Tarea 1 Pupila Generalizada, PSF y c´ alculo de la imagen final

One Sri Maddina Rama Mohana Naidu, S/o Sri M. Krishnama Naidu, doing business at, and a resident, of Nellore took the above life insurance policy from City Branch-II, Nellore of LIC, under Nellore Division. The policy was in a lapsed condition due to non-payment of premium due from 02/2001. Subsequently, the policy was revived by the life assured on 29.09.2001, by submitting a Declaration of Good Health Form and also paid the entire arrears of premia. But the life assured died on 30.07.2002. The cause of death was reported to be AIDS. Smt. M. Anuradha, who is the nominee and complainant under the policy, lodged a claim with the LIC. But the claim was repudiated by LIC of India, citing the reason, that the life assured, while reviving his lapsed policy, gave false answers to certain questions in the declaration of good health form, submitted by him at the time of reviving his lapsed policy. It was also stated by the LIC that they held indisputable proof, to show that even before he revived his lapsed policy, he suffered from AIDS and took

treatment for the same. He , however, did not disclose these facts in the declaration of good

health form. Instead, he gave false answers to the relevant questions in the declaration of good health form. Finding the life assured to be guilty of deliberate suppression of material facts relating to his health at the time of reviving his lapsed policy, the insurer repudiated the claim by setting aside the revival.

DECISION:-

I heard the contentions of LIC as the complainant did not attend the hearing and also perused all the documents, including the written submissions of the complainant, placed before me.

i) The life assured took a life insurance policy in 05/1999 for a Sum Assured of Rs.2,00,000. Premiums under the policy from 02/2001 onwards were not paid. Hence the policy lapsed. The life assured got the policy revived on 29.09.2001, by paying the entire arrears of premia with interest and also submitted declaration of Good Health Form, duly executed by him. Later, the life assured died on 30.07.2002. The duration of the claim from revival was just 10 months and 8 days. Since it was a very early claim, the LIC arranged for investigation of the claim;

ii) LIC repudiated the claim by setting aside the revival effected on 29.09.2001, as the life assured deliberately suppressed material facts relating to his health prior to revival of the policy. Since the policy did not acquire any paid up value as on the date of revival, as per the terms and conditions governing the policy and revival, nothing was payable to the life assured/complainant;

iii) In support of their repudiation action, the insurer, obtained a statement given by Sri M. Gopal Naidu on 16.11.2002, addressed to LIC authorities. In the said statement, Sri Gopal Naidu informed that his brother (life assured) was suffering from AIDS, even before taking the insurance policy. It was also reported by him that the life assured suppressed the above fact at the time of taking the insurance policy. It was also informed by Sri Gopal Naidu that the life assured (his brother) himself executed a will;

iv) LIC also obtained a copy of the registered will executed by the life assured himself on 21.06.1999. This will was also registered by the District Registrar,

Nellore. According to this will, the life assured was suffering from AIDS. The life assured also clearly informed the procedure to be adopted for settlement of his entire property after his death. Apparently the life assured took the policy way back, for the first time, in 05/1999 to provide some monetary benefit to the surviving as he was aware of HIV +;

v) According to the underwriting norms of LIC, had the life assured disclosed the fact he was suffering from AIDS since 06/1999 and was on treatment, at the time of revival of his lapsed policy, the insurer would have advised the life assured for obtaining some more special medical tests and depending upon the outcome of these tests, the question of considering revival would have been decided;

vi) The policy was revived on 29.09.2001, while he was suffering from AIDS and was on treatment for the same. Therefore, the life assured knew that he was suffering from AIDS and taking treatment for the same. As such, it was well within his knowledge and the life assured ought to have disclosed the same to the insurer, at the time of revival of the policy by disclosing truthfully the facts in the declaration of good health form;

vii) Even the investigating official who enquired into the bonafides of the claim also reported that the life assured was not keeping in good health at the time of revival of the policy and that the life assured was suffering from AIDS;

viii) In the circumstances of this case, therefore, the suppression of material facts by the life assured is very clear. Revival of an insurance policy is considered to be a fresh contract between the parties and in the present case, the facts suppressed were obviously material to the fresh assessment of the risk. The fraudulent intention is also very clear, in that, the life assured had not disclosed the deadly disease of AIDS (which is incurable and even terminal as per extent of treatment) in the personal statement of good health form submitted by him for the purpose of revival of his lapsed policy, although he was very much aware of the same;

ix) The insurer was well within his right to invoke Section 45 of the Insurance Act, 1938 in the present case and fulfilled all the three ingredients, as required under the said section and repudiated the claim;

x) Therefore, I have to hold for the reasons as aforesaid and also in the light of the legal evidence available on record as referred to above, the repudiation of the claim, setting aside the revival, by the insurer has to be upheld on law as well as on facts and hence the repudiation of the claim by the insurer does not warrant any interference at my hands.

The complaint is, therefore, dismissed.

Hyderabad Ombudsman Centre Case No. L-2040/2003-04

Smt. T. Gangamma Vs.

Life Insurance Corporation of India Aw ard Dated 1.1.2004

Sri D.K.Puttappa, Police Constable working in Viveknagar Police Station, Bangalore took a life insurance policy from Malleswaram Branch of Bangalore D.O.II, as per details furnished below.

Date of Proposal : 10.12.1999 Date of Acceptance/FPR : 05.01.2000

Sum Assured : 1,00,000

Plan & Term : 14-15 Date of commencement

of risk : 05.01.2000

Date of Death : 11.09.2001

Date of Repudiation : 31.12.2002 Cause of death : IVC Obstruction,

Right Plueral Effusion

FACTS OF THE CASE

Sri D.K.Puttappa, Police Constable in Viveknagar Police Station, Bangalore took the above insurance policy from Bangalore Division II of LIC of India. The life assured died on 11.09.2001. The cause of death was reported to be IVC Obstruction, Right Plueral Effusion with severe anemia, Cirrhosis of Liver. Smt. T. Gangamma, who is the nominee and complainant under the policy, lodged a claim with the LIC. The LIC repudiated her claim on 31.12.2002 citing the reason that the life assured while proposing for insurance gave false answers to certain questions in the proposal forms. It was also stated by the LIC that they held indisputable proof to show that before he proposed for the above policy, he was operated for cholecystectomy. He, however, did not disclose these facts in the proposal. Instead he gave false answers. Finding the life assured to be guilty of suppression of material facts relating to his health at the time of taking the insurance policies, the claim was repudiated by LIC.

DECISION:-

I heard the contentions of both sides and also perused all the documents placed before me.

i) The life assured took the insurance policy on 05.01.2000 after executing the proposal for insurance on 10.12.1999. He died on 11.09.2001 in Sri Jayadeva Hospital, Bangalore. The Primary Cause of death was: “IVC Obstruction” and the Secondary Cause of death was: “Right Pleural Effusion, Severe Anemia,

Cirrhosis of Liver”;

ii) The insurer obtained evidence in the form of case history from Victoria Hospital, Bangalore, where the life assured was treated during the period 28.08.2001 to 06.09.2001. Also the insurer obtained Admission sheet from Sri Jayadeva Institute of Cardiology, Bangalore, the life assured took treatment there between 06.09.2001 and 11.09.2001 i.e. the date of death.

iii) According to case sheet no 720681 of Victoria Hospital, Bangalore the life assured developed “a bout of haematemsis 3.5 years back with melena about 200-300 ml - * - *-*. The life assured was operated for Gallstone 3.5 years following which he developed abdominal distention, cord like dialation over side of chest and abdomen”. The duration of illness was reported as 3.5 years, which indicates that the life assured was not keeping in good health even before taking the policy in question.;

iv) According to the treatment particulars obtained by the insurer in their claim forms B/B1 and discharge summary from Jayadeva Institute of Cardiology,

Bangalore, the life assured was admitted there during the period 06.09.2001 to 11.09.2001, under IP No.107969, the date of death of the life assured. The history of illness was reported as “Cirrhosis of Liver and haematemisis 3

years back, cholecystectomy 3 years back, chest pain on and off’. This

clearly established the fact that the life assured was not keeping in good health at the time of taking the insurance policy;

v) The life assured was a literate person, working as a Police Constable. The diseases with which he was suffering and the various admissions and treatments for them were all well within his knowledge and he ought to have disclosed to the insurer while effecting the proposals for insurance;

vi) Incidentally, the suppression of material fact of his illness Cirrhosis of liver and other associated diseases since three years prior to his admission in Victoria Hospital, Bangalore and Sri Jayadeva Institute of Cardiology has nexus with the cause of death on 11.09.2001;

vii) From the foregoing facts of the case, it became evident that the life assured was not in good health at the time of taking the insurance policy from the insurer and he had suppressed the material facts of his ill health intentionally to defraud the insurer. Further, as the insured had undergone Cholecystectomy operation, and treatment for Haemate-misis, and other associated ailments including the fact that he was alcoholic, the insured should have disclosed these material facts while answering the relevant questions in the proposal forms. Therefore, I am of the view that repudiation of the claim by the insurer was right under Sec.45 of the Insurance Act, 1938;

viii) Therefore, for the reasons as mentioned above and in the light of the medical evidences submitted by the insurer, which were available on record, the repudiation of the claims on the ground that the insured had fraudulently suppressed the material facts relating to this health condition at the time of effecting the insurance policies is legal, proper and correct and does not warrant any interference at my hands.

The complaint is, therefore, dismissed.

Hyderabad Ombudsman Centre Case No. L-2049-2003-04

Smt. T. V.Tara Vs.

Life Insurance Corporation of India Aw ard Dated 1.1.2004

Sri T. V. Sridhar, an Electronics Engineer, employed in RELQ Software, Jayanagar, Bangalore, took a life insurance policy from City Branch-II, Shimoga of LIC under Udupi Division, as per details furnished below:-

Policy No. : 621688754

Date of Proposal : 11.07.2001 Date of Acceptance/FPR : 14.07.2001

Date of commencement : 10.06.2001 (Dated Back Case)

Sum Assured : 5,00,000

Plan & Term : 112-25 Date of Death : 02.03.2002

Date of Repudiation : 13.1 1.2002

FACTS OF THE CASE

Sri T. V. Sridhar, working as RELQ Software Engineer, Bangalore took a life insurance policy from City Branch-II, Shimoga of LIC of India, under Udupi Division. The life assured was an Electronics Engineer. The life assured died on 02.03.2002. The cause of death was reported to be Budd-Chiari Syndrome. Smt. T. V. Tara, who is the nominee and complainant under the policy, lodged a claim with the LIC. The LIC repudiated her claim on 13.11.2002, citing the reason that the life assured, while proposing for insurance, gave false answers to certain questions in the proposal form. It was also stated by the LIC that they held indisputable proof to show that about 4-1/2 months before he proposed for the above policy, he had suffered from ‘Budd-Chiari Syndrome’ disease and took treatment for the same in Kasturba Hospital, Manipal, Karnataka. He, however, did not disclose these facts in the proposal. Instead he gave false answers. Finding the life assured to be guilty of suppression of material facts relating to his health at the time of taking the insurance policy, the claim was repudiated by LIC.

I heard the contentions of both sides and also perused all the documents placed before me.

i) Sri T. V. Sridhar, working as Associate Quality Assurance Engineer in RELQ Software, Bangalore took a Jeevan Shree Policy on 14.07.2001 for a Sum Assured of Rs.5,00,000. The life assured died on 02.03.2002. The cause of death was reported to be “Budd-Chiari Syndrome”. The duration of the claim was reported just 8 months;

ii) According to the treatment particulars obtained by the insurer in their claim form B1 from the Kasturba Medical College Hospital, Manipal, the life assured was admitted there on 26.02.2001 with complaints of abdominal distension-15 days and loss of appetite-10 days and was discharged on 03.03.2001. The diagnosis arrived by them was “Budd- Chiari Syndrome”;

iii) According to the discharge summary of Kasturba Hospital, Manipal, the life assured was admitted there on 26.02.2001 vide IP No.387176-Hospital No.01371968. The treatments given in the hospital and the various pathological tests undertaken for the life assured also indicated “Ascites and moderate

hepatomegaly”;

iv) The life assured was also admitted in Bapuji Hospital, Shimoga in 12/2001, 01/2002 and 02/2002. It was reported that the life assured was a known patient of Budd-Chiari Syndrome associated with distension of abdomen, loss of appetite;

v) According to the treatment particulars obtained by the insurer in their claim forms B/Bl from Bapuji Hospital, Shimoga, the primary cause of death was: Budd-Chiari Syndrome and the secondary cause of death was (Ascites)-cardiac respiratory failure. It was also reported in these forms that the other diseases which co-existed were Ascites & Portal Hypertensive Gastropathy and the final diagnosis arrived in the hospital was “Vene-occlusive disease (Budd-Chiari Syndrome) of liver;

vi) According to Mosby’s Medical Dictionary 2003 (Page No.166), the implications of Budd-Chiari Syndrome are: A disorder of hepatic circulation, marked by

various obstruction that leads to liver enlargement, ascites, extensive development of collateral vessels and severe portal hypertension. Also called Chiari’s Syndrome;

vii) The admission and treatment by the life assured at Kasturba Hospital, Manipal was prior to taking the insurance policy;

viii) The disease with which the life assured was suffering and the admissions and treatments for the same were all well within his knowledge especially, these occurred under four months before the date of proposal and he ought to have disclosed to the insurer while effecting the proposal for insurance;

ix) From the foregoing facts of the case, it is evident that the life assured was not in good health at the time of taking the insurance policy from the insurer and he suppressed the material facts to the insurer. Though the insured had been suffering from Budd-Chiari Syndrome and other associated diseases, as reported by the hospital authorities before taking the insurance policy, the insured suppressed the material facts relating to his health condition from the insurer so as to induce the insurer to accept the proposal made by him for insurance;

x) Incidentally, the suppression of material fact of his illness Budd-Chiari Syndrome from which the life assured suffered and took treatment prior to taking the insurance policy has nexus with the cause of death on 02.03.2002; xi) From the foregoing facts of the case, it became evident that the life assured

was not in good health at the time of taking the insurance policy from the insurer and he had suppressed the material facts of his ill health intentionally to defraud the insurer. Further, as the insured was on treatment for Budd-Chiari Syndrome prior to taking the insurance policy, the insured should have disclosed these material facts while answering the relevant questions in the proposal form. Therefore, I am of the view that repudiation of the claim by the insurer was right under Sec.45 of the Insurance Act, 1938;

xii) Therefore, for the reasons as mentioned above and in the light of the medical evidences submitted by the insurer, which were available on record, the repudiation of the claim on the ground that the insured had fraudulently suppressed the material facts relating to his health condition at the time of effecting the insurance policy is legal, proper and correct and does not warrant any interference at my hands.

The complaint is, therefore, dismissed.

Hyderabad Ombudsman Centre Case No. L-1063/2003-04

Smt. K. Suguna Vs.

Life Insurance Corporation of India Aw ard Dated 4.1.2004

Sri K.Govinda Rao working as Radiographer in MGM Hospital took the following two policies:-

Policy No. : 681894589 681906182 Date of Proposal : 30.09.2000 28.03.2001

Date of Acceptance/FPR : 28.09.2000 09.07.2001 Sum Assured : 50,000 1,00,000

Plan & Term : 14-16 106-15 Date of Death : 10.08.2002

Date of Repudiation : 31.12.2002

Cause of death : Sudden heart attack

BACKGROUND

Sri K.Govinda Rao, working as Radiographer in MGM Hospital, Warangal took the above insurance policies from Warangal Branch under Warangal Division. The life assured died due to sudden heart attack on 10.08.2002. The insured was first admitted in MGM Hospital, Warangal on 13.12.1997 vide IP No.22261 and discharged on 22.12.1997, after taking treatment. The diagnosis arrived at this hospital was Lateral Wall Myocardial Infarction + HTN. He was also admitted there in 5/98 (06.05.98 to 13.05.1998) and took treatment. The life assured, according to his employer, availed leave on sick grounds during the period 06.05.1998 to 12.06.1998 and 30.11.98 to 27.01.1999. Again, the life assured was admitted in NIMS Hospital, Hyderabad on 30.11.1998 had undergone Coronary Artery Bypass Grafting Surgery on 08.12.1998 and was discharged on 14.12.1998. All the above admissions and treatments therefor were prior to taking the insurance policies in question. Smt. K.Suguna, who is the nominee under the policies, lodged a claim with the LIC for settlement of the two claims. But the claims were repudiated by LIC holding that the life assured deliberately