Smt. Shanti Devi w/o Late Rajendra

v.Office Of Insurance Ombudsman

Air 2008 All 72

Judgement by :-

Justice Amitava LalaJustice J.

Facts of the case• On 31st January, 2002 - Petitioners deceased husband made a policy

under the money back scheme of LIC.• On 2 8th December, 2002 - Policy lapsed due to nonpayment of

premium.• On 15th February, 2003 - Policy was revived on full payment of premium.• On 16th February, 2003 - Insured expired due to heart attack.• On 27th May, 2004 - Senior Divisional Manager of LIC Allahabad rejected

the claim of his wife on account of her husband’s death.• On 18th January 2005 – Zonal Manager of LIC from Kanpur had also

rejected the claim and had formally informed the same to the wife of deceased. An appeal was then preferred before the Insurance Ombudsman.

• On 30th June 2005 – Insurance Ombudsman upheld the repudiation action by insurer, in repudiating the claim under the policy.

Issues :-• Whether the repudiation order by the Life

Insurance Company is justified ?

• Whether the facts of the case is related with Section 45 of Insurance Act 1938 ?

• Whether the petitioner is entitled to get the claim from the policy ?

Arguments by Petitioner• Before the date of death the deceased attended his office to

work. He was not under treatment for any disease to be treated by any Doctor. However, as per the certificate given by the particular hospital, the deceased was suffering from jaundice.

• A person having jaundice normally can not attend his office to do the work just before one day of his death. Death occurred by heart attack. No specific denial is available whether the deceased was medically treated any where before his death.

Arguments by Respondent The second part of Section 45 of Insurance Act 1938 applies to the current situation i.e.

a) the statement must be on a material matter or must suppress facts which it was material to disclose.

b) the suppression must be fraudulently made by the policy-holder

c) (c) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.

Judgement

It is hold that the petitioner is entitled for the said sum which will be released by the Insurance Company in favour of the petitioner as early as possible but not beyond the period of one month from the date of communication of this order.

Thank You PRESENTATION BY:- SOUMYA SUBHANKAR