Death Claim - Gbic.co.in

Complainant further informed that the DLA was admitted for second delivery in theChristian Hospital, Dhamtari in the year 1991 and she was in good health afterdischarge from the hospital till 4 th January 2003.During hearing, the Respondent replied that there is sufficient evidence confirming thatthe DLA was suffering from Rheumatic Heart Disease with other ailments since 1991which was not disclosed at the time of taking the policy no. 383886548 on 25.12.2002.This information was very much material to the Respondent for deciding the case.Considering the above facts the Respondent repudiate the claim with the reason“suppression of material facts”.On scrutiny, it is observed from the certificate issued by the Dr. S.K.Chatterjee Medicalsuperintendent of Dhamtary Christian Hospital, Dhamtari (C.G.) dated 16.05.2005 thatthe DLA was taking treatment from DCH DMT for sever MR Mild to Moderate MS,Chronic Rheumatic Heart Disease sickle cell D/s irregularly since 1991.It is also seen from the copy of ECHO CARDIOGRAM Report dated 02.05.2003 fromthe Cardiologist, Dhamtari Christian Hospital, Dhamtari that the clinical diagnosis isRHD with MS + MR.Thus, from the foregoing facts it is clear that the DLA has intentionally suppressed thematerial facts regarding her health to the Respondent at the time of taking the policy inquestion.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 instant case, there is a sufficient evidential proof to showthat the DLA was already suffering from serious ailments but suppressed the same inthe proposal form at the time of taking the policy. Thus, the DLA has misled theRespondent by not providing vital information regarding her health at the time ofproposal and hence the Respondent was not able to take proper underwriting decision.Had the facts been brought to the knowledge of the Respondent, its underwritingdecision would have been different.In view of the circumstances stated above, I am of the considered opinion that thedecision taken by the Respondent is just and fair hence does not require anyinterference.The complaint is dismissed without any relief.Bhopal Ombudsman CentreCase No.: LI-1066-21/10-07/INDSmt.Ratan Bai BaroniaVsLife Insurance Corporation of India, DO: IndoreAward Dated : 28.12.2006Smt. Ratan Bai Baronia, resident of Indore [hereinafter called Complainant] is the wifeof Late Shri Gopal Baronia, Deceased Life Assured (in short DLA). The DLA had a lifeinsurance policy number 340361465 taken from LIC of India, DO: Indore, BO-1, Indore[hereinafter called Respondent]. The Policy commenced on 11.02.2003 underTable/Term: 154-12 for Sum Assured of 50,000/- The DLA expired on 18.09.2005 dueto heart attack. The death claim was preferred by the Complainant with the Respondentbut the same was repudiated on the grounds of suppression of material facts regardinghealth of DLA at the time of taking policy. Aggrieved from the repudiation action ofRespondent, the Complainant has lodged a complaint with this Office seekingdirections to Respondent to settle the claim amount under the policy.