Death Claim - Gbic.co.in

the owner of the opposite vehicle involved in the accident. The LA was riding amotorcycle at the time of accident and the opposite vehicle involved was a heavyvehicle.After hearing the contentions of both sides it was decided to uphold the decision takenby LIC, as the exclusion clause provided in the policy is very clear about non-paymentof the benefit when the LA is under intoxication. In effect the complaint is dismissed.Hyderabad Ombudsman CentreCase No.L-21-001-0419-2006-07Smt. K.V.LalithammaVsLife Insurance Corporation of IndiaAward Dated : 22.02.2007Facts of the Case:(Late) K. Ramappa s/o Thimmaji obtained policy no.660998180 for a sum assured ofRs.1,00,000 from Hospet branch of LIC. The LA nominated his wife Smt.K.V.Lalithamma under Sec.39 of the Insurance Act, 1938. The policy commenced on5.6.2003, under T-149-16 with a half-yearly premium of Rs.4785.00. The LA died on7.11.2004 and his age at entry was 57 years. The policy was completed under Medicalscheme of LIC. The policy completed duration of 1Y-5M at the time of death.As the claim turned out to be a very early one as per standards of LIC, theyinvestigated it repudiated on 27.3.2006 on the grounds that the LA did not discloseabout his voluntary retirement from service on health grounds. The LA was employedwith Indian Railways and he took VRS w.e.f.28.2.2003.As per evidence obtained by LIC, the LA was treated as an in-patient in the RailwayHospital for hypertension since 25.5.2001. He was on regular treatment thereafter andhe was treated in the hospital from 29.6.202 to 27.11.2002. The doctors of Railwayhospital have recommended for VRS on health grounds and the LA applied for VRS on19.11.2002. He was discharged from service on 28.2.2003. The LA however did notdisclose the details of previous treatment and reasons for his voluntary retirement fromservice in his proposal dated 4.6.2003. The insurer produced a photo copy of themedical pass book issued by the Railway Hospital to support their action of repudiationof claim.DECISIONThe LA was aged 57 when he applied for insurance and his proposal was completed onthe strength of a medical report. The LA did mention in his proposal that he was aretired employee of Railways. This indicates that the insurer had a fair chance ofknowing further about the retirement status and about actual condition of health.Hence, there appears to be some failure on the part of the insurer in getting requireddata before issuing the policy. Considering the other facts, it was decided to award anex-gratia payment of Rs.50,000.Hyderabad Ombudsman CentreCase No.L-21-001-0332-2006-07Smt. Vanitha Laxman RaghunathiVsLife Insurance Corporation of IndiaAward Dated : 22.02.2007