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Shri K. Perumal, the nominee under a policy of life insurance on the life of his wife Late P.Rameshwari complained to this forum that the Insurers, L.I.C., Madurai Division repudiatedhis claim on his wife’s policy alleging materiel suppression of information in her proposal.The Insurers contended that the assured suffered from chronic renal failure beforeproposing but did not reveal the said vital information in the proposal, leading to theirrepudiation of the claim. This decision was challenged by the complainant.The relevant case records have been called and perused. The contending parties havebeen called for a personal hearing and their pleadings recorded. A careful study of entiredocumentary evidence and oral submissions revealed that the insurers had based theirdecision of repudiation on a Medical Attendant’s Certification in Claim form ‘B’ given by Dr.K. Senthil of Madurai Medical College, Madurai. In the said certificate, the doctormentioned the cause of death of the assured as Chronic Renal Failure and Uremia. He didnot furnished any further details as to from when the ailment was persisting, the course oftreatment etc. Further as an answer to other relevant questions he pointed out that he wasthe usual medical attendant of the assured for the past 6 months and during that periodtreated the assured for minor ailments like respiratory infection, that too only on two orthree occasions. The doctor also gave a letter in which he further clarified that he treatedthe assured for about 6 months for minor ailments like Upper and Lower Respiratoryinfections. There was no other medical evidence available in the case file to throw any lighton the pre-existence of the ailment renal failure. It was also not clear as to how the doctorarrived at his diagnosis during terminal illness that the ailment which caused death wasChronic Renal Failure, in the absence any supporting evidence such as investigationreports or particulars of course of treatment for such a chronic ailment etc. TheInvestigating Officer of L.I.C. also in his report could not adduce any additional evidencewhich could given credence to the theory of pre-existence of kidney ailment.In the absence of any tangible evidence to conclusively establish the existence of ailmentchronic renal failure by the insurers, their contention that there was material suppression inthe proposal was held to be factually and legally untenable. As such the repudiationdecision was set aside and the insures directed to make payment of claim under thenpolicy to the complainant.The Complaint is allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2480 / 2004 - 05Shri M. SelvamVs.Life Insurance Corporation of IndiaAward Dated 03.02.2005Shri M. Selvam, the nominee under LIC policy no. 742710664 on the life of his wife Smt. S.Geetharamani, preferred a complaint to this Forum against repudiation of death claimunder the policy on ground of suppression of treatment for uterus problem andhysterectomy underwent, prior to proposing for insurance. The policy for Rs. 50,000/- commenced on28.8.2000. The life assured died on 30.1.2003 after committing suicide.A personal hearing was held. The complainant contended that his wife did not undergo anyuterus removal surgery but for removal of tumour only and in support cited the post -mortem report which stated that the uterus was normal. The Insurer contended that as perthe records of Govt. Hospital, Madurai, the life assured had undergone VaginalHysterectomy prior to proposing for insurance, but did not disclose the same at the time oftaking the policy and pointed out that the life assured committed Suicide by consumingpoison as a result of unbearable pain she continued to suffer from uterus problem. Aperusal of records evidenced that the life assured did undergo vaginal hysterectomy andsample was also taken for biopsy hence the post-mortem report which made a normal study