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Case No. IO (CHN) / 21.08.2405 / 2004 - 05Smt. R. PunithavathiVs.Life Insurance Corporation of IndiaAward Dated 30.12.2004(Late) K. Ravindran took 2 LIC policies on his life for Rs. 50,000/- and Rs. 25,000/- on20.3.2001. He nominated his wife Smt. R. Punithavathi. He died on 25.6.2003 due to heartattack. The claims under the policies were repudiated for suppression of materialinformation relating to health and leave availed on sick grounds. The repudiation decisionwas upheld by the Zonal Claims Review Committee. Thereafter the complainant hasapproached this Forum.A personal hearing was held and the records perused. In the medical records of treatmentreceived by the life assured before death, it was mentioned that the life assured was aknown diabetic for 12 years. But no treatment particulars were made available tocorroborate the stand that the life assured continued to suffer from Diabetes. Similarly, forsick leave also, no supporting medical record was made available to prove that the lifeassured was suffering from serious ailments. Since Section 45 of the Act was applicableand the Insurer having failed to prove fraudulent suppression with clinching evidence, theInsurer was directed to settle the claim under both the policies. The decision of Hon’bleSupreme Court of India in the case of Mithoolal Nayak Vs. LIC was relied upon.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.02.2387 / 2004 - 05Smt. G. Fatima RaniVs.Life Insurance Corporation of IndiaAward Dated 4.1.2005(Late) M. Amalraj took a policy of insurance on his life with LIC for Rs. 50,000/- under triplecover plan which covered risk of Rs.1,50,000/-. The policy commenced on 28.5.2000. Henominated his wife Smt.G. Fatima Rani under the policy. He died on 18.4.2003 due to massive Haemoptysis andcardio respiratory arrest. The claim for policy monies was repudiated by LIC leading topresent complaint.A personal hearing of the disputants was held. The complainant contended that the lifeassured was completely cured of TB in 1995 after receiving treatment. The medicalcertificates produced by LIC evidenced that the life assured was a known case ofPulmonary Tuberculosis since 1995 and was treated with Anti-Tubercular drugs and wascured. It was held that there was material suppression of pre-proposal illness TB, whichhad the effect of altering the character of risk undertaken by the Insurer more particularlyunder a high risk plan. But the Insurer could not produce irrefutable evidence of continuedexistence of and treatment for TB or any other illness. The Insurer therefore failed tosatisfy the stipulations of Section 45 of the Insurance Act with regard fraudulent intention.The leave records of the life assured were not suggestive of any failing health and absencedue to such reasons. Hence in tune with the principles of equity and natural justice, it wasdecided to allow one basic sum assured plus bonus under the policy to the complainantinstead of three times the sum assured as available under this special plan.The complaint was partly allowed for Rs. 50,000/- plus accrued Bonuses.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2394 / 2004 - 05Smt. D. Panchavarnam