Death Claim - Gbic.co.in

concealment of material facts regarding health of DLA. Had the DLA’s ill health andtreatment details been brought to the knowledge of the Respondent in the proposalform submitted by the DLA, the underwriting decision of the Respondent would havebeen different.It is observed from the Medical certificate dated 10.06.2002 and 10.08.2002 issued bythe Medical Officer of NTPC Hospital Korba (M.P.) that the DLA was suffering from DMc Nephrotities & DM c HT c IHD with CRF and the same is also confirmed from theOPD Ticket issued by the NTPC Hospital Korba. Hence the contention of theComplainant that the leaves are taken on medical ground for other purpose is nottenable.It is also observed from Claim forms B & B1 issued by the NTPC Hospital Korba whoattended the DLA during his last illness that the primary cause of death is DiabetesMellitus c IHD with the history of disease of 15 years. This clearly shows that DLA wasalready suffering from Diabetes Mellitus and Hypertension but intentionally suppressedin the Proposal forms under 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 present case, there are sufficient evidential proofs to showthat the DLA was already suffering from serious ailments but suppressed in theProposal form. Had the same been brought to the knowledge of the Respondent, theunderwriting decision would have been different.In view of the above, the decision taken by the Respondent is just and fair hence doesnot require any interference.The complaint is dismissed without any relief.Bhopal Ombudsman CentreCase No.: LI-974-21/08-07/RPRShri Dilip Kumar ShrivastavVsLife Insurance Corporation of IndiaAward Dated : 26.12.2006Shri Dilip Kumar Shrivastav, resident of Keshkal Distt.: Bastar (M.P.) [hereinaftercalled Complainant] is the husband of late Smt. Shakuntala Shrivatav, Deceased LifeAssured [in short DLA]. The DLA took a life insurance policy numbered 382886548under Table/Term 14-5 for sum assured of Rs 1,00,000/- from LIC of India, DO: Raipur,BO Jagdalpur [hereinafter called Respondent]. The Policy commenced on 28.12.2002.The DLA died on 28.11.2003 due to Rheumatic Heart Disease. The death claim waspreferred by Complainant with the Respondent which was repudiated by theRespondent on the grounds of suppression of material facts regarding health of DLA atthe time of taking the policy. The complainant had referred the case to Respondent’sClaims Review Committee for reconsideration which was also upheld by them on06.06.2006. Aggrieved from the repudiation action of Respondent, the Complainant haslodged a complaint with this Office seeking directions to the Respondent to settle theclaim amount.Observations of Ombudsman : I have gone through the materials on records andsubmissions made during hearing and my observations are as follows:There is no dispute that the Policy No. 382886548 was issued to DLA by theRespondent on 28.12.2002 and death of DLA occurred on 28.11.2003.During hearing, the complainant informed that the DLA was not suffering from anydisease and was in good health at the time of taking the policy in question. The