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Life Insurance Corporation of IndiaAward Dated 30.11.2004Smt. K. Devikumari (Late) took 2 LIC policies on her life for Rs.25,000/- and Rs. 45,000/- on 15.12.2001 and 7.2.2001 respectively. She nominated herhusband Shri S. Shanmuga Sundaram under the policies. She died on 18.2.2003. The claimwas repudiated for suppression of sick leave of 38 days availed prior to proposing forinsurance under both the policies. The repudiation decision was upheld by the ZonalClaims Review Committee whereupon the complainant chose to represent to this Forum.A Personal hearing was held. The complainant admitted that due to a family quarrel, hiswife consumed some expired tablets, developed chest pain, was hospitalised and passedaway. He also stated that the leave was taken on sick ground for exhausting theaccumulated leave and that too for common problems like diarrhoea and fever only. Therecords of the case were perused. LIC could not produce medical certificates in support ofleave as the same were not available with the concerned authorities. Hence the reason forleave was not ascertainable and it was held that the Insure did not prove materialsuppression with fraudulent intention in view of attraction of Section 45. Though there wasan attempt to suicide, suicide clause exclusion was not attracted as death had taken placeone year after taking the policies. Hence the repudiation decision was set aside.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.02.2360 / 2004 - 05Smt. T. E. ShanmugamVs.Life Insurance Corporation of IndiaAward Dated 15.12.2004S. Sankar (Late) took a policy of insurance on his life for Rs.60,000/- with LIC which commenced on 28.3.1996. He nominated his father Shri T. E.Shanmugam under the policy. He died on 21.10.1996. The insurer repudiated the claim astime barred since the claim was preferred after a period of 6 years attracting provisions ofthe Limitation Act. The repudiation decision was upheld by the Zonal Claims ReviewCommittee. The complainant preferred a complaint to this Forum.A personal hearing was held. The complainant contended that his son died of sudden chestpain and did not commit suicide. The insurer stated that the claim forms were received byLIC only on 30.9.2002, six years after the date of death. As per their investigation, thecause of death was suicide within 1 year, attracting exclusion under Suicide clause andclaim was purposefully preferred belatedly denying the opportunity to LIC of establishingthe real cause of the death. However, the complainant produced a reminder letter from theBranch Office of the Insurer dated 17.6.2002 showing that the claim was intimated to LICmuch prior to the date of submission of Claim Forms to LIC. However, it is fact that therewas delay in submission of claim forms to LIC, hampering the Insurer from conductinginvestigation and collecting evidence on the cause of death. In the circumstance of thecase, it was decided to allow an Ex-gratia at the rate of 50% of the sum assured to thecomplainant.The complaint was party allowed and LIC ordered to pay Rs.30,000/- representing 50% of the basic sum assured.Chennai Ombudsman CentreCase No. IO (CHN) / 21.03.2395 / 2004 - 05
Smt. C. AnnapooraniVs.Life Insurance Corporation of IndiaAward Dated 15.12.2004M.R.Chinraj (Late) took a policy of insurance on his life for Rs. 1,00,000/- with LIC whichcommenced on 28.3.2002. He nominated his wife Smt. C. Annapoorani under the policy. Hedied on 3.4.2002. The insurer repudiated the claim for suppression of material informationthat the life assured suffered from Right leg Cellulitis and had taken treatment thereforduring pre-proposal period. The repudiation decision was upheld by the Zonal ClaimsReview Committee. Thereafter the complainant preferred a complaint to this Forum.A personal hearing was held. The complainant contended that Cellulitis developed due to athorn prick only and not due to any ailment. The medical records producted by the Insurerevidenced that the life assured was indeed hospitalised for 10 days and treated forCellulitis during pre-proposal period and to that extent there was suppression of materialinformation. But the ailment did not have a deleterious effect on the health of the lifeassured and did not affect the risk assessment process of the Insurer in any way. Moreoversince stipulations under Section 45 of the Act as regards fraudulent intention was notproved, the claim was allowed.Reliance was placed on the case decided by the Hon’ble High Court of Madras in Athayeevs LIC that a legal principle could not be pushed to extreme logical conclusions.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2380 / 2004 - 05Smt. M. ArulselviVs.Life Insurance Corporation of IndiaAward Dated 21.12.2004J. Mathivanan (Late) took 2 LIC policies on his life each for Rs.50,000/- which commenced on 13.2.2001. He nominated his wife Smt. M. Arulselvithereunder. He died on 21.11.2002 after consuming poison due to stomach pain. Theinsurer repudiated the claim for suppression of material information that the life assuredsuffered form Peptic / Duodenal Ulcer and was hospitalised and took treatment thereforand also availed sick leave during pre-proposal period but did not disclose the materialinformation in his proposals. The repudiation decision was upheld by the Zonal/CentralOffice Claims Review Committee also whereupon the claimant chose to prefer a complaintto this Forum.A personal hearing was held. The complainant contended that while settling claim under 8previous policies, LIC had unjustly negated her claim under 2 policies alone. She howeveradmitted to her husband suffering form stomch pain and taking treatment and dying afterconsuming poison due to unbearable pain. The police records and post mortem reportconfirmed of the life assured’s death due to poisoning. The leave records alluded to the lifeassured’s treatment for Ulcer. The medical records did evidence that the life assured hadtaken treatment for Peptic Ulcer during pre-proposal period. But LIC could not produce anytreatment records from the doctors who have treated the life assured throwing light on theintensity of aliment and its material bearing on the death and Peptic Ulcer could not be saidto be life threatening. There was material suppression but the insurer had failed to provefraudulent suppression with concrete evidence satisfying the stipulations of Section 45 ofthe Insurance Act.The repudiation was set aside and LIC orderd to pay 50% of the sum assured (Rs. 50,000/-) as Ex-gratia.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2409 / 2004 - 05
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 and 34: 3 years as per policy conditions. T
Page 35: suppression of material information
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
Page 85 and 86: admitted with diabetic pulmonary ed
Page 87 and 88:
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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