Death Claim - Gbic.co.in

Smt.M.PeriakkalVsLife Insurance Corporation of IndiaAward Dated : 29.03.2007Sri P.Muniappan submitted a proposal for life insurance on 09.09.2000 and 07.09.2002to LIC of India, City Branch 16 of Chennai Division I. The Insurer issued him thepolicies numbered 713186124 and 713519726 for a sum assured of Rs.5 Lakhs each,under plan nos.112 and 151 respectively. Sri P.Muniappan died on 11.07.2004 due tocardiac arrest. Smt. M.Periakkal, wife and nominee under the policies preferred herclaim with the Insurer. The Insurer rejected her claim on the grounds that the lifeassured withheld material information pertaining to his health.The complainant stated that her husband was engaged in the building contract workalong with his father. She added that her husband had been to Trichy to attend afunction and after that he went to her father’s house where he died. They were told thathe had died due to heart attack. When questioned whether he had undergone surgeryat Saveetha Dental College Hospital, she admitted that the life assured had undergonesurgery at the hospital in 2002. She admitted that the arrangement of his teeth wouldnot be proper and to correct the same, surgery had been performed. She said thatotherwise he did not have any other illness. When questioned whether her husbandhad undergone any surgery prior to 2002 she said that they were married in 1996 andfor the first time he underwent surgery only in 2002. When questioned about the pasthistory mentioned in the case sheets of Saveetha Dental College Hospital for thesurgery in 2002 where it has been mentioned that he had undergone 7 surgeries earlierin various hospitals, she denied the same. Her father-in-law and father of the deceasedlife assured, who accompanied her to the hearing, admitted that earlier his son hadundergone surgeries twice where even grafting was done.The Insurer stated that they had obtained clear evidence that the life assuredunderwent TMJ surgery in the year 1997 for Ankylosis at Saveetha Dental College andHospital. They had produced a letter from Saveetha Dental College where it has beenmentioned that the life assured had undergone surgical treatment for Ankylosis of TMJtwice in their institution in 1997 and 2002. They had also obtained the case sheetspertaining to his treatment in 2002, where under the past history, details of surgeriesundergone by the patient has been mentioned. She said that Ankylosis meant restrictedopening of mouth. He had not disclosed the details of the surgeries in the proposalforms of the two policies.It is therefore evident that the life assured had undergone a series of operations to setright his facial deformity. The doctor’s noting in 2004 indicate that the repeatedoperations had a bearing on his health. By replying in the negative to the relevantquestions in both the proposals the life assured had denied the Insurer a chance ofcalling for the hospital reports, test reports and other special reports. The Insurerunderwrote the risk without full information. The insurer had proved with medicalevidence the relevance of suppression.The Complaint was dismised.Chennai Ombudsman CentreCase No. : IO (CHN)/21.04.2572Smt.H.Hameela BegumVsLife Insurance Corporation of IndiaAward Dated : 29.03.2007