Death Claim - Gbic.co.in

next before the date of revival of the policy. The D.G.H. was signed on 9thSeptember,’04The Medical attendant’s certificate (Form No.3784 : Claim Form ‘B’), and certificate byemployer (Form 3787; claim form ‘E’ ) have clearly mentioned that DLA startedsuffering from 04-09-04 and died of Carcinoma of gall bladder. Thus, answering thequestion aforesaid in negative was not proper and correct. The employer of the DLAhas issued a certificate stating that the DLA availed commuted leave on medicalground w.e.f. 23.08.04 to 30.09.04.Therefore, evidence collected by the insurerappears to be sufficient to establish that the policy in question was revived only afterhaving the knowledge that the DLA was suffering from serious disease like cancer etcand policy was also in lapsed condition. Therefore, revival of policy was withconcealment of material facts and it appears that repudiation of the claim under factsand circumstances as discussed, was done on the genuine grounds and there is hardlyanything to agitate against such acts of insurer.However, considering the collateral prayer of the complainant that the family has beenled to great misfortune on the death of the sole earning member, some considerationsfrom this Authority may be made to help them to come out of the sufferings to someextent. It appears that approximately, an amount of Rs.15,512/- has been deposited bythe DLA as premiums in connection with the policy in question prior to his death andLICI may not loose much if, as a special case, an amount nearer to such amount ispaid to the complainant as ex-gratia relief on the strength of provisions of Rule 18 ofthe R.P.G. Rules, 1998. This step is considered necessary by this Authority particularlyin reference to the prayer of the complainant in the last few lines of complaint that ‘incase repudiation is upheld she may be given some pecuniary relief’.In view of the discussions aforesaid, it is hereby ordered that insurer will pay a sum ofRs.20,000/- (Rupees Twenty Thousand Only) as an ex gratia relief.Guwahati Ombudsman CentreCase No. : 24/01/112/L/06-07/GHY.Smt. Dipali BhuyanVsLife Insurance Corporation of IndiaAward Dated : 01.03.2007Facts (Statements and counter statements of the parties)The grievance is for non-settlement of death-claims under the three policies despiteapproaches made by the complainant on the death of insured, her husband Late JoyBhuyan on 27.12.2004.The contentions of the insurer/LICI, inter alia, are that death claims under policy nos.480684991and 481840210 were admitted by the Competent Authority on 27.11.06 andthe Branch concerned were advised to make payments. That in regard to policy no.481841755, which was assigned to P.G. Bank, policy documents were received fromthe Bank, but on examination it was found that the claim under said policy was liable tobe repudiated by setting aside the revival as it was found on investigation that the DLA(Deceased Life Assured) was bed-ridden on the day of revival of policy and had beenunder treatment of Doctors Dr. B.N. Sarma and Dr. B. Hazarika since 01/09/2004.Accordingly, the death claim in so far the sum assured was repudiated but the heirs ofthe DLA were held to be entitled to receive the ‘paid-up value along with accruedbonus upto first unpaid premium (FUP) due on 28/03/03’ etc.Decisions & Reasons