Repudiation of death claim by lic
shyam poddar
(Querist) 20 January 2015
This query is : Resolved
I have 2 questions.
My Late Uncle took 6 policies from Rourkela (orissa) office of LIC and now the claims have been repudiated. Can i file a case against LIC from Pune
2nd Query
Please read the entire mail to understand the issue
Dear Sir/Madam,
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> This is with reference to your letter dated 31/3/14 for Repudiation of the death claims under the following policies favoring my uncle Late Vishnu Kumar Poddar
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> 1. Policy No. – 593921063 effecting from 17th Aug, 2010
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> 2. Policy No. – 593931295 effecting from 13th April, 2011
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> 3. Policy No. – 593932631 effecting from 2nd June, 2011
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> 4. Policy No. – 594519837 effecting from 6th Mar, 2013
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> 5. Policy No. – 594510315 effecting from 18th June, 2012
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> 6. Policy No. – 594502448 effecting from 14th Nov, 2011
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> It was mentioned by LIC of India that it has repudiated all liabilities under the above policies on the account that deceased had withheld material information regarding his health at the time of effecting the assurance and it was mentioned in the case history of Apollo Hospital, Bhubneswar that the deceased was consuming alcohol for the last 15 years and the deceased didn’t disclose this fact in his proposal forms.
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> LIC of India doesn’t have any proof or reliable evidence at all to show that the life assured was suffering from any disease (related to the death) prior to the date of commencement of the various policies. There is also no concrete evidence to show that the life assured took any treatment prior to the date of commencement of the above mentioned policies. The hospital records indicate that the deceased was alcoholic, but this has not been supported by any authentic evidence, which is very essential, especially when Sec. 45 is applicable.
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> LIC of India decision is based on the case history of Apollo Hospital, Bhubaneswar and it doesn’t have any corroborative evidence to support the findings of Apollo hospital nor it has any proof to establish that it was within the knowledge of the deceased about any illness related to his death prior to the date of proposal.
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> The first 3 policies among those mentioned above were taken more than 2 years before my uncle expired (9th June, 2013) and hence Section 45 is applicable. As per the Central Government Act, Section 45 of The Insurance Act, 1938
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> “Policy not to be called in question on ground of mis-statement after two years.—No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement 1[was on a material matter or suppressed facts which it was material to disclose and that it was
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> fraudulently made] by the policy-holder and that the policy-holder knew at the time of making it that the statement was false 2[or that it suppressed facts which it was material to disclose]: 2[Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.” Thus LIC of India doesn’t have anything to prove that: (1) the deceased had at the time of proposal for policy made a false or inaccurate statement; and (2) such statement was on a material matter; or (3) it suppressed facts which it was material to disclose. Neither of the three conditions applicable as per second part of Sec 45 of The Insurance Act, 1938 is fulfilled in the present case.
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> 2 In reference to the first 3 policies as mentioned above,
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> For the last 3 policies as mentioned above even if claim is repudiated within two years from the date policy was effected, the insurer is required to establish that the information suppressed by the deceased life assured was on material facts and that these were within his knowledge. There should be an amount of credible, reliable and acceptable evidence to substantiate the repudiation. A mere two line casual description on a medical paper without
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> supporting evidence has no value of its own
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> We also got a confirmation letter from Apollo Hospital, Bhubaneswar that they don’t have any information about the health of the deceased prior to May, 2013.
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> The deceased was suffering from Hemorrhoids at the time he was admitted to Apollo, but LIC of India doesn’t have any concrete information on material matter to prove that the deceased was suffering from Hemorrhoids prior to the date of proposal of the last policy and any ways this was not the cause of death of the deceased.
Please let me know if i will win the case. i think the case is pretty staright forward.
P. Venu
(Expert) 20 January 2015
You can take up the issue with the Insurance Ombudsman.
ajay sethi
(Expert) 20 January 2015
file complaint before consumer forum for deficiency in service against LIC and challenge repudiation by LIC
Kumar Doab
(Expert) 20 January 2015
You have already gathered some relevant clauses..........
You can lodge complaint with IRDA, DCDRF.......
It shall be better to show all docs on record to a lawyer specializing in consumer cases and your lawyer can advise you including on The jurisdiction after examining all docs and inputs.
malipeddi jaggarao
(Expert) 20 January 2015
Only legal heirs of the deceased can file the complaint against LIC. The jurisdiction will be the place wherein the legal heirs reside.
Rajendra K Goyal
(Expert) 20 January 2015
File complaint with the consumer forum. Consult local lawyer.
Advocate Bhartesh goyal
(Expert) 20 January 2015
Yes,approach to District Consumer Redressal Forum having jurisdiction, as advised by experts.
Dr J C Vashista
(Expert) 21 January 2015
Be precise, it is not a query but a story to go through and advise you properly.
T. Kalaiselvan, Advocate
(Expert) 22 January 2015
In the first place the jurisdiction lies within the place the where the policies were repudiated and not outside. Secondly, though the LUC divisional office has sent you a letter repudiating the death claims, in the same letter at the foot note they would have mentioned that in case you are not satisfied with the decision, you may approach the Zonal Manager at the concerned Zonal office with a representation for review of the decision. If you taken this step,in my opinion, the Review committee in the zonal Office will properly review and it is likely that they may admit the death claim in view of the flimsy reasons quoted by the Divisional Office, so try this, you have chances for your claims to be settled in your favor. However, if you do not get a proper response or a favorable reply, you may approach the jurisdictional consumer forum for relief and remedy.
