Page 29 - Life Insurance Today December 2017

Findings : Sr. Divisional Manager, Ludhiana confirmed that The life assured went missing after he set out for fishing
both the cheques were credited in LIC account on in a boat with other fisherman at 7.00 AM on 6.8.2002
3.6.2002. However, proposal forms were not submitted. when the boat capsized 30 meters from the seashore and
The depositor had died on 13.7.02, but no intimation was the life assured was injured. The fellow fisherman made
given to the office. The consideration amount was good escape and the life assured's body was washed
deposited through the agent Shri B.P. Sood, who confirmed ashore on 10.8.2002 at 12.45 PM in a highly decomposed
non receipt of proposal forms from LA despite repeated state. LIC repudiated the claim on the plea that the
reminders. It was stated that the deposit amount would premium due was paid after the death of the life assured,
be refunded to class-I legal heirs of Shri Rawat on as otherwise policy was in a lapsed condition and nothing
completion of formalities. The death claim was not payable was payable thereunder. LIC however refunded the
in view of the fact that insurance contract had not been premium of Rs. 896/- paid after the death of the life
finalized. assured. The complainant has approached Zonal Claims
Review Committee who upheld the repudiation decision.
On behalf of complainant it was stated that two policies
were proposed by late Shri Subhash Dawar for SA of Rs. The parties to the dispute were heard and the records of
10 lacs. After getting the cheques, the agent did not bother the case perused. F.I.R., Policy Inquest Report, Death
to contact him again to get the proposal forms filled up. Certificate and Postmortem report did not throw any light
The agent stated in his report that he tried to contact the on the time of death. The Post - Mortem Report stated
proposer to have the proposal forms filled up. But when that the death was due to drowning, that there were cut
he was informed by late Shri Subhash Dawar that he was injuries on his body and the body was in a highly
having heart problem and was being treated at DMC, he decomposed state. The Death Certificate recorded the
refused the proposal and advised him to get the refund date of death as 6.8.2002, on which the Insurer greatly
from office. Besides, the claim was lodged two years after relied upon to repudiate surmising that the life assured
the death of Shri Subhash Dawar. met with instantaneous death on capsize of the boat. But
the exact time of death was not ascertainable from the
Decision : Held that it was evident that, for whatever Death Certificate. It was probable that since the liffe
reasons, contract between the parties was not effected. assured was a fisherman by profession, he could have tried
Therefore, the basis for admitting the claim does not exist. to save himself and could have been alive even after his
The complainant also failed to explain why the claim was injuries. It was also probable that the life assured met with
lodged after two years and intimation about his death was instantaneous death on drowning since the life assured
not given earlier. The obvious inference is that it is an after reportedly suffered injuries when the boat capsized.
thought. Hence the complaint was dismissed. Therefore the claim of the complainant for full sum
assured could not be considered and LIC was directed to
Chennai Ombudsman Centre pay the basic sum assured of Rs. 53,000/- on Ex-gratia
basis. The complaint was partly allowed.
Case No. IO (CHN) / 21.07.2247 / 2004 - 05

Smt. M. Jeramma Chennai Ombudsman Centre
Vs. Case No. IO (CHN) / 21.08.2463 / 2004 - 05

Life Insurance Corporation of India Smt. G. Kotteswaran

Vs.
Late S. Michealdas, a fisherman, took a policy of insurance
on his life with LIC for a sum assured of Rs. 53,000/- on Life Insurance Corporation of India
15.11.2000 and nominated his wife Smt. M. Jeramma
thereunder. The policy lapsed due to non-payament of Smt. K. Tamilselvi took a LIC policy for Rs. 50,000/- on
premium due from 15.5.2002. The premium under the 28.12.2002. She nominated her husband Shri G.
policy was paid to LIC at 11.17 hours on 6.8.2002 along Kotteswaran under the policy. She died on 5.2.2004 due
with late fee. to heart atttack. The claim was repudiated for suppression

Life Insurance Today December 2017 29

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