Page 44 - Life Insurance Today January-June 2020

LEGAL

Legal Case Studies (Ombudsman)

Death Claim 2016 i.e within 3 years from the date of policy. Hence it is
justified.
Mr Hemantkumar N Vasra
The policy was obtained by misrepresentation of material
V/S
facts, it is void abinitio. The premium paid by the insured is
Reliance Nippon Life Insurance Co Ltd. refundable under second proviso to section 45(4) of the
Insurance Act.
Complaint Ref. No. AHD-L-036-1718-0086
Taking into account the facts & circumstances of the case
The deceased life assured Sajiben Naranbhai Vashra, aged and the submissions made by both the parties during the
43 years had purchased the subject policy from the Respon- course of hearing the Respondent is hereby directed to
dent for a sum assured of Rs.742500/- with the date of make payment of Rs.99000/- to the complainant being full
commencement as 08/10/2014. The deceased life assured and final settlement of the claim.
expired on 12-01-2016. The Respondent repudiated the
claim stating that the deceased life assured had suppressed Smt. Ushaben H. Prajapati
the material fact viz. she was suffering from Diabetes
Mellitus and Ischemic Heart Disease since prior to Octo- Vs.
ber 12,2013 and was on treatment for the same.
LIC of India. Ahmedabad

As per the investigation report the Life Assured was admit- Complaint Ref. No. AHD-L-029-1718-0154
ted to Giriraj Hospital on 10/12/2013 and discharged on 14/
12/2013As per the discharge card the treatment of diabe- Mr. Hashmukhbhai Kalidas Prajapati, the DLA, was insured
tes mellitus and Ischemic Heart Disease p/w Urinary tract with LIC’s Jeevan Rakshak policy No. 839266768 issued on
infection with Diabetic ketoacidosis was given. 25/05/2015 by Life Insurance Corporation of India,
Ahmedabad Divisional office. The DLA expired on
As per the investigation report the Life Assured was men- 20.02.2016 due to the Heart Attack. The Respondent, con-
tally challenged since Birth and was living with her mother. tending that Mr. Hashmukhbhai had not disclosed history
LA was high diabetic patient from last 2-3 years and as per of old ant Wall MI and severe LVF in the proposal form,
repudiation letter, the deceased Policyholder, in her Pro- had repudiated the claim. Aggrieved by the decision, the
posal Form dated 06/10/2014 of the subject policy, had Complainant had approached the Forum for redressal of his
answered, question No. 31 & 33 related to personal health, grievance.
in negative. The respondent has obtained the documentary
which shows that the Life Assured was suffering from Dia- From the records it was observed that the DLA had pro-
betes Mellitus and Ischemic Heart Disease since prior to posed for the policy at the age of 46 years. Respondent
October 12,2013. The death claim was repudiated on 2/3/ had issued a policy based on the proposal submitted to

Doing is a quantum leap from imagining.

44 January - June 2020 Life Insurance Today