Death Claim - Gbic.co.in

yellowish discolourization of the eyes and swelling of abdomen for last 20 days, historyof known ethonolic for ten (10) years, and he was diagnosed to be a case of Cirrhosisof Liver with decompensation in precoma, and was managed conservatively. The dateof admission being 05/02/04 and discharged being 07/02/04. The RIM Hospital ofImphal where DLA was treated from 7/2/04 till 10/2/04 ( a day before the date of death)also issued a certificate that Shri W. Biren Singh was diagnosed as an AlcoholicCirrhosis on his admission on 08.02.04.The employer of DLA also issued a certificatestating that DLA availed 30 days earned leave on medical ground w.e.f. 28.09.02 to27.10.02 due to fracture of left leg.It is also seen that it is a policy which ran for 3 years 3 months 25 days since DOCincluding the lapse period and after revival the duration of the policy was 6 months 2days only. Thus, repudiation appears to be justified. But the complainant has alsoprayed for reliefs otherwise on humanitarian ground due to her pathetic financialcondition.Situated such, we find no ground to interfere with the decision of repudiation of theclaim on merit but are of the opinion to grant an ex-gratia relief of Rs.15,000/- on thestrength of Rule 18 of the R.P.G. Rules, 1998. The LICI may pay the same withinreasonable time with intimation to this Authority.Guwahati Ombudsman CentreCase No. : 21/01/150/L/06-07/GHYSmt. Geeta MaliVsLife Insurance Corporation of IndiaAward Dated : 29.03.2007Facts (Statements and counter statements of the parties)The complainant states that her husband expired on 13th April, 2005 and death-claimin connection with the two policies above noted were made but were repudiated by LICI(Jorhat Divisional Office). That representation to Zonal Manager was also without anypositive result. Hence this complaint.The stand taken by the LICI is that the Deceased Life Assured (DLA) had given twodifferent dates of birth, i.e., 09/06/63 and 20/04/64, in the concerned proposal forms.That LICI could procure certificate from employer of the DLA where his date of birth(DOB) has been stated as 28/06/1946 and thus, there was large difference to theextent of about 17 years or so in between the given ages and real age (collected fromemployer). That had the actual age been disclosed, the insurer would not haveaccepted his proposals and accordingly, as per terms and conditions of the policy, thedeath-claims were repudiated.Decisions & ReasonsWe have considered the views expressed by the parties and perused the documentsand noted the contents thereof. Interestingly, it appears that the policies wereaccepted by the insurance company without ‘age proof’ and now at the time when theclaims have arisen, it is demanding ‘proof of age’. The complainant has stated that dueto devastating fire her house was completely burnt down for which she is not in aposition to supply ‘age proof’ certificate. It appears that in the policies different DOBswere given and hence there was scope for the insurance company to ask forclarification to remove the doubt before accepting the proposals. Evidently which wasnot done and now, the insurance company has raised the issue after collecting acertificate from the employer where a different DOB has been mentioned.