Death Claim - Gbic.co.in

questions provided in item no.11 of the proposal form, we will find that it was notobligatory under the particular facts and circumstances of the case for the proposer tomention any ailment requiring treatment for less than one week and ailments regardingliver, stomach, heart, lung, kidney, brain or nervous system. The medical reportsprocured by the insurer do not mention attack on any such vital organ of the bodyexcepting one or two. But then, such minor disease of stomach or digestive system,viz., amoebiasis, gastritis may be overlooked and one may not remember such ailmentsparticularly when the ailments were of very short duration and not of serious nature.Therefore, we are of the humble opinion that it will be too technical interpretation ofthe proposal clauses/conditions regarding ‘Personal History’ to find and hold that therewas any case of withholding correct/material informations regarding health at the timeof effecting the insurance in order to invite serious action like the repudiation of deathclaimwhich is otherwise valid. The complainant has rightly submitted that there was nomalafide intention in filling up the proposal form and ‘all the questions were answeredhonestly and innocently on good faith’. We agree with the submissions of thecomplainant that under the particular facts and circumstances of these claims, theclaims repudiations were not justified and are liable to be set aside, which we do.It is hereby directed that the insurer will re-open and review the death-claims and takeappropriate decision for payment of the just claim due to the complainant as per theterms and conditions of the policy.Guwahati Ombudsman CentreCase No. : 24/01/003/L/06-07/GHYSri Ramesh SharmaVsLife Insurance Corporation of IndiaAward Dated : 28.11.2006Facts (Statements and counter statements of the parties) :One Sri Ramesh Sharma is the complainant. He states that his father DewchandSharma (DLA) purchased a policy from LIC, Tinsukia Branch, sum assured beingRs.45,000/- under New Jana Raksha Policy and died on 2/01/05 at Galimpur, P.O.Tariya, Dist. Saran (Chhapara), Bihar. The death claim was lodged but no settlementwas made by the LICI.The LIC has not submitted any ‘self-contained note’ although through correspondencesit is stated by Jorhat Divisional Office that it is making some enquiries like verificationof the age etc., from Muzaffarpur Divisional Office and branch office but till date noresponse from either side of offices has been made. A subsequent letter from theManager (Claims) of Jorhat Divisional Office states that the enquiry report has beenreceived by it and the matter is under process.Decisions & ReasonsIt may be noted that on registration of the complaint on 12/04/06 we have alreadyconsumed a period of over 7 months to come to a decision but failed due to non-cooperationof LIC Division concerned. It may be noted that age factor by itself, will notcreate much hindrance in settling the claim if the adjustment of premium is made asper the LIC policy conditions. We are constrained to observe that D.O., Jorhat is nottaking the matter seriously to resolve the issue quickly and efficiently but trying to dragthe matter on unacceptable grounds, making it difficult for us to dispose etc. the matterwithin 3 months as stipulated by R.P.G., 1998.In view of the discussion aforesaid, it is hereby directed that LIC will take up the matterin right earnest and settle the death-claim within next 30 days from the date of receipt