Page 31 - Life Insurance Today December 2017

nominee named by the life assured in his Jeevan Rekha Guwahati Ombudsman Centre
Policy No. 182405098, all the death benefits due to her
under the said policy. Case No. L / LIC / 21 / 91 /03-04 / GHY
Mrs. Rani Chutia
Delhi Ombudsman Centre
Vs.
Case No. LI - DL - I / 120
Life Insurance Corporation of India
Shri. Om Prakash Mahawar
Facts : One late Utpal Chutia was a policyholder of 2
Vs
policies of Rs. 1,60,000/- & Rs. 50,000. On his death his
Life Insurance Corporation of India wife perferred the death claim on 24.02.04 before the
insurer which was repudiated by the insurer/opposite on
Facts of the case : The policy in this case was taken by the 14.012.03. The policyholder died on 01.02.2003 due to
complainant's wife, Smt. Juli Mahawar. The policy cardio vascular accident & the duration of the policies
commenced on 15.05.1998. It lapsed on 15.05.2002 due were 6 months & 3 days only. The cause of repudiation
to non payment of premium. It was revived on 25.02.2003. was suppression of illness of various diseases suffered by
The policy was revived on the basis of a personal the DLA next before the date of commencement.
statement (declaration of good health) made by Smt. Juli Findings : The claimant vide her letter dtd. 24.02.2004
Mahawar. In the personal statement, she had suppressed addressed to the Insurance Ombudsman, Guwahati would
the fact that she had undergone six months' treatment for submit that the concerned LIC agent "in-put all the
tuberculosis. This was a material fact from the point of questions regarding the medical ground & answered as
view of LIC. Smt. Juli Mahawar ought to have disclsoed this 'NO' and 'NO'." It appears that Jorhat Divisional Office of
fact to the LIC. She might have been cured of tuberculosis the LICI in its 'claim inguiry report' stated that the claim is
at that time but she ought to have disclosed the fact in not bonafide & opined that there was suppression of
any case. She failed to do so and thereby violated the duty material facts. A statement of leave on medical ground was
of disclosure and the principle of utmost good faith. It is procured by opposite party. It will be seen from the leave
true that before revival she was also medically examined. statements that the policyholder was suffering from
In the confidential report of the medical examiner, there various illness prior to date of commencement of the
is nothing adverse. But this report does not contain any policy (Evidence discussed). Thus, it will be seen that
question regarding tuberculosis. The report has, therefore, before he got admitted into the hospital next before his
to be read in conjunction with the personal statement death the policyholder (DLA) was suffering from headache
made by Smt. Juli Mahawar. A little more than two months & giddiness & this symptom of disease / illness was
after revival of the policy Smt. Juli Mahawar died. She died available much before the date of commercement of the
because of tuberculosis. Because of this, the fact of her policy, i.e., w.e.f. 09.06.1998. The extract of nature of
having undergone anti-tubercular treatment becomes all illness would show that the policyholder had severe illness
the more material in this case. of giddiness & mild hypertension, Urinary infection etc.

which are material in deciding the risk question & these
Observations of Hon'ble Insurance Ombudsman facts were suppressed while filling up the forms. It cannot
In the Circumstances, Hon'ble Insurance Ombudsman sees be argued that the agent filled up the form without
no reason to interfere in the decision of LIC to repudiate consulting the policyholder as contended by the claimant.
the claim of the complainant. The complainant has failed to file any other document,
which would have been helping her in getting benefit in
In the result, Hon'ble Insurance ombudsman dismisses the this case.
complaint.
Result Complaint dismissed. T

“The best revenge is massive success.”

Life Insurance Today December 2017 31

Sashi Publications Pvt Ltd Call 8443808873/ 8232083010