Death Claim - Gbic.co.in

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was revived on 08.09.2003.Life Assured expired due to brain stroke on 09.09.2003 atSaudi Arabia. Life Assured was not present in India on 08.09.2003 when the policy wasrevived and his signatures on the Declaration of Good Health were found forged by theHand Writing Expert. Life Insurance Corporation of India vide their letter dated02.12.2004 repudiated Death Claim on the ground that Life Assured was not present inIndia and was abroad as on 08.08.2003 which is date of Declaration of Good Healthand date of revival. Policy was revived with fraudulent intention by making forgedsignature of the deceased Life Assured on Declaration of Good Health.I phold the decision of Life Insurance Corporation of India vide their letter Ref No.claim/D/Rep/48/191785035 dated 02.12.2004 Ref NO: claim/D/rep./48/191785035,repudiating the Death Claim.Complaint is disposed of.Delhi Ombudsman CentreCase No. : LI-DL-I/214/04-05Shri Satish ChandVsLife Insurance Corporation of IndiaAward Dated : 29.12.06My office has received a complaint from Shri Satish Chand on 10.09.2004 against LifeInsurance Corporation of India, Divisional Office -I, Delhi, regarding the adjustment ofpremiums under policy No. 112417761.During the hearing on 27.12.2006 the complainant Shri Satish Chand was absent andthe Life Insurance Corporation of India, Divisional Office -I, was represented by Smt.Santosh Bakshi Manager (PS/SSS), Sh. R.K. Premi A.O(SSS) and Ms. Renu F. SethiA.O. (PS/Claims). The representatives of Life Insurance Corporation of India hasconfirmed vide their letter dated 23.12.2006 that the Death claim has been settled bythem vide their cheque No. 271460 dated 19.7.2006 for Rs. 69065/-. The SurvivalBenefit, which was due on 28.3.2004, has also been paid vide cheque No. 272266dated 23.8.2006 for Rs. 10000/- favoring Smt. Maya Devi (Nominee of Late Shri SatishChand). The Life Insurance Corporation of India has also paid the penal interest ondelayed payment of Survival Benefit vide cheque No. 275753 dated 23.12.2006 for Rs.1860/-There is no further relief to be granted to the complainant.The complaint is disposed.Delhi Ombudsman CentreCase No. : LI-DL-I/285/04-05Shri Devender KumarVsLife Insurance Corporation of IndiaAward Dated : 29.12.06My office has received a complaint from Shri Devender Kumar on 1.11.2004 that LifeInsurance Corporation of India, Divisional Office-I, Delhi, has not settled the DeathClaim under Policy No. 120575564.During the hearing on 27.12.2006 the complainant Shri. Devender Kumar was notpresent and Life Insurance Corporation of India was represented by Ms. RanjanaKumar Manager(claims), Sh. Rakesh Bajaj A.O(claims), Ms. Renu Fotedar A.O(claims).
The representative from Life Insurance Corporation of India, confirmed vide their letterdated 22.12.2006 that the Death Claim has been settled and a sum of Rs. 107600/- hasbeen paid vide cheque No. 275707 dated 22.12.2006. This claim cheque was handedover to the complainant personally on 22.12.2006There is no further relief to be granted to the complainant.The complaint is disposed.Delhi Ombudsman CentreCase No. : LI-ICICI - 107/06Smt. Nathi BaiVsICICI Prudential Life Insurance Co. Ltd.Award Dated : 29.12.06My office has received a complaint on 20.10.2006 from Smt. Nathi Bai against theICICI Prudential Life Insurance Co. Ltd., that Death Claim of Late Sh. Bahadur Singhunder Policy No. 02357482 has not been settled by the ICICI Prudential Life InsuranceCo. Ltd.ICICI Prudential Life Insurance Co. Ltd., has informed vide their letter dated12.12.2006 that the matter of this complaint has been examined by the InternalGrievance Redressal Committee of the company and it was decided to give ex-gratiapayment of Rs. 100000 to the complainant. The complainant Smt. Nathi Bai hasaccepted the payment and has withdrawn her complaint.In the circumstances, there is no further relief to be granted to the complainant. Thecomplaint is disposed of finally.Delhi Ombudsman CentreCase No. : LI/DL-II/257/05-06Smt.Anu MahendruVsLife Insurance Corporation of IndiaAward Dated : 08.01.2007Smt. Anu Mahendru lodged a complaint with this Forum on 13.09.2005 that her latehusband Shri Atul Kumar Mahendru had taken three LIC policies No.110456368,120367153 and 120700117. The Central Office, Claim Review Committee of LIC ofIndia had repudiated the claim upholding the decision of the lower office.LIC of India, vide their letter dated 16.11.2005, informed that Shri Atul KumarMahendru had taken three policies under Table 75-20 which commenced from13.03.1987, 15.02.1994 and 15.01.1996 respectively. Sum Assured of above mentionedpolicies was Rs.25000/-, Rs.50,000/- and Rs.3,00,000/- respectively. Shri Atul KumarMahendru had died on 11.01.2004. Revival was effected on 26.06.2003 under PolicyNo.120700117. Claim was rejected due to non-disclosure of material informationregarding previous/prolonged illness of cirrhosis of Liver with Portal HTN, upper GIBleed, Esophageal varices from which he was suffering since November,2002 as isevident from claim form. The claimant herself admitted this fact in the claim form thather husband was suffering from Liver Problem since November,2002 and he receivedtreatment from Dr.J.C.Vij of Pushpawati Singhania Research Institute during the period11.04.2002 to 07.02.2003 on different dates as is evident from Discharge Summary andClaim form. Policies were revived in June 2003 without disclosing previous/prolongedillness of Life assured from which he was suffering from 04.2002. He did not disclose
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Repudiation of Claim for Payor’s
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Award Dated : 27-11-2006Repudiation
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The Complainant’s husband held a
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sniped at Utmost Good Faith that fo
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In view of the above, the decision
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concealment of material facts regar
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The complaint was registered and ne
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he had never suffered from any ailm
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from Chronic Hepatitis c Cirrhosis.
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same till death claim arises. The R
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adhikar ewam Rin pustika ” for Ag
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10 days from date of commencement a
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grounds of suppression of material
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the claim for the reason “Suppres
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It is observed from the Medical cer
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It has also not been verified by th
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disbursement of salary as reported
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There was no dispute that the DD fo
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proposal the contract remains uncon
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the claim stating that her son bein
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states that no common poison was fo
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the Insurer on the ground that the
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On perusing the documents it is obs
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application for insurance on 22.12.
Page 53 and 54: preferred a claim with the Insurer.
Page 55 and 56: the time of taking the policies. In
Page 57 and 58: in January 2000. The policy was rev
Page 59 and 60: Subsequently he was referred to Tir
Page 61 and 62: All the spells of medical leave hav
Page 63 and 64: In the hearing, the complainant sta
Page 65 and 66: KTVR Group Hospital due to “Hepat
Page 67 and 68: Chennai Ombudsman CentreCase No. :
Page 69 and 70: He was also on leave during 11.04.2
Page 71 and 72: Life Insurance Corporation of India
Page 73 and 74: Chennai Ombudsman CentreCase No. :
Page 75 and 76: found in the body. It was further r
Page 77 and 78: family doctor. He admitted that his
Page 79 and 80: Smt.S.Shanthi obtained a life insur
Page 81 and 82: act. She stated that as per the sta
Page 83 and 84: evival was almost like a fresh cont
Page 85 and 86: contended that the deceased life as
Page 87 and 88: Sri J. Hussain Mohammed submitted a
Page 89 and 90: and his wife was sitting after her
Page 91 and 92: In the hearing the complainant stat
Page 93 and 94: VsLife Insurance Corporation of Ind
Page 95 and 96: Jodhpur on 11.11.2002 and was disch
Page 97 and 98: He had concealed the material fact
Page 99 and 100: They further needed claim forms No.
Page 101 and 102: on life of her husband Late Shri. R
Page 103: Delhi Ombudsman CentreCase No. : LI
Page 107 and 108: 3 months and 14 days of taking poli
Page 109 and 110: 09.06.2003 and the proposal was sub
Page 111 and 112: Leukemia. Bone Marrow Report dated
Page 113 and 114: Thus, he withheld facts and was gui
Page 115 and 116: questions provided in item no.11 of
Page 117 and 118: the claims excepting the present on
Page 119 and 120: The submission of LIC is that the p
Page 121 and 122: LIC that other two policies of Sum
Page 123 and 124: Branch Office of LICI. It is stated
Page 125 and 126: We have considered the photocopies
Page 127 and 128: On the circumstances aforesaid, it
Page 129 and 130: Life Insurance Corporation of India
Page 131 and 132: nos.722662607 for Rs.50000/- and 72
Page 133 and 134: information. The insurer also suspe
Page 135 and 136: The claim was rejected by LIC stati
Page 137 and 138: Facts of the Case: (Late) G.Appa Ra
Page 139 and 140: Head Notes: Life assured availed a
Page 141 and 142: in English, which suggest that he i
Page 143 and 144: LIC about usage of herbal medicines
Page 145 and 146: age proof. She requested for settle
Page 147 and 148: the owner of the opposite vehicle i
Page 149 and 150: action was found to be based on pro
Page 151 and 152: certificate issued by one Dr.H.R.De
Page 153 and 154: suffering from disease prior to rev
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establish that the LA failed to dis
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The complaint under Rule 12(1)(b) r
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not be blamed entirely. But, the mi
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Life Insurance Corporation of India
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hypertensive before the inception o
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Ltd and expired on 30.09.04. Theref
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Kotak Mohindra Old Mutual Life Insu
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We may mention that the insurance c
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evidence to prove that the DLA was
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The insurance company in their self
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time of taking the policy and that
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the required papers and hence there
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their own guidelines can consider t
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the contract was not complete and e
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and, therefore, she interpreted tha
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cheque No.258433 dt.20.2.2007. Prob
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We were unable to modify the order
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certificates submitted by the claim
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Smt. Phoolpatti had lodged a compla
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dispute the will but contended that
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Jaiswal who in their report confirm
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treated the person but since the si
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31.03.05/11.04.05 issued under the
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Shri Sarvjit Gupta had lodged a com
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complainant awarded payment of full
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with him during the period 02.03.04
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Award dated 31.02.2007Smt. Shakunta
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asis of which proposal was complete
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Consultation/Treatment as proof of
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Smt Shantona Kanaiya Ghosh had take
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ody with altered behavior for few m
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Mumbai Ombudsman CentreCase No. : L
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Diabetes Mellitus since 20 years an
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Jhatingrao Gaikwad to pursue the ca
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into consideration, it would be rea
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Mumbai Ombudsman CentreCase No. : L
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