulmonary tuberculosis since 1997. The leave applications producedto the employer also cited Pulmonary Tuberculosis and the life assured had availed asmuch as 119 days of leave on various spells during a period of 3 years from 1998 to 2001for treatment thereof. Therefore the history of ailment went prior to the earliest policy ofinsurance in 2000 and the same was not disclosed in proposals for insurance. Theintentional suppression of material information was held established on the basis ofmedical evidence satisfying the stipulations of Section 45 of the Insurance Act.The complaint was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.05.2274 / 2004 - 05Smt. V. ChandraVs.Life Insurance Corporation of IndiaAward Dated 26.11.2004Shri K. V. Veeramani (Late) took a LIC policy for Rs. 50,000/- on 28.1.2000. He nominatedhis wife Smt. V. Chandra thereunder. The policy lapsed due to discountinuation ofpremiums and was revived on 11.6.2001 on the strength of declaration of good health. Theassured died on 18.2.2003 due to Bronchiectasis and renal failure. The claim for policymonies was repudiated on ground of suppression of pre-revival ailments. The decision wasupheld by the Zonal Office Claims Review Committee, leading to the present complaint.A personal hearing was held and documents perused. Though an inference could be drawnthat the assured was not well beore revival, no concrete evidence was produced by Insurerby way of treatment particulars to prove that the life assured suffered from Bronchiectasisprior to revival. Section 45 of the Insurance Act was also operative. Hence the repudiationdecision was set aside.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2363 / 2004 - 05Shri N. NedunchezhianVs.Life Insurance Corporation of IndiaAward Dated 26.11.2004Ms. N. Allirani took a LIC policy for Rs. 50,000/- on her life on 15.3.2001. She nominatedher brother Shri N. Nedunchezhian under the policy. She died on 7.6.2003 due to PrimaryPulmonary Hypertension. The claim for policy monies was repudiated by the Insurer forsuppression of material information relating to health. The decision was upheld by theZonal Claims Review Committee leading to the present complaint.Parties to the dispute were heard. An examination of the hospital records produced by theInsurer evidenced that the life assured was a patient of Hypothyroidsm since 2000 onmedicines and had breathlessness on exertion for 5 years. The cause of death PulmonaryHypertension had nexus with pre-proposal illness. It was therefore held that there was
suppression of material information incapacitating the Insurer from making properassessment of risk and Section 45 was not attracted.The complaint was dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2361 / 2004 - 05Shri S. FrancisVs.Life Insurance Corporation of IndiaAward Dated 26.11.2004Shri T. Selvaraj took a LIC policy for Rs. 20,000/- on 21.5.2002. He nominated his son ShriS. Francis under the policy. The policy lapsed due to non-payment of premium and wasrevived on 3.10.2003 on the strength of a declaration of good health. He died on4.10.2003, the next day of revival. The claimant stated the cause of death as heart attack.But LIC on investigation obtained hospital records evidencing that the life assured washospitalised from 22.6.2002 and 15.7.2002 for treatment of Pneumothorax. Due tosuppression of pre-revival illhealth, LIC repudiated the claim declaring the revival null andvoid.Parties to the dispute were heard. The complainant did accept that the life assured wasunder hospitalisation and treatment during pre-revival period. But he disowned that hisfather had ever signed the declaration of good health but accepted that with great difficultyhe managed to pay the money for revival demanded by the Agent. A perusal of the recordsdid evidence that there the signature contained in the declaration of good health variedwidely with that in the proposal for insurance, pointing to foulplay by the Agent. Thereforethe contention of the complainant that the life assured did not sign the declaration of goodhealth was accepted and consequently the revival treated as non-existent.LIC ordered to pay to the complainant Rs. 1617/- paid to LIC towards revival of the lapsed policy ofinsurance and initiate action against Agent.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2354 / 2004 - 05Smt. V. ValliammalVs.Life Insurance Corporation of IndiaAward Dated 30.11.2004M. Jeyapaul (Late) took 2 LIC policies for Rs. 50,000/- each with effect from 28.5.2002. Henominated his wife Smt. Valliammal. He died on 20.10.2002. The claim under the policieswas repudiated for suppression of material information relating to health by the life assuredand for not disclosing the leave availed prior to proposing for insurance. The decision wasupheld by the Zonal Claims Review Committee leading to the present complaint.Personal hearing was held and records perused. The complainant contended that herhusband availed leave on sick grounds as is the common practice amongst Govt. servants,to attend to family matters only. The medical certificates produced for leave purposesstated Acute Gastritis and Chronic Obstructive Pulmonary Disease as reasons for leave.But other than the medical certificates, no other evidence was produced by the Insurer toprove that the life assured had suffered from any illness prior to proposing for insurance.Hence the repudiation decision was set aside.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2334 / 2004 - 05Smt. S. Shanmuga SundaramVs.
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 and 32: suicide. Since the same was exclusi
Page 33: 3 years as per policy conditions. T
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
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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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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
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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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