Death Claim - Gbic.co.in

The submission of LIC is that the policy was in the lapsed condition due to nonpaymentof premium due 2/2005. That the premium due 1/05 was adjusted on 31/3/05but three numbers of MLY premiums due 2/2005, 3/2005 and 4/2005, were not paidbefore the death taking place on 8/5/2005. That the claim is not payable because thepolicy was lapsed and that although it was a ‘SSS’ policy, the DLA was bound to paythe premiums in view of the fact that DLA signed on Annexure-I(A) & Annexure II (A) ofthe policy which makes it mandatory (although under SSS) for the insured to makepayment of the premium due in case there was no deduction from monthly salary etc.Decisions & ReasonsSo, the terms and conditions aforesaid clearly debars the insured (DLA) to claim reliefif there is any non-payment of the premium by the employer unless and until in suchdefault he himself has paid the premium to keep the policy in running condition.Be that as it may, the policy in question was in running condition for more than one anda half year and the insured died due to sudden heart attack leaving behind his wife andcollege-going children. We think some ex-gratia relief may be given to the familymember of the DLA to overcome the sudden financial distress, particularly, in view ofthe fact that reasons for non-payment of the premium was due to non-availability of thesalary of the DLA and circumstances beyond his control.In view of findings and discussions as aforesaid in exercise of powers under Rule 18 ofR.P.G. Rules, 1998 I hereby direct that 50% of the sum assured may be paid to thenominee of the DLA/claimant.Guwahati Ombudsman CentreCase No. : 21/01/072/L/06-07/GHYSmt. Lakhimi DuttaVsLife Insurance Corporation of IndiaAward Dated : 19.12.2006FactsDeath-claims under the above-mentioned two policies were repudiated by the insurer,hence this complaint.The insurer would submits that Deceased Life Assured (DLA) had been suffering fromJaundice/Hepatitis before the date of commencement of the above-noted polices andthere is evidence of his availing leave for 79 days w.e.f. 01/10/2002 till 20/12/02. Thatthe DLA did not disclose his ailments while filling-up the proposal forms at the relevantplace. That he gave false answers to questions in item no.11 of the proposal forms andaccordingly, as per terms and conditions of the contract, the claim under the aforesaidpolicies were repudiated.Decisions & ReasonsIt will be seen that the DOCs in both the cases were 8/5/03 and duration of the policies5 months 27 days. LIC collected certificate from Dr. P.C. Saikia which has certified thatDLA was victim of ailment of Jaundice c infects hepatitis from 01-10-02 to 21-10-02..There is also a discharge certificate issued by Srishti Hospitals & Research Centre (P)Ltd., Paltan Bazar, Dibrugarh showing admission of the DLA on 04/03/03 for ‘FUC ofRTA with Ethanol dependence’. The certificate issued by Dy. Director, Food & CivilSupplies, Dibrugarh, shows that the DLA availed earned leave on medical ground from01/10/2002 to 20/12/2002. The enquiry report of the ABM(S), Jorhat DO, has clearlyindicated that the DLA was not in good health at the time of proposal and the claim isnot at all genuine. In connection with both the proposals, the answers of the proposer