Death Claim - Gbic.co.in

It is quite significant to note that the policy in question, DOC-22.03.2001, was in lapsedcondition for quite a long period after the initial payment of three premiums and wasrevived only on 08/01/04 i.e., 26 days next before the death of DLA on 04/02/2004 bypayment of as many as 9 quarterly arrears of premiums w.e.f. 12/2001 to 12/2003. Theduration of the policy was 2 years 10 months 12 days in total inclusive of the revivalperiod of 26 days. As per the report of the I.O., the DLA had no income of her own. Butit appears from the proposal form that she stated her annual income as Rs.26,000/-from ‘cutting’, ‘knitting’, etc., It is also shown that her husband had a policy of sumassured of Rs.15,000/- taken on 30th January, 1987 and another of Rs.2,000/- taken inthe year 1972. But she procured the policy for sum assured of Rs.50,000/- at muchlater stage of her life in the year 2001. As per facts given under column ‘FamilyHistory’ of the proposal of her husband signed on 30-01-1987 the age of the proposerwas 53 years and age of his wife (i.e., present DLA) was 47 years and ages of childrenwere 29, 27, 24. years etc. In a policy procured by the present complainant (son of theDLA), his date of birth was shown as 20-02-1958 and age on 17-03-01 (date ofproposal) as 43 years. From this it was rightly calculated out by the insurer that underall probability, the age nearer birth of the DLA at the time of taking the present policywas 61 years. It is also stated that under table-14, the maximum age at entry is 60years. The I.O. in the enquiry report also noted that DLA had no income of her own andas per the established norms, a house-wife with no income of her own can be givenmaximum insurance equal to income of husband. The certificate issued by Gaobura on27/08/2006 shows that the DLA was having handloom and broiler farm business. If it istaken to be true then it contradicts the statement of the DLA in the proposal form whereshe stated she has having business of ‘cutting and knitting’.Thirdly, the LIC has procured information from the Headmaster of No.2 Dobok LPSchool. The copy of letter says that there is no record of any certificate being issued infavour of Ms Loufuli Begam, daughter of Alicha Ali. Ali of No.2 Dobok on 1/3/1965.Therefore, it is likely that age verification certificate was a fraudulent documentproduced while submitting the proposal. From the copies of the ‘notes and decision’ ofthe policy docket, it appears that all the relevant factors were considered by the‘standing committee’ of the insurer and there is no infirmity in the decision so arrivedat while repudiating the claim. It has been rightly submitted by the insurer that at theage of 61, the DLA was of uninsurable age and could not have taken the policyaforesaid for sum assured of Rs.50,000/-.Concluding, in the background of the discussions aforesaid, we find no infirmity in thedecision taken by the LIC/insurer and accordingly, in our view there is no scope for anyinterference from this authority.In view of the discussions and findings aforesaid, the complaint stands closed.Guwahati Ombudsman CentreCase No. : 21/01/047/L/06-07/GHYSmt. Kiran SaikiaVsLife Insurance Corporation of IndiaAward Dated : 08.12.2006Facts leading to grievance of complainantIn brief, the grievance of the complainant is that on the death of her husband , thepolicyholder, she lodged the death-claim but no settlement has been done till date.Counter-statements from opp.party/insurer