Death Claim - Gbic.co.in

Head Notes: Life assured had two policies on his life and died within a short periodfrom the commencement dates of the policies. LIC repudiated the claims on the pleathat the LA did not disclose his personal medical history correctly. Evidence submittedby LIC was found to be in order and hence the complaint was dismissed.Facts of the case:(Late) Laxman Venkatesh Raghunathi, Agricultural Assistant in the office of the Asst.Director of Agriculture, Sirsi obtained policies bearing nos. 632187163 for Rs.50000and policy no.638815586 for Rs.30000 from Sirsi branch of LIC with commencementdates of 25.3.2003 and 20.3.2004 respectively. The policies were issued under Plan14-20; 14-15 respectively and under SSS scheme. The LA died on 15.11.2004. As theclaims were treated as early claims, LIC investigated the claims and repudiated thesame as they came to know that the LA was under treatment even beforecommencement of the policies. As per evidence collected by LIC, the LA was admittedinto Rotary Charitable Hospital, Sirsi on 3.10.2002 with complaints of abdominal pain,viral hepatitis and was discharged on 5.10.2002. Further, the enquiries of LIC revealedthat the LA was a chronic alcoholic and death was due to alcoholic cirrhosis. As the lifeassured did not disclose about his hospitalization in 10/2002 for viral hepatitis, LICrepudiated the claim vide letter dated 9.3.2005.Section 45 of the Insurance Act, 1938 isnot applicable.Decision : LIC settled death claims under some more policies which were held by theLA, which come under non-early category. As per the complainant, the LA sufferedfrom illness for about a month before death, while the insurer contended that the LAwas suffering from hepatitis since 3.10.2002. They have also pleaded that there is anexus between the final cause of death and the disease for which the LA washospitalized in 10/2002. As the evidence produced by LIC was found to be in order, thecomplaint was dismissed for reasons of non-disclosure of material information.Hyderabad Ombudsman CentreCase No.L-21-001-0392-2006-07Smt. Renuka BarkiVsLife Insurance Corporation of IndiaAward Dated : 26.02.2007Head Notes: Early death claim on a policy for Rs.30000 sum assured. Death occurreddue to suicide and the LA had a proven past medical history of mental illness. Claimwas rejected by LA for reasons of suppression of past medical history. Based on theevidence produced by LIC, the complaint was dismissed without any relief.FACTS OF THE CASE AND DECISION :Late Laxman Barki, the LA under policy no.637188463 submitted a proposal for thepolicy to Haveri branch of LIC on 8.8.2003. He nominated his sister Smt. Renuka underSec.39 of the Insurance Act, 1938. The LA allegedly committed suicide on 23.11.2004by falling under a running train and as per police records, it was held to be a case ofsuicide due to mental illness. As the LA died in about one year-three months periodfrom the commencement date of the policy, LIC investigated the claim. As per formssecured by LIC, the LA was treated in Manasa Nursing Home at Shimoga from14.10.1995 to 20.10.1995 for mental disorder. The cause of death also was attributedto mental disorder by the complainant in her claim forms given to LIC. The LA wastreated in the Government Mental Hospital, Dharwad from 9.4.2004 to 8.5.2004. As thefinal cause of death is due to mental disorder, the insurer could establish a clear nexusbetween the past medical history and cause of suicide. As the insurer’s repudiation