Death Claim - Gbic.co.in

Head Notes: Repudiation of death claim on grounds of suppression material facts.Insurer submitted recorded evidence to show that material information was suppressedat the proposal stage. Complaint was rejected.Facts of the case and Decision : The complainant is the wife of the LA under pol.No. 623964080. (Late) R. Umapathi obtained a policy for Rs.30,000 sum assuredbearing pol. no. 623964080 with a commencement date of 28.7.2003. He was employedas a Head Master in the Government Model Higher primary Boys School, Thyavanige atthe time of issue of the policy and he died on 1.5.2004. As per the contention of thecomplainant, the LA was healthy at the time of issue of the policy and he suffered fromdiabetes after issue of the policy in 07/2003. The insurer contended that the LA wastreated in Bapuji Hospital at Davanagere as an in-patient for 12 days from 11.1.2002.At the time of treatment he was diagnosed to be suffering from NIDDM with alcoholiccirrhosis of liver. The LA was admitted into the same hospital for treatment during histerminal illness in 04/2004 and he died while undergoing treatment due to cirrhosis ofliver. There was clear nexus between the final cause of death and the treatment takenprior to the issue of the policy. Section 45 of the Insurance Act, 1938 is applicable andthe insurer submitted enough recorded evidence to show that the LA was not healthy atthe time of proposal. As LIC could prove that material information was suppressed witha fraudulent intent, the complaint was rejected.Hyderabad Ombudsman CentreCase No. : L-21-001-0294-2006-07Smt. P.VishalammaVsLife Insurance Corporation of IndiaAward Dated : 28.12.2006Head Notes: Repudiation of death claim on the grounds of suppression of non-paymentof premium within the days of grace. Complaint rejected as the complainant could notestablish payment of premium.Facts of the case and decision :(Late) P. Siva Kumar obtained a policy bearing no.621369242 for Rs.100, 000 sumassured under Bima Kiran Plan of LIC (T&T-111-20) and nominated his mother underSec.39 of the Insurance Act, 1938. The policy commenced on 28.6.1999 and the lifeassured died on 5.2.2006. At the time of death, the first unpaid premium was due on28.12.2005. As per policy conditions, a grace period of one month but not less thanthirty days is allowed for payment of premium. If death occurs within the grace period,the sum assured is payable after deducting the premiums due within the policyanniversary. There is no dispute between the parties regarding non-payment of thepremium due in 12/2005. The complainant contended that her son could not pay thepremium due to domestic problems and also due to non-receipt of premium notice. Theinsurer offered refund of premiums amounting to Rs.8190.00 as per their rules, whichwas rejected by the claimant. The policy conditions are very clear about consequencesof non-payment of premiums. The complaint was not allowed.Hyderabad Ombudsman CentreCase No. : L-21-002-0240-2006-07Smt. K. PadmavathiVsSBI Life Insurance Co. Ltd.Award Dated : 28.12.2006