Death Claim - Gbic.co.in

Hyderabad Ombudsman CentreCase No. : L-21-001-0121-2006-07Smt. Mallavva S. JallerVsLife Insurance Corporation of IndiaAward dated 29.10.2006Head Notes: Death claim repudiated by LIC on grounds of suppression of material facts– Record of treatment prior to the commencement of policy submitted by LIC -complaint rejected.FACTS OF THE CASE(Late) Honnappa Siddappa Jaller obtained Policy No.637341548 for Rs.100000/- underTable 149-21 with a half yearly premium of Rs.2647/-. The policy commenced on28.09.2004 and the LA died on 06.04.2005 due to encephalitis. As the LA died within 6months from commencement, LIC enquired into the bonafides of the claim. As per theirenquiries the LA had taken treatment from Dr. S.C. Bangalore, MBBS for presence ofglands on the right side of neck. The obtained prescription slips given by the doctor, asper which the LA was prescribed Akurit-4 tablets for 45 days. LIC produced evidence ofconsultations on subsequent dates also from the same doctor. The insurer contendedthat the DLA was prescribed TB drugs as he was suffering from TB and AIDS. Theyobtained opinions from the DMR showing all the prescription slips obtained by them. Astheir DMR opined that the LA was under treatment for TB before commencement, theyrepudiated the claim.The evidence produced by LIC suggests treatment taken for TB. Section 45 is notapplicable and the insurer proved suppression of fact relating to treatment taken beforecommencement of the policy. Hence decision of LIC upheld and complaint was reject.Hyderabad Ombudsman CentreCase No. : L-21-001-0126-2006-07Sri SomasekharVsLife Insurance Corporation of IndiaAward dated : 07.11.2006Head Notes: Death Claims under two policies repudiated by LIC alleging suppressionof facts – Complaint rejected.FACTS OF THE CASELate Smt. Laxmamma W/o Somasekhar obtained two policies bearing no.722519725 forRs.50000/- and 722520811 for Rs.25000/- from Sriranga Patna Branch of MysoreDivision. These two policies were taken under Janaraksha Plan (91-Table) for a 20-year term. The policies commenced on 15.01.2003 & 15.02.2003 respectively with halfyearlymode of premium. The LA died on 05.02.2005 allegedly due to chest pain.As claims occurred in less than three years, LIC enquired into the merits of the case.They came to know that the LA was suffering from renal disease one year prior tocommencement of the policies and was undergoing haemodialysis for at least twoyears prior to death. Medical record relating to treatment from 12/2001 onwards wasobtained by LIC. Further there was no cross reference of previous insurance in thepolicies. LIC also found out that the LA obtained two more policies bearing