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Wife of the Complainant was holding two LIC Policies. After her death, the claim lodgedwas repudiated on the ground of withholdment of material information regarding her healthand mis-statement. Documents perused. It is observed that in the COHT issued byAssociate Professor of Surgery, M. P. Shah Cancer Hospital, it has been indicated that theDLA registered her case with the Hospital in May 2002 and the diagnosis arrived at isCancer of left Maxilla. It is also observed that the answer to questions 11 (a), (b), (c) & (i)of proposal Form was given in negative by the DLA. As the Proposal Form was submittedsubsequent to May 2002, suppression of health history and mis-statement committed by theDLA is proved. The ennobling provisions under Section 45 of the Insurance Act 1938 isalso not available to the Complainant. Repudiation upheld.Ahmedabad Ombudsman CentreCase No. 24 - 001 - 0201Smt. Neha S. ShahlVs.Life Insurance Corporation of IndiaAward Dated 10.1.2005The Claim was arisen from the death of complainant’s husband for DAB in seven LICPolicies. Just in the moment of Hearing, it was come to the knowledge of the Forum thatthe Complainant had approached the Consumer Redressal Forum. Hence u/s. 13 (c) ofRPG Rules, 1998, an Order is issued dismissing the complaint.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0075Smt. Pramila N. PatelVs.Life Insurance Corporation of IndiaAward Dated 18.1.2005Death Claim - Complainant wife of DLA. Respondent repudiated the claim on the ground ofdeliberate mis - statement and withholdment of material information. They also claimed tohave indisputable proof to prove that the DLA was suffering from HT, IDDM with BronchialAsthama etc. To substantiate their contention, the Respondent relied on MAC, COHT andClaim Form - B issued by the Treating Doctor. The point taken for determination is whetherthe DLA knowingly suppressed the material information as alleged by the Respondent intheir repudiation letter. Documents perused. It is observed that none of the aforementionedCertificates revealed any past history of diseases. In the meantime, the Treating Doctormentioned in the diagnostic part of Form - B that he ascertained the disease fromsymptoms and appearance. The inhouse Investigator as well as the DMR of theRespondent could not find any evidence of pre-existence of disease. Respondent to payproceeds of the subject Policy alongwith 8 % simple interest computing from 2 months afterthe claim Form submitted.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0107Smt. Snehlata B. MaruVs.Life Insurance Corporation of IndiaAward Dated 18.1.2005
Complainant’s husband took a Policy vide Proposal dated 27.01.03. He died on 1.4.03 dueto Cancer in Pancreas. Claim repudiated on the ground of suppression of material fact withregard to state of health of DLA. Complainant submitted that the DLA was not aware ofdisease. Respondent produced before the Forum COTs and COHT to substantiate theirpleading that the disease was pre-existing, the fact of which was not disclosed whileproposing for insurance. Documents perused. It is observed that in all the Certificatesubmitted by the Respondent clearly indicated that the DLA was suffering from this diseaseprior to the proposal for insurance. Repudiation upheld.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0204Smt. Pratima S. PatelVs.Life Insurance Corporation of IndiaAward Dated 18.1.2005Mr. S. D. Patel had held three LIC Policies. After his death due to Cancer - BM (Left) inJuly 2003, Complainant lodged Claim which was repudiated on ground of incorrectstatement and withholdment of material information committed by DLA. The point taken fordetermination is whether the DLA Knowingly suppressed the material information at thetime of Proposal for insurance on 25.10.2002. Documents perused are MAC & COHT. It isobserved that both MAC & COHT does not indicate the duration of disease prior toinception of Policy. As regards the h/o past ailment noted in a certificate, it is observedthat such common diseases cannot be taken as valid reason for repudiation, particularly inthe light of judicial pronouncements in such similar cases. Cases referred are [1 1998 CPJ45 (NC)], [1986-99 Consumer 1119 (NS)], [2 CCJ 4 (564)], [1 (1991) acc 411(DB)] etc. Heldthat Respondent could not prove that the DLA took treatment for any serious disorder inhealth prior to Proposal and also the same was within the knowledge of DLA. Respondentto pay SA with 8% simple interest in all the Policies from the date after expiry of 2 monthsof compliance.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0247Smt. Khatunnisa S. AnsariVs.Life Insurance Corporation of IndiaAward Dated 31.1.2005Husband of the Complainant proposed for insurance on 3-12-2002. He died on 12-12-2002.Proposal was underwritten on 16-12-2002. Claim intimation made by the Complainant on 6-1-2003. Because of unconcluded Contract, Claim repudiated. Examined the case withevidence adduced by the Respondent to asertain whether the Contract was an unconcludedContract with reference to the necessary requirements such as Subject Matter, offer,Consideration and Acceptance which are the essential parts to be completed in all aspectsfor conclusion of a Contract. It is observed that as death occurred on 12-12-2002, thesubject matter (life to be covered) ceased to exist on 16-12-2002 and the underwriting doneon 16-12-2002 was simply because intimation of death was given only on 6-1-2003. Judicialpronouncements in decided cases like [II (1993) CPJ 146 (NC)] and [I (1993) CPJ 128(NC)] were also referred. Non-payment of Claim upheld.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0223Smt. Nathiben M. KhantVs.Life Insurance Corporation of India
Page 3 and 4: of treatment for urinary tract infe
Page 5 and 6: Mr. Ramesh D. MakwanaVs.Life Insura
Page 7: Case No. 21 - 001 - 0249Mr. K. D. D
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 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
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proposal for assurance, the opposit
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Life Assured was guilty of any brea
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time. This ground of incorrect info
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Fact of The Case : One Shri Y. C. M
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Fact of The Case : Shri G. Prabhaka
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disease with chronic bronchitis and
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Decision : I heard the contentions
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ii) It was alleged by the insurer t
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ii) The insurer repudiated the clai
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The life assured was admitted there
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Award Dated 08.10.2004Facts of The
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I heard the contentions of both and
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admitted with diabetic pulmonary ed
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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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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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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
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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
Page 205 and 206:
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
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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