Death Claim - Gbic.co.in

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medically fit to resume his duties after Typhoid as per the certificate given by Dr.SunilJaiswal.I, therefore, pass the Award that Smt. Lajja Devi be paid the full sum assured alongwith accident benefit under policy No.111036549 favouring late Shri Inder Singh, asper the terms and conditions of the policy.The Award shall be implemented within 30 days of receipt of the same. The complianceof the Award shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No. : LI/JD/437Shri Hapu Ram VishnoiVsLife Insurance Corporation of IndiaAward Dated : 26.02.2007Shri Hapu Ram Vishnoi has lodged a complaint with this Forum on 07.03.2005 that hislate wife Smt. Meera Devi had taken a life insurance policy No.101048092 from LifeInsurance Corporation of India. He has lodged a claim with LIC of India as Smt. MeeraDevi, the life assured, had died on 26.09.2003. LIC of India had repudiated the claimon the grounds that late Smt. Meera Devi had not disclosed in the proposal form thatshe was not keeping good health. He stated that his wife was healthy at the time ofdeclaration as he was insured at the same time. The Development Officer had madenecessary enquiries before acceptance of proposal. She was even medically examinedby the Corporation’s doctor. At the time of insurance, she had not concealed anymaterial fact and his wife was keeping good health. He has requested the Forum todirect LIC of India to pay the death claim to him as he is the nominee under the policy.LIC of India, vide their letter dated 28.03.2005, informed the Forum that Smt. MeeraDevi died due to heart failure. The Officer who has conducted the investigation, in hisreport, has declared that she was a cancer patient for the last 2-1/2 years. A certificateto this effect was obtained from Natural Health Care Centre, dated 06.01.2005 where itis declared that Smt. Meera Devi Vishnoi was admitted in the Natural Health CareCentre on 09.06.2003 and discharged on 18.06.2003. She was treated for cancer ofovaries. She had cancer of ovaries for the last 2 years. Smt. Meera Devi had submitteda proposal to LIC of India on 30.01.2003. As such, she was suffering from Cancer atthat time. She has concealed the material fact at the time of taking the policy.Accordingly, the claim was repudiated and was communicated to the nominee, ShriHapu Ram Vishnoi.At the time of hearing, the representative of LIC of India informed the Forum that oninvestigation it was found out that Smt. Meera Devi was treated at Natural Health CareCentre, Jodhpur and in her declaration submitted in the hospital, she stated that shewas suffering from cancer of ovaries for the last 2 years which was well before thecommencement of the policy. As such, they have rightly repudiated the claim.On enquiry by this Forum that on perusal of the medical report of Dr.N.Vyas dated30.01.2003 against Question No.17 (3):Do you suspect any disease of uterus, cervix or ovaries ? : NOThe representative of LIC of India informed that disease could not be identified withoutclinical/medical examination. As such there was a reply “ NO “.On examination of the papers submitted and after hearing representative of LIC ofIndia, it is observed that Smt. Meera Devi was a patient of cancer of ovaries as per theNatural Health Care Centre, Jodhpur for the last 2 years when she was admitted on
09.06.2003 and the proposal was submitted on 30.01.2003. The disease could not bedetected by the medical examiner of LIC of India since no clinical tests wereconducted. Therefore, the doctor was not able to detect the disease.Since Smt. Meera Devi has disclosed in her statement to Natural Health Care Centre,Jodhpur that she was suffering from cancer of ovaries for the last 2 years, that is,before submitting the proposal to LIC of India, there is concealment of material fact.I uphold the decision taken by LIC of India repudiating the claim of Shri Hapu RamVishnoi under the above said policy.There is no further relief to be granted to the complainant.Complaint is disposed of finally.Delhi Ombudsman CentreCase No. : LI-DL-III/04/06-07Shri Harish BansalVsLife Insurance Corporation of IndiaAward Dated : 07.03.2007Shri Harish Bansal has lodged a complaint with this Forum on 06.04.2006 that his wifeSmt. Kusum Bansal had taken a life insurance policy No.331370848 from LIC of Indiawhich was inforce at the time of her death. After filing a claim after her death, LIC ofIndia after 9 months has repudiated the same. He sees no logic for repudiating theclaim. He has requested the Forum that his case may be considered sympathetically.LIC of India, vide their letter, dated 10.05.2006, informed the Forum that PolicyNo.331370848 was issued on 31.01.2005 with date of commencement as 28.01.2005 infavour of Shri Harish Bansal and Smt. Kusum Bansal under table and term 89.20, thatis, Jeevan Sathi Plan. They have received the death intimation from Shri Harish Bansalthat Smt. Kusum Bansal had died on 20.06.2005 just after 4 months and 19 days oftaking policy due to heart attack.In the case history received from Orchid Hospital and Form No.5152 received from Dr.Arun Anand, it is stated that she was a known case of Rheumatic Arthritis andPulm.Koch’s and was taking treatment from him for the last two years for cough andcold and old arthritis. This non disclosure is material as the cause of death of lifeassured as per Orchid Hospital record is Pulm.Koch’s and Sepsis which has directnexus with the previous disease of the deceased. Therefore, they have rightlyrepudiated the claim.At the time of hearing, Shri Harish Bansal contested that his wife was medicallyexamined by Dr.S.Yadav and as per his medical report, she was not suffering from anydisease. Further, he contested that his wife died because of heart failure and notbecause of Rheumatic Arthritis. As such non disclosure of the same has no relevancewith the cause of death. His claim, therefore, should be paid.LIC of India contested that Smt. Kusum Bansal was first admitted in Orchid Hospitaland Heart Centre on 18.06.2005 at 2.10 p.m. and was discharged on 20.06.2005 andwas shifted to Kukreja Hospital and Heart Centre Private Limited and was diagnosed acase of Right sided Massive Pneumonic and Pulm.Koch. Since as per Form No.5152submitted by Dr.Arun Anand, Smt. Kusum Bansal was a patient of cough and cold andold Pulm.Coch for the last 2 years which was before the commencement of the policy,that is, 31.01.2005. The deceased life assured had not declared of her disease in theproposal form and the policy having only run for 4 months and 19 days, the claim is notpayable.
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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.
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preferred a claim with the Insurer.
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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 and 104: Delhi Ombudsman CentreCase No. : LI
Page 105 and 106: The representative from Life Insura
Page 107: 3 months and 14 days of taking poli
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
Page 155 and 156: establish that the LA failed to dis
Page 157 and 158: 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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