Death Claim - Gbic.co.in

Head Notes: Life assured availed a housing loan from SBI and covered under a GroupPolicy. Claim rejected by the insurer as the LA committed suicide within one year.Complaint allowed partially on ex gratia basis.Facts of the case and decision : (Late) K.V.Basaveswar Rao, R/o Pidiguralla Townobtained a housing loan from SBI and joined the Group Insurance Scheme namely‘Super Suraksha’. The scheme is meant for borrowers from SBI and its associatedbanks. The LA was sanctioned a loan of Rs.5 lakhs and was disbursed Rs.150000 as atthe time of his death on 12.4.2006. He joined the scheme on 12.12.2005 and as per theterms of the Master Policy, death due to suicide within one year from the date ofenrollment is not covered for payment of death claim. The life assured died due todrowning in the river Krishna. As per Police Inquest and Post Mortem reports, the lifeassured jumped into the river in a mentally depressed state. The LA’s brother gave astatement to the Police, mentioning that his brother committed suicide. Death due tosuicide within one year from the date of joining the scheme is excluded from coverageas per policy conditions. However, as the insurance company collected a singlepremium for the full term of the policy for the full value of loan and as the loandisbursed was only Rs.150000, the insurer was asked to refund Rs.10000 on ex gratiabasis.Hyderabad Ombudsman CentreCase No. : L-21-001-0228-2006-07Smt. ParvathammaVsLife Insurance Corporation of IndiaAward Dated : 29.12.2006Head notes: LA committed suicide within one year from the date of vesting under aCDA plan. Complaint allowed partially and ex-gratia to the tune of premium refundallowed.Facts of the case and decision: The complainant obtained a policy no. 720708886 forRs.12000 sum assured on the life of her minor son Sri Arkesha. The policy was takenunder a CDA plan (Table-50-14) with a deferment period of seven years. The policycommenced on 28.9.1997 and the LA was 11 years old at the time of issue of thepolicy. The vesting date was 28.9.2004 and the life assured committed suicide on10.3.2005. As per policy conditions, death due to suicide within one year from thevesting date is not covered for payment of any benefit under the policy. However, asper clause 3 of the special provisions under the policy, in case of death before thevesting date, refund of premiums can be allowed. Further, the policy provides forpayment of full sum assured in the event of the LA dying after one year from thevesting date. No logic was found in the suicide clause and hence the insurer wasordered to refund the premiums collected on ex gratia basis.Hyderabad Ombudsman CentreCase No. : L-21-001-0309-2006-07Smt. AswathammaVsLife Insurance Corporation of IndiaAward Dated : 29.12.2006Head Notes: Payment of death claim under three policies rejected by LIC on thegrounds of delayed intimation of death and suppression of material facts. Complaintdismissed.