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Since the life assured died due to drowning, an accidental death and his physical deformitywas very minor which did not in any way incapacitate him from discharge of duties and theInsurer would have even otherwise granted him insurance by charging only a small extra, itwas held that there was no material supprssion.The claim was fully allowed for full sum assured together with accident benefit.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2524 / 2004 - 05Smt. D. ReetaVs.Life Insurance Corporation of IndiaAward Dated 08.03.2005Late B. Victor took a LIC policy for Rs. 1 lakh on his life as per proposal dated 28.7.1999.He nominated his wife Smt. D. Reeta. The policy lapsed due to non-payment of premiumand was revived on 7.2.2001. He died on 26.3.2002 due to viral fever and vomitting. Theclaim was repudiated setting aside the revival for suppression of prerevivalillnesses like Amoebic Colitis, Diabetes Mellitus and Hypercholesteriamia.A hearing was held and the documents perused. The Insurer has repudiated the claim onthe basis of prescription slip dating to pre-proposal period and the medical opinion of theirDivisional Medical referee that the medicines therein were prescribed for treatment ofserious ailments. The complainant contended that her husband was in good health and thatthe prescription slip relied upon by LIC to repudiate claim did not pertain to her husbandbut to her own treatment as the name of the patient on the prescription slip was Mrs. Victoronly. She produced similar such prescription slips to the effect that she herself was takingtreatment from the same hospital.The Insurer did not produce any hospital records of treatment underwent by the lifeassured except a confirmation from the hospital that prescription slip pertained to tretmentgiven to a male patient. Hence the Insurer’s allegation of material suppression was notheld proved.LIC decision to set aside revival was interfered with and the complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.02.2424 / 2004 - 05Smt. U. SuganthiVs.Life Insurance Corporation of IndiaAward Dated 09.03.2005The complaint from Smt. U. Suganthi is against repudiation of claim for full sum assured forsuppression of pre-proposal ailments under the 3 policies on the life of her husband LateE. Udhayakumar. LIC had however settled Rs. 25,000/- as Exgratia sum under all the 3policies put together.Documentary evidence perused and a personal hearing held. The complainant stated thather husband consumed alcohol occasionally and had taken treatment for stomach painonly. The Insurer produced medical record from the employer’s hospital for a week’shospitalisation and treatement for Alcoholic Gastritis. No further evidence of treatment, ifany, was made available, proving that the treatment was on a solitary occasion. Moreover,there was no adverse leave history. Section 45 was applicable under all the 3 policies andthe Insurer had failed to prove fraudulent material suppression with irrefutable evidence.The repudiation decisions set aside and the complaint allowed for full sum assured plusbonuses under all the 3 policies.Chennai Ombudsman Centre
Case No. IO (CHN) / 21.08.2509 / 2004 - 05Shri J. SivashankarVs.Life Insurance Corporation of IndiaAward Dated 09.03.2005The complaint from Shri J. Sivashankar was against repudiation of death claim under thepolicy on the life of his wife Smt. J. Anusuya for suppression of material information thatshe was suffering from Bronchial Asthma for past 10 years and took treatment for the samebut did not disclose that material fact at the time of proposing for insurance.Documents perused and hearing was held. The medical book and certificates obtained fromthe hospital run by the employer himself, produced to this Forum, testified to the fact thatthe life assured had suffered from Poly Arthritis, Fibroid and that she was a known case ofBronchial Asthma for 10 years and also a known case of Hypertension and DiabetesMellitus but not on regular treatment. The death was also of the same ailments. The lifeassured also underwent various diagnostic tests like blood, X-ray and ECG. The lifeassured did not disclose the pre-proposal ailments and the tests underwent at the time ofproposing for insurance and hence material suppression was held proved.The repudiation decision upheld and the complaint dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.05.2547 / 2004 - 05Smt. M. DhanalakshmiVs.Life Insurance Corporation of IndiaAward Dated 09.03.2005Late N. Manivannan took a LIC policy on 25.11.1985. He nominated his mother Smt. M.Dhanalakshmi. The policy remained lapsed due to non-payment of premium due from25.11.1991. The life assured died on 15.6.1993. LIC refused to settle full sum assuredunder the lapsed policy but offered to settle Paid up Value since premiums were paid for aminimum period of 3 years.The records were perused. As per the policy conditions, the policy continued to be in forceeven if premiums were unpaid provided deah took place within 1 year of first unpaidpremium. In this case, death of the life assured took place more than 1 year after lapse andhence claim could not be considered under relaxed claims concessions clause. Hence thedecision of the Insurer not to settle sum assured but only the paid up value is in tune withpolicy conditions and the same is upheld.The complaint is dismissed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.03.2528 / 2004 - 05Smt. G. SurathaVs.Life Insurance Corporation of IndiaAward Dated 09.03.2005Smt. G. Suratha, wife of Late Shri R. Hariharasubramanian complained to this Forumagainst rejection of claim for full sum assured under the Jeevan Shree policy on the life ofher husband. LIC had offered to settle paid up value.The records were perused. The policy commenced on 28.1.2002. The premiums were paidupto the quarterly premium due 28.1.2004 and since further premiums were not paid, thepolicy remained lapsed from 28.4.2004. The life assured died on 11.6.2004. Thecomplainant contended that full sum assured should have been settled applying Chairman’srelaxation rules as death had taken place within 1 year from the date of lapse. But LICCentral Office Circular dated 18.10.1999 expressly excluded interalia Jeevan Shree policy
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 and 46: Shri K. Perumal, the nominee under
Page 47 and 48: The repudiation decision was upheld
Page 49: The complaint under all 3 policies
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
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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
Page 173 and 174:
not fulfill all the three ingredien
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Page 177 and 178:
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
Page 189 and 190:
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
Page 209 and 210:
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
Page 215 and 216:
Shri Raju Shankar Makadwale took tw
Page 217 and 218:
life assured withheld material info
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Respiratory Arrest” and the secon
Page 221 and 222:
epudiated by Nagpur DO of LIC stati
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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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