Death Claim - Gbic.co.in

eceived by insurance adviser Sri Borah on 28/05/05, i.e., even earlier than the duedate in case of due date of 8/6/05 and deposited with insurer by 15/6/05. Thephotocopy of the counterfoil of cheque has also been filed. Thus, we don’t findanything from the documents forwarded to us by the insurer to substantiate the pleathat cheques drawn on other’s account / third party account were not acceptable to theinsurer. Interestingly, other premia paid on behalf of the insured by demand drafts wereaccepted. Even the cheque no. 897312 dated 15.06.05 was not returned by the insurereither to the insurance adviser or to the insured with endorsement that such payment isnot acceptable. Rather, receipt was issued belatedly on 3rd August, ’05 by acceptingthe premium. Therefore, we find the objection raised is ‘an objection for objection’ssake’ and has not been substantiated by appropriate policy conditions to carry out anymeaning. Incidentally, it may be remembered that there is no question of fraud beingpractised as the insured died unfortunately in a motor accident on 12-07-05 afterdeposit of the premium with the advisor for necessary regularization of payment ofpremium with the insurer and it was accepted issuing receipt after his (insured) death.Therefore, we don’t agree with the decision of the insurer that the policy in questionwas in lapsed condition on the date of death of the insured.It is hereby directed that the amount due to the insured is to be paid by the insurer tothe claimant together with penal simple interest @ 6% p.a. w.e.f. 13-02-06 .Guwahati Ombudsman CentreCase No. : 21/01/079/L/06-07/GHYMr. Lamhao DoungelVsLife Insurance Corporation of IndiaAward Dated : 15.11.2006Brief Facts leading to complaintBriefly stated, the grievance of the complainant is that death-claims lodged by him withthe LICI due to death of his father in connection with two policies were repudiatedimproperly on the pretext that the D.L.A.(deceased life assured) made incorrectstatements and withheld correct informations from them regarding his health at thetime of effecting the insurance etc.Opponent’s viewsThe submission of the insurer is that it was revealed during enquiry of the death-claimsin question that the D.L.A. had been suffering from malaria-fever, gastritis andrespiratory tract infection, amoebiasis during the period of four years prior to his death.But these facts were not disclosed by the D.L.A. at the time of taking these two policiesfor which there was suppression of facts with fraudulent intentions to procure the twohigh risk policies.DECISIONS & REASONSIt appears that the doctor who treated the D.L.A. issued two certificates on 21/02/05and 06/07/05. There is no dispute that in questionnaire of item no.11 of the proposalform regarding ‘Personal History’ the answers were in ‘negative’ by the proposer/D.L.A.while submitting the proposal form, the relevant part of which is as in annexure ‘C’ tothis judgement. There is no dispute that the D.L.A. died of ‘congestive heart failure’.The medical report dated 06/07/05 is more specific and exhaustive to say why theailments for which the D.L.A. had undergone treatment were of minor nature and forshort duration. It is also there that there is no evidence of D.L.A. taking any medicalleave from his employer during his service career. Thus, if we go carefully by the