Death Claim - Gbic.co.in

he had never suffered from any ailment whatsoever in the past and that he wasabsolutely keeping normal health, hence the contention of Complainant is not tenable.Thus, from the foregoing facts it is clear that there is a direct nexus between the causeof death and the ailments suffered by DLA. Hence, it is clear that the DLA intentionallysuppressed the material facts regarding health to the Respondent at the time ofreviving the policy in question.Insurance is a contract of Utmost Good Faith where both parties are required todisclose all the material facts. No party can be allowed to gain any undue advantage bysuppressing any fact. In the instant case, there are sufficient evidential proofs to showthat the DLA was already suffering from serious ailments but suppressed the same inthe DGH report at the time of revival. Thus, the DLA has misled the Respondent by notproviding vital information regarding his health at the time of revival and hence theRespondent was not able to take proper underwriting decision. Had the facts beenbrought to the knowledge of the Respondent, its underwriting decision would have beendifferent.In view of the circumstances stated above, I am of the considered opinion that thedecision taken by the Respondent is just and fair hence does not require anyinterference.Bhopal Ombudsman CentreCase No.: LI-1026-21/09-07/RPRSmt. Sharda Devi GuptaVsLife Insurance Corporation of IndiaAward Dated : 26.12.2006Smt. Sharda Devi Gupta, resident of Jamnapali Distt, Korba [hereinafter calledComplainant] is the wife of Late Shri Gouri Shankar Gupta, Deceased Life Assured (inshort DLA). The DLA had a life insurance policy number 382837709 taken from LIC ofIndia, DO: Raipur, BO-1, Korba [hereinafter called Respondent]. The Policycommenced on 28.03.2003 under Table/Term: 151-05 (3) for Sum Assured of Rs. 5,00,000/- The DLA expired on 13.12.2003 due to Diabetes Mellitus IAD-A with MIA withHeart Failure. The death claim was preferred by the Complainant with the Respondentbut the same was repudiated on the grounds of suppression of material facts regardinghealth of DLA at the time of taking policy. Aggrieved from the repudiation action ofRespondent, the Complainant has lodged a complaint with this Office seekingdirections to Respondent to settle the claim amount under the policy.Observations of Ombudsman : I have gone through the materials on records andsubmissions made during hearing and summarize my observations as follows:There is no dispute that the policy number 382837709 was issued to DLA by theRespondent on 28.03.2003 and death of DLA occurred on 13.12.2003.During hearing the complainant stated that the DLA was an employee of NTPC Korbataken voluntary retirement from service before more than 2 ½ years and further addedthat the leaves were taken on medical ground as DLA was transferred to Rewa wherehe did not want to join there and was trying to cancel his transfer.During hearing, the Respondent contended that there are sufficient evidencesconfirming that the DLA was a known case of DM with HTN prior to taking the policy.However, the history of aforesaid diseases/ailments was not been mentioned by theDLA in the proposal form dated 17.02.2003 submitted for above policy. The DLA wasdiagnosed for aforesaid diseases/ailments and hence the claim was repudiated due to