Page 44 - Insurance Times February 2016
P. 44
On perusal of the records, it was observed that Mr. Daulat Hyderabad Ombudsman Centre
had account with Nasik District Central Co-op Bank Ltd. His Case No. L-045-1314-0267
premium of Rs. 612/- for policy no. 962851380 was deb- Mr.Mallappa
ited on 28th day every month. From the copy of the pass- V/s
book submitted to this forum, it is observed that bank has
charged him with Rs. 50/- for insufficient funds as on Star Union Dai-ichi Life Insurance Co Ltd
28.05.2012, though there is subsequent transaction show-
ing credit of Rs. 98075/- on the same day. Mr. Mallappa, nominee had filed a complaint stating that
the death claim under the policy of his deceased father was
The company representative has clarified that ECS trans- wrongly repudiated by Star Union Dai-ichi Life Insurance
action takes place in the morning and on 28.05.2012, there Company Ltd; hence, he requested for settlement of the
was only Rs. 1034/- to the credit of Mr. Daulat Shinde when claim.
ECS transaction took place. Since Mr.Daulat Shinde had
availed of cheque facility, the minimum balance to be main- On a careful consideration of the written and oral submis-
tained by him is Rs. 500/-. sions of both the parties and the documentary evidence
adduced, it was observed that the insurer had repudiated
Thus it is clear that ECS was dishonoured by bank due to the claim for taking insurance policy by suppressing the
insufficient balance as on 28.05.2012. Mr. Daulat expired material facts and for misrepresentation. It was evident
on 18.06.2012. i.e. after the grace period of 15 days. Thus from the Income Tax Returns that the documents were
the policy was in lapsed condition as on date of death. Since manipulated and fraud was committed.
the policy has not run for 3 years, the policy has not ac-
quired any value. Thus rejection of claim by LIC is as per The Income Tax Returns of the son of deceased life assured
the terms and conditions of the policy. were shown as those of the insured person with an intention
of taking insurance policy. The complainant and insurer, both,
Complaint No. LI - 65 (2012 - 2013) were not disputing the fact that there was a fraud. The fact
of not disclosing the correct sources of income and manipu-
Complainant: Smt. Shobha Solapure lating the records proves that there was a non-disclosure of
material fact. Moreover, as the death occurred within a year,
V/s it attracts the provisions of section 45 of the policy.
Respondent: ING Vysya Life Insurance Co. Ltd. The contract of insurance is one of "utmost good faith" and
both parties to the contract shall disclose all facts, whether
Mr. Mallikarjun Solapure had bought policy no. 00405174 material or not, in full, to the other. Since the insured did
from ING Vysya Life Insurance Company Ltd on 28.03.2006. not disclose the source of his income, the claim was rightly
He expired on 30.10.2011. When his wife Mrs. Shobha repudiated by the insurer. In view of the above, there was
Solapure lodged the claim with the insurer, it was repudi- no reason to interfere with the decision of the insurer. In
ated on the grounds that the policy was in lapsed condition result, the complaint was dismissed.
as on the date of death.
Corrigendum
On hearing the deposition of both the parties to dispute, it
was observed that since the life assured had paid the pre- The January, 2016, issue had an article titled 'Underwriting
miums for more than 3 years, the policy attained the Paid Liability Insurance - Process, Principles and Perspectives' by
-up status as per Clause 5 of the policy terms and condi- CA. R C Guria.
tions. Hence the company paid only paid- up value of Rs.
53711/- to the claimant and denied claim for full sum as- In the article following corrections may be noted on Page
sured. The company has not violated the contractual agree- 28 - 'Q2. If not, would 2004 policy…' should be 'Q2. If not,
ment and has acted as per policy terms and conditions. would 2014 policy…' and '2. No, 2014…. was made in 2005
(after policy period).' should be '2. No, 2014…. was made in
Also it is observed that there is no Claim Concession provi- 2015 (after policy period).'
sion in policy terms and conditions. Under the above cir-
cumstances, the forum finds no reason to intervene in the We regret for the error.
decision of ING Vysya Life Insurance Company and the com-
plaint is treated as closed. Chief Editor
44 The Insurance Times, February 2016
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