Death Claim - Gbic.co.in

20.4.2005 and the LA was engaged in hotel business. He was 54 years old and thepolicy was taken or a 25 year term. The LA died on 25.2.2006 and cause of deathreported to the insurer was for natural reasons. The complainant is the nominee underthe policy and she raised the present complaint before this office after refusal of herclaim by the insurer through their letter dated 19.7.2006. Section 45 of the InsuranceAct, 1938 is not applicable. A personal hearing session was held on 24.1.2007 atHyderabad and both sides attended the session.The LA died in about 10 months time and the policy was issued under non-medicalscheme. As per evidence secured by the insurer, the LA had undergone ECG test on14.1.2002 and he was shown to be of 70 years old at that time. The insurer produced acopy of Health Card from SSH Dispensary dated 7.2.2001, wherein the LA was shownas 75 years old and was stated to have been treated from 14.2.2005 to 20.2.2005.The complainant contended that her husband visited a doctor on 14.11.2002 becauseof body pains. He had undergone ECG as suggested by the doctor and no problem wasnoticed in the ECG. In the month of 04/2005, the LA consulted a Homeo doctor forknee pains, which was a minor problem. She contended that there was nounderstatement of age of the LA and there was no history of treatment for any disease.After personal hearing session and after examining various papers submitted by bothsides, it was felt that the insurer has not proved in a convincing manner aboutsuppression of material information. As the insurer could not produce any substantialevidence to prove their point, the complaint was admitted and the insurer was asked topay benefits under the policy.Hyderabad Ombudsman CentreCase No.L-21-001-0380-2006-07Smt. M.RavanammaVsLife Insurance Corporation of IndiaAward Dated : 31.01.2007Facts of the Case and Decision:(Late) M. Malli Babu S/o Bapanna obtained a policy no.693403757 for a sum assuredof Rs.1 lakh from Rajam branch of LIC. The policy was taken under ‘jeevan Anand’ plan(T-149-16) with a half yearly premium of Rs.4285.00 and the commencement date was26.3.2004. The LA died on 22.5.2005 due to renal failure. As death claim occurredwithin a period of one year, LIC enquired into the bonafides of the claim and repudiatedthe claim vide their letter dated 31.3.2006. The claim was rejected stating that the LAunderstated his age at the time of proposal and did not disclose information aboutprevious insurance policies while proposing for the present policy.A personal hearing session was held on 24.1.2007 at Hyderabad and both sides werepresent and submitted their contentions. The insurer contended that during the courseof their investigations, they came to know that the LA had a previous policy bearingno.690342135 for Rs.60,000 and it matured on 28.3.2005. As per the old policy, the LAwas born on 1.12.1943, while the DOB declared under the present policy was 1.7.57.They contended that there was a clear understatement in age by 14 years and allegedthat the LA made a deliberate understatement to commit a fraud on them.The complainant contended that she was not aware of the previous policy as thematurity value was claimed by the LA during his life time. She claimed that herhusband was given the present policy based on a voter identity card, which is a valid