Death Claim - Gbic.co.in

establish that the LA failed to disclose about a previous policy for a high sum assuredof Rs. 1 lakh, the repudiation action was upheld and accordingly the complaint wasdismissed without any relief.Hyderabad Ombudsman CentreCase No.L-21-009-0469-2006-07Sri I.Ramalingeswar RaoVsBajaj Allianz Life Insurance Co. Ltd.Award Dated : 30.03.2007Facts of the case & Decision:(Late) Smt. Itha Sathyavathi, a resident of Vijayawada obtained a policy bearing no.10098354 for a sum assured of Rs.150000 under ‘Unit Gain’ plan and paid a firstpremium of Rs.30,000.The policy commenced on 18.8.2005 and the LA died on22.3.2006.The complainant is the son of the LA and the nominee under the policy. TheLA died as a result of a sudden heart attack. As the LA died in about seven monthsfrom the commencement of the policy, the insurer enquired into the bonafides of theclaim. As per their enquiries, the LA was known to be a diabetic for about three yearsbefore death. This information was given in the Last Medical Attendant certificateproduced by the claimant. The complainant also admitted to the fact of treatment of hismother for diabetes. The main contention of the insurer is that the LA did not discloseabout her medical history of diabetes in her proposal form dated 03.8.2005 andpleaded that they would not have issued the policy had there been a disclosure abouttreatment for diabetes.The complainant in his submission during a personal hearing session held on28.3.2007 stated that his mother used to take oral pills for diabetes and she neverfaced any problem with diabetes. He stated that her diabetes was well under controland his mother was kept in dark by the agent about specific reply given to the relevantquestion in the proposal. He further mentioned that his mother was aged 58 years atthe time of policy issue and his mother signed on the dotted line as per the suggestionof the agent.After hearing the arguments of both sides and after examining the papers produced, itbecame evident that the insurer succeeded in proving that the LA did not discloseabout her history of diabetes. Hence it was decided to uphold the rejection action andoffer refund of the first premium paid as ex gratia relief.Hyderabad Ombudsman CentreCase No.L-21-001-0470-2006-07Smt. P.SaradammaVsLife Insurance Corporation of IndiaAward Dated : 30.03.2007Facts of the case and Decision:The complaint is about three policies taken on the life of (late) P.Nagabhushanam,Driver in APSRTC. Policy nos. 650292691; 650523409; 841852558 were taken underSSS. The policies commenced on 28.11.1190; 20.3.1995; 28.4.1998 respectively forRs.50000; 25000 & 10000.The LA was murdered on 23.6.2000 and LIC settled claimsonly for basic sum assured. Though the policies were covered for accident benefit, LICrejected payment of AB on the plea that the LA was murdered in a faction feud. As perrecord, the LA was involved in another murder case and he was on a conditional bail