Page 28 - Life Insurance Today December 2017

Nav Prabhat Plan without Profit under Table & Term 137- Salary Savings Scheme at different intervals during 1990 to
15 bearing Policy No. 583445223 from Cuttack Dist. Branch 1993. He died on 26.8.94. His wife/ nominee Smt. Supari
of LIC of India, Cuttack Division for a Sum Assured of Rs. Devi lodged the claim with BO Nangal, which was not settled
1,50,000/- with Qly. mode of payment nominating the for many years on the plea that records had been misplaced.
Complainant as beneficiary in the event of his death. As She filed a complaint in this office on 15.7.04.
ill luck would have it, he died on 12.1.2002. LIC of India
repudiated the claim on the ground of suppression of Findings : It was confirmed that all four policies were in
material fact. force on the date of death of policyholder. However, the
claimant failed to submit requisite documents despite
Complained that LIC repudiated the claim on flimsy ground repeated reminders. Last reminder was reportedly sent on
i.e. availing of Sick leave before taking the Policy. Actually 8.2.96 to submit original death certificate and the policy
the deceased was not suffering from any serious disease. bonds within a period of 10 days. After receipt of a copy
As he no other leave to his credit he availed Sick leave. of complaint from this office on 20.7.04, the Divisional
Office sought policy dockets and detailed report from the
Countered by LIC that the deceased Life Assured had not branch office to proceed further in the matter. The branch
only availed of medical leave before taking the policy but office informed that the basic record could not be traced,
also had taken reimbursement of medical bills by as it was destroyed in Sept 1990 during Mandal
submitting prescriptions of the doctor & medical bills etc. Commission agitation. However, original ledger sheets
were sent to the DO. Claim papers were also collected
Observed that the Life Assured was working as PA (BCR), from the claimant and the matter was under active
Head Post Office, Rayagada. The Sr. Superintendent of Post consideration for payment.
Offices, Koraput Division in his letter No. E-15-13/00-01
dtd. 27.10.04 has submitted Essential Certificates, Decision : Held that the claimant cannot be held
Prescription etc. produced by the deceased life assured for responsible for misplacement or destruction of record. The
availing of medical bills reimbursement, from which it insurer was liable to settle the claims. Directed to do so
appears that he was being treated by Dr. N. Dash, Medicine within a period of three weeks.
Specialist, D. H. H. Rayagada from 27.8.99 to 16.12.99 for
hypertension & I. H. D. He mooted the proposal on Chandigarh Ombudsman Centre
18.3.2000 declaring that he had no pre-existing disease
Case No. LIC/410/Ludhiana/Ludhiana - I/24/05
and was in good state of health though in fact he was
suffering from heart disease and died of heart disease Smt. Parveen Dawar
about a year there after. Evidently he obtained policy by
misrepresentation. Vs.
Life Insurance Corporation of India
Held that LIC was justified in repudiating the Claim. The
complaint was dismissed without any relief. Facts : Shri Subhash Rawat issued two cheques for Rs.
7875 and Rs.6000 as deposit for purchase of policies. The
Chandigarh Ombudsman Centre amount was credited to LIC account on 03.06.02. However,
Case No. LIC/138/Chandigarh/Nangal/24 - 05 policy bonds were not issued. He died on 13.07.02. Smt.
Praveen, his widow, filed an application for settlement of
Smt. Supari Devi
claim. She pleaded that the required proposal forms filled
Vs. up by the agent were also signed by her husband.
Life Insurance Corporation of India However, neither policies nor receipts were issued. Her
application was not entertained for want of contract due
Facts : Shri Dharam Chand purchased four policies under to non submission of proposal form.

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28 December 2017 Life Insurance Today

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