Death Claim - Gbic.co.in

were ‘negative’. and answer to the question ‘what has been your usual state of health?’ was stated ‘Good’. Thus, we find that there was a clear case of violation of utmostgood faith’ (Uberimma Fide) and accordingly, there is nothing wrong in the decision ofrepudiation recorded by theLIC Branch/Division concerned. The certificate of hospital treatment and MedicalAttendant’s Certificate issued in this context are indicative of the fact that death wasdirectly resulted from the complications of Jaundice/Hepatitis which was concealedwhile presenting the proposals for the aforesaid policies in question.In the result and on the basis of the discussions aforesaid, we find that there is nothingwrong in the act of repudiation recorded by the LIC and as such there is nothing tointerfere. The matter stands closed accordingly.Guwahati Ombudsman CentreCase No. : 21/01/053/L/06-07/GHYSri Bimal MurahVsLife Insurance Corporation of IndiaAward Dated : 18.12.2006Facts leading to grievance of complainantThe view of the complainant is that his father late Thaneswar Murah, the life assured(L.A.) purchased the policy in question during his lifetime and expired on 25/05/03.That death-claim was lodged with LICI but the claim was repudiated on the plea thatthe Deceased Life Assured (DLA) died of Carcinoma Oesophagus after suffering fortwo years before death and accordingly, nothing was payable.Counter-statements from opp.party/insurerThe view expressed by the insurance company is that DLA was suffering fromCarcinoma Oesophagus before date of commencement of the policy in question andno-disclosure of the said fact was made in the proposal/personal statement rather DLAhad given false answers to all the items under question no.11 of the proposal form andaccordingly, as per the terms and conditions of the policy the claim had to berepudiated.Decisions & ReasonsThere is no dispute that the DLA died of the disease of Carcinoma Oesophagus and insupport thereof the complainant also submitted medical record from Dr. BhubaneswarBorooah Cancer Institute. The connected proposal form shows that the policy inquestion, sum assured Rs.50,000/-, was issued consequent to proposal submitted on26th July, ’02 and all the queries made under question no.11 (personal history),excepting question regarding health condition No. 11 (i), were answered in ‘negative’stating therein in question no.11 (i) that the health condition of the proposer was‘Good’ at the time of taking the policy (DOC : 20/08/02). The certificate obtained fromemployer of the DLA states that the DLA was absent from duty w.e.f. 28/02/98 till20/08/02 and the Doctor-in-charge of Dr. Bhubaneswar Borooah Cancer Institute hassubmitted a report in Form No.5152 stating thereupon that the DLA was suffering fromCarcinoma Oesophagus for the last 2 years and he was consulted for the first time on23rd April, 2003 with symptom of difficulty in swallowing and was treated from 23/04/03till 05/05/03 which will mean that DLA was suffering from cancer on and from a datemuch earlier to DOC of the present policy which policy continued for 9 months 5 daysonly till the death of the DLA. Incidentally, it appears from the papers submitted by the