Life Insurance - Gbic.co.in

Findings : The complainant asserted that her husband was a healthy person and hadhonestly stated in the proposal forms that he smoked and took liquor occasionally. Besides,doctors authorized by LIC had examined him, to whom intake of liquor and tobacco wastruthfully disclosed. He died of jaundice on 5.2.2003 which might have been caused by foodpoisoning. The ailment was not in the knowledge of her husband or any other familymember. Sr. Divisional Manager, Chandigarh informed that the claim was repudiated onjustifiable grounds, as LA suffered from ALD and was also a habitual drinker and hedeliberately concealed material facts regarding his health. If these were disclosedcorrectly, the proposal would have been accepted only after calling for certain specialrequirements. It was further stated that no medical examination was conducted. Theproposer was required to answer questions contained in the personal statement form. Theinvestigation officer also confirmed that DLA was a habitual drinker for the last 10 years.The death report issued by hospital authorities Sec- 32, Chandigarh in form no. 3816corroborated that the insured had died due to ALD and was a habitual drunkard for the last10 years. The Zonal Claims Review Committee also rejected the representation of thecomplainant.Decision : Held that from the perusal of hospital report in form no. 3816 and the deathreport, it was abundantly clear that the death was caused by alcoholic liver disease. Thematerial fact that deceased life assured was given to excessive drinking was not disclosedat the time of purchase of policy which renders the policies a nullity. The repudiation ofclaim by the insurer was, therefore, held to be in order.Chandigarh Ombudsman CentreCase No. LIC / 410 / Ludhiana / Ludhiana - I / 24 / 05Smt. Parveen DawarVs.Life Insurance Corporation of IndiaAward Dated 28.03.05Facts : Shri Subhash Rawat issued two cheques for Rs. 7875 and Rs.6000 as deposit forpurchase of policies. The amount was credited to LIC account on 03.06.02. However, policybonds were not issued. He died on 13.07.02. Smt. Praveen, his widow, filed an applicationfor settlement of claim. She pleaded that the required proposal forms filled up by the agentwere also signed by her husband. However, neither policies nor receipts were issued. Herapplication was not entertained for want of contract due to non submission of proposalform.Findings : Sr. Divisional Manager, Ludhiana confirmed that both the cheques werecredited in LIC account on 3.6.2002. However, proposal forms were not submitted. Thedepositor had died on 13.7.02, but no intimation was given to the office. The considerationamount was deposited through the agent Shri B.P. Sood, who confirmed non receipt ofproposal forms from LA despite repeated reminders. It was stated that the deposit amountwould be refunded to class-I legal heirs of Shri Rawat on completion of formalities. Thedeath claim was not payable in view of the fact that insurance contract had not beenfinalized.On behalf of complainant it was stated that two policies were proposed by late ShriSubhash Dawar for SA of Rs. 10 lacs. After getting the cheques, the agent did not bother tocontact him again to get the proposal forms filled up. The agent stated in his report that hetried to contact the proposer to have the proposal forms filled up. But when he wasinformed by late Shri Subhash Dawar that he was having heart problem and was beingtreated at DMC, he refused the proposal and advised him to get the refund from office.Besides, the claim was lodged two years after the death of Shri Subhash Dawar.Decision : Held that it was evident that, for whatever reasons, contract between theparties was not effected. Therefore, the basis for admitting the claim does not exist. Thecomplainant also failed to explain why the claim was lodged after two years and intimation