Death Claim - Gbic.co.in

Contentions of Insurer: Admission into the policies was based on two separate GoodHealth Declarations. As per such declarations, the LA should not be suffering from anyphysical defect or deformity at the time of joining and he should be in sound health. Asper the scheme, persons suffering from any physical defect or deformity are not eligibleto become members. As per their investigations, the LA was a physically handicappedperson with 50% disability. He got a government job under P.H. quota and as such wasnot eligible to join the schemes. Had the LA disclosed about his disability, they wouldnot have admitted into the schemes. The insurer was not medically examined beforeentry into the schemes.Contentions of the complainant: Her husband joined a Government job in the year 1986and he worked as a Teacher till his death without taking any kind of help from others.He was having only residual polio and not suffering with defect or deformity. Herhusband did not die of deformity but died due to liver cancer. Before entering thescheme, her husband discussed with the bank authorities about his deformity and thebank officials did not object to his joining the schemes. Further, her husband’sdeformity was clearly visible to viewers and his disability was not a thing that could behidden.Decision: The main reason for rejection of the claim was non-disclosure of thedisability of the life assured. The insurer produced medical leave record of the LA as apart of their defense. As per leave record, the LA was on sick leave from 13.9.2005 to22.9.2005. This leave is prior to the LA joining policy no.83001000203. Hence, theaction of the insurer was upheld. Considering the duration of the membership underPolicy no.83001000507, it was decided to order the insurer to settle claim on gratisbasis. In effect, the complaint was allowed partially.Hyderabad Ombudsman CentreCase No.L-21-001-0442-2006-07Sri V. JakeerVsLife Insurance Corporation of IndiaAward Dated : 30.03.2007Facts of the case & Decision:(Late) Smt. V.Haseena w/o Sri V. Jakeer obtained a policy bearing no.841320285 forRs.28000/- from Piler branch of LIC. The policy commenced on 28.3.2002 under newJanaraksha plan (T&T91-15). The LA paid a half yearly premium of Rs.1034-00 and shewas a cultivator as per proposal form. The LA died on 7.6.2003 allegedly due to highfever. When the complainant submitted claim papers, LIC investigated the claim as theLA died in a very short period from the commencement date of the policy. As per theinvestigation of LIC, the LA had another policy for Rs.1 lakh sum with a policyno.840507757. The details of this policy were not mentioned while securing policyno.841320285. LIC rejected claim under the policy for Rs.28000/- and settled claim forRs.1,00,000 under the first policy. The contention of LIC is that they give insurance toself-employed females up to a maximum of Rs.1 lakh and insurance beyond that will besubject to a matching policy being there on husband’s life. In the present case as theLA’s husband was not holding any matching insurance, LIC rejected the claim on thesubsequent policy.The complainant contended that his wife paid three premiums in all with her hardearned money and requested for payment of full claim.A personal hearing of the parties was held on 28.3.2007. The complainant remainedabsent for the session and he did not deny the grounds of repudiation. As LIC could