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of uterus was worthy to be ignored. However the Insurer did not make available fullerparticulars of further treatment underwent by the life assured. The available records did notpoint to any malignancy. The investigating official attributed the cause of death toestranged family relations. The Insurer could prove material suppression only. but hadfailed to prove fraudulent suppression and thus satisfy with irrefutable evidence thestipulations of Section 45 of the Insurance Act. Hence the repudiation of full claim monieswas not held justified and the Insurer was ordered to pay 75 % of the basic sum assuredand 75 % of Bonus, payable under the policy. The decision of the Apex Court of India inMithoolal Nayak vs LIC was relied upon.The claim was partly allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.04.2488 / 2004 - 05Smt. V. ManoranjithamVs.Life Insurance Corporation of IndiaAward Dated 04.02.2005The complaint from Smt. V. Manoranjitham nominee under the policy no. 742310819 on thelife of her husband Late K. Velu was against repudiation of death claim by LIC MaduraiDivisional Office alleging suppression of material information on health relating to prerevivalperiod.A personal hearing was held and documents perused. The policy for a sum of Rs. 1 lakhcommenced on 28.5.1999. The policy lapsed due to non-payment of premium and wasrevived on 30.11.2001 on the strength of a declaration of good health. The life assureddied on 23.12.2001. The extensive hospital records produced by the Insurer establishedthat the life assured was diagnosed to be suffering from Carcinoma Bladder as far back as1996 itself on the basis of various tests. There was also hospitalisation and continuedtreatment for Cancer during pre-revival period. The material information was not divulgedat the time of revival, leading to conclusion of fraudulent suppression of materialinformation, satisfying stipulations of Section 45 of the Insurance Act.The decision of LIC to set aside revival and repudiate the claim under the policy wasupheld and the complaint dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.03.2489 / 2004 - 05Smt. J. ShanthakumariVs.Life Insurance Corporation of IndiaAward Dated 04.02.2005Smt. J. Shanthakumari nominee under the policy no. 762803850 on the life of her husbandLate A. R. Joseph Sundraraj, preferred a complaint to this Forum against repudiation ofdeath claim by LIC Coimbatore Division. Her appeal to the Zonal Claims Review Committeewas also rejected.A personal hearing was held and the documents perused. The policy for a sum of Rs.31,000/- commenced on 28.2.2001. The policy lapsed due to non-payment of premium andwas revived on 11.2.2003 on the strength of declaration of good health of the life assured.The assured died on 19.3.2003 due to Brain Haemorrhage and Hypertension. The hospitalrecords produced by the Insurer evidenced that the life assured was hospitalised and hadreceived treatment for various ailments like Chronic Renal Failure, Hypertension,Hemiparesis and haemorrhage in brain, during pre-proposal period. There was fraudulentmaterial suppression by way of non-disclosure of material information at the time of revivaland clear breach of utmost good faith on the basis of documentary evidence on record.
The repudiation decision was upheld and the complaint dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.07.2448 / 2004 - 05Smt. S. VeeralakshmiVs.Life Insurance Corporation of IndiaAward Dated 09.02.2005Smt. S. Veeralakshmi, nominee under 3 LIC policy nos. 741167543, 320354140 and320737690 for a total sum assured of Rs. 40,000/- on the life of her husband K.Santhanavel (Late) complained to this Forum against the decision of LIC to set aside therevival for suppression of material information relating to health in the declaration of goodhealth submitted at the time of revival. LIC had however offered to settle paid up valueincluding bonus acquired prior to revival under 2 policies plus an exgratia of Rs. 5,000/-under all the 3 policies. The complainant prayed for settlement of full sum assured plusbonuses on compassionate grounds.A personal hearing was held and the documents produced perused. The hospital recordsrevealed that the life assured was treated for complaints of Chronic Dysentry, Loss ofappetite and fever and was diagnosed as HIV+ve. The life assured continued his treatmentat Tambaram Sanatorium for the said ailments and Pulmonary Tuberculosis. This prerevivaldiagnosis of HIV+ve infection and related ailements was not divulged at the time ofrevival in the personal statement regarding health constituting serious breach of principleof upmost good faith on which the contract of insurance rested.The insurer’s repudiation decision and his offer to settle paid up value together with an exgratiaof Rs. 5,000/- to the complainant was not interfered with and the complaint rejected.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2476 / 2004 - 05Smt. J. AmuluVs.Life Insurance Corporation of IndiaAward Dated 28.02.2005Late M. Jayaraman of Cheyyar in Tamilnadu insured his life with LIC of India, CheyyarBranch under policies bearing nos. 731356767 and 732205064 for a sum of Rs. 50,000/-each on 10.02.2001 and 20.09.2001 respectively and nominated his wife Smt. J. Amuluunder the policies. He died on 01.03.2002 due to Brain Stem Infarction and Sudden CardiacArrest. The Complainant’s claim for policy monies was repudiated by LIC on 22.05.2003alleging material suppression. The said decision was challenged before this forum.All the case records have been called and perused. A personal hearing of both thecontending parties was arranged. LIC brought forth evidence in the form of two hospitalcards wherein it was mentioned that the assured was attending the hospitals as an outpatientfor treatment of tuberculosis. No further details such as duration of ailement, thecourse of treatment were available to ascertain the severity of the ailment. There was oneblood report, which mentioned that his blood sugar reading was high. But again there wasno further information available as to the duration of diabetes and course of treatmentavailed to ascertain its materiality. Even the claim forms such as Medical Attendant’sCertificate made a mention about diabetes, there was no detailed information as to for howlong the disease subsisted etc.Out of these two policies, one policy attracts provisions of Sec. 45 of Insurance Act,enjoining upon the insurer the additional responsibility of proving fraudulent intention and
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 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: Shri K. Perumal, the nominee under
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
Page 89 and 90: date of birth as 05.07.1946 at the
Page 91 and 92: established beyond all doubt that t
Page 93 and 94: x) Therefore, for the reasons as af
Page 95 and 96: Decision : I have carefully perused
Page 97 and 98:
it was a very early claim, the insu
Page 99 and 100:
Hyderabad Ombudsman CentreCase No.
Page 101 and 102:
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
Page 121 and 122:
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
Page 127 and 128:
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
Page 133 and 134:
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
Page 145 and 146:
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
Page 163 and 164:
Decision : I have carefully perused
Page 165 and 166:
insurer in the claim form no. 5152
Page 167 and 168:
Tetralogy. This admission and the t
Page 169 and 170:
insured did not declare any income
Page 171 and 172:
case on hand, the insurance policy
Page 173 and 174:
not fulfill all the three ingredien
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
not been heard of for seven years,
Page 181 and 182:
The duration of the claim for risk
Page 183 and 184:
eviewing the decision of the respon
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Even if the Life Assured were alive
Page 187 and 188:
The complainant under Rule No. 12(1
Page 189 and 190:
Award Dated 22.2.2005Facts / Submis
Page 191 and 192:
Award Dated 07.10.2004Shri Chandray
Page 193 and 194:
view of this, the claimant approach
Page 195 and 196:
was conveyed to the claimant by the
Page 197 and 198:
Employer’s Certificate and leavel
Page 199 and 200:
Vs.Life Insurance Corporation of In
Page 201 and 202:
normally develops in childhood. Thu
Page 203 and 204:
Certificate dated 3.3.03 issued by
Page 205 and 206:
were not disclosed. Under the circu
Page 207 and 208:
the deceased life assured withheld
Page 209 and 210:
his health at the time of effecting
Page 211 and 212:
history of Appendectomy 15 years ba
Page 213 and 214:
Mumbai Ombudsman CentreCase No. LI
Page 215 and 216:
Shri Raju Shankar Makadwale took tw
Page 217 and 218:
life assured withheld material info
Page 219 and 220:
Respiratory Arrest” and the secon
Page 221 and 222:
epudiated by Nagpur DO of LIC stati
Page 223 and 224:
Therefore, there was suppression of
Page 225 and 226:
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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