Death Claim - Gbic.co.in

Therefore, the view taken by the LICI as per the ‘official note’ prepared that the DLAsustained head injury caused by sudden fall due to convulsive disorder has substance.It is also established by the documents produced by the LICI that DLA was an ailingperson before DOC of the policy but there was no mention of these sufferings ordiseases in the connected part of the proposal forms submitted by DLA.Unfortunately, the proposal forms disclose that all the questions regarding ‘PersonalHistory’ were answered in negative (excepting one where the state of health has beenmentioned as ‘Good’), refer answer to question no.11 of the proposal forms. Healthcondition is an important material for the insurer to take decision in the underwritingand accordingly, it has got serious implications for which any omission or commissiontherein cannot be overlooked. Convulsion as per medical dictionary is a violentinvoluntary contraction or series of contractions of the voluntary muscles and disorderis a derangement or abnormality of function etc. Therefore, convulsion disorder is aserious disease and needs to be mentioned in order to know the actual health conditionof the proposer at or during time of submission of proposal for procurement of policy.In this context, we find that during a service career the DLA availed both privilegeleaves and sick leaves and sometimes extending over 37 days. (from 9/4/98 to 15/5/98due to convulsive disorder).We also observe that the policy duration in these cases were 2 years 8 months 18 daysand 1 year 9 months 21 days respectively procured in consecutive years of 2000 and2001, although the DLA was in service from 1997 onwards, if not from earlier period,as per available datas which contradicts the statement of the complainant in hercomplaint where it is stated that the DLA ‘discharged his duty without any absencefrom his work’. In the result, we don’t find any strong ground to interfere with thedecision arrived at by the insurer.In view of the discussions aforesaid, the matter stands closed.Guwahati Ombudsman CentreCase No. : 21/01/076/L/06-07/GHY.Smt. Sarita AgarwallaVsLife Insurance Corporation of IndiaAward Dated : 31.01.2007Facts (Statements and counter statements of the parties)The complainant is the wife of the Deceased Life Assured (DLA) who purchased thepolicy (the particulars of which is noted above) vide proposal (DOC dated 28/02/2000)and it is stated by the complainant that the DLA died on 6th December, ’03. That theLICI issued discharge voucher for Rs.2,49,200/- in December, 2003 but thereafter isnot responding to the queries regarding the full and final settlement of the death-claimlodged.The Branch Manager of Moran Branch Office of LICI vide his letter dated 25.09.06stated that the Divisional Office Jorhat has repudiated the claim on 31/07/04 but theconnected file/record of the claim case was missing.Decisions & ReasonsCorrespondences were made unfortunately with negative results to get the selfcontainednote from the LICI. Although it is stated in the complaint that 4 yearspremiums have been paid by the DLA, in support thereof no documents or copy of thepremium receipts etc. or any other documents have been filed by the complainant. Theclear ground of repudiation is also not available from the concerned Divisional Office or