Page 27 - Life Insurance Today December 2017

LEGAL

Legal Case Studies on Death Claim

Ahmedabad Ombudsman Centre disclosure of sick leave taken by the DLA with respect to
certain diseases alleged to have been suffering prior to the
Case No. 21 - 001 - 0180 Proposal for insurance, Respondent denied liability. They
Mr. Sunilkumar Pandav Claimed to have indisputable proof to establish
suppression of fact and mis-statement based on COHTs
Vs. issued by Dr. J.D. Shah, Dr. C. C. Kalaria and Dr. Y. R. Joshi.

Life Insurance Corporation of India Documents and submissions perused. It is observed from
these COHTs that the Doctors in all these Certificates only
advised Rest putting question marks against the diseases
Joint Policy - Insured died in the Hospital on the same day
mentioned and there was nothing to prove that any
of her delivery on 29.06.03. Policy commenced from
treatment was given nor any Tests for diagnostic purpose
9.12.2002. Complainant submitted that Proposal was a
were conducted. Hence, all these certificates served to be
Medical one and hence both of them were medically
examined by a Panel Doctor of the Respondent. Hence as supportive documents for availing medical leave.
Further observed that the in-house investigation
repudiation on the ground of suppression of material fact,
conducted by the Respondent also couldnot bring out any
is to be set aside. Respondent submitted that the DLA
suppressed the very fact that she was pregnant at the time evidence of suppression of fact or mis-statement which
ultimately recommended to treat the Claim as genuine.
of Proposal and even misguided them by mentioning her
Decided cases in the matter of LIC Vs Sanjeev Mahendralal
last date of menstruation as 29.12.2002 in the Declaration
Shah [I (1998) CPJ 45 (NC)], LIC Vs. Paramjit Kaur Gill [III
of Good Health dated 29.12.2002. Verified the records
(1997) CPJ 35] and Nirmala soni Vs. LIC & Others (2004 CCJ
such as DGH and MAC and observed that the suppression
217) were also referred. Respondent to pay Rs. 314600/-
of fact is established by the Respondent. Complaint
alongwith 8% simple interest to the Complainant. Policy
dismissed without any relief.
No. 851198951.
Ahmedabad Ombudsman Centre
Bhubaneswar Ombudsman Centre
Case No. LIC / 2 / 158
Case No. I.O.O.O. / BBSR / 24 - 202
Smt. Kokilaben R. Barot
Smt. Sarojbala Behera
Vs.
Vs.
Life Insurance Corporation of India
Life Insurance Corporation of India
After the death of LA, his wife lodged Claim With the Happened that Late Surath Chandra Behera of Vill.
Respondent for Policy benefits. On the ground of non- Damodarpur P. O. Kantapada, Dt. Cuttack had obtained a

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Life Insurance Today December 2017 27

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