Death Claim - Gbic.co.in

The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 relates torepudiation of a life insurance claim by the respondent under Pol.No.782753481 heldby the mother of the complainant. The policy was issued on 7.12.2002 based on aproposal for insurance dated 1.12.2002 where under all health related questions wereanswered as if the life assured was hale and hearty. However, the life assured died on12.5.2005 due to multiple Myeloma, CAD and Cardio-respiratory arrest. Theinvestigations conducted by the insurer proved that the life assured was diagnosed tobe suffering from Myeloma as early as in 2001 and it was further confirmed by theRegional Cancer Centre, Trivandrum in February 2002. The policy had commencedonly in December 2002. The life assured was an SSLC holder and it was improbablethat she was not aware of the seriousness of her problems. In any case, thesuppression of pre-proposal illness being very obvious, the insurer had repudiated theclaim. on going through the medical reports, this Forum also was convinced of the caseas true and therefore the action of the insurer in repudiating the claim was upheld. Thecomplaint was dismissed as devoid of merits.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-084/2006-07Smt.Lathika RamachandranVsLife Insurance Corporation of IndiaAward Dated : 26.10.2006The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 relates torepudiation of a life insurance claim by the insurer under Pol.No.392561123 held by thehusband of the complainant. The policy commenced in July 2002 and the life assureddied on 3.1.2005 at MCH Kottayam due to Diabetic nephropathy Grade V, acute renalfailure Type 2 Diabetes and Ischaemic heart disease. The Doctor of MCH Kottayam hadcertified that the life assured was suffering from Diabetes for the past 16 years. Hewas also reportedly under treatment at Mavelikkara before his admissions at MCHKottayam. In the proposal, all health related questions were answered as if the lifeassured was hale and hearty. The circumstances of the case being analysedobjectively, it was clear that all the these serious diseases could not have developed oraggravated all on a sudden and that the life assured was fully aware of them even atthe time of proposing for insurance. The suppression of material facts being very clear,the action of the insurer in repudiating the claim was upheld and the complaint wasdismissed.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-163/2006-07Sri.Kuriakose T.VsLife Insurance Corporation of IndiaAward Dated : 05.12.2006The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 relates tonon-payment of accident benefit under life insurance policy no.774269957 held by lateAlice K A, wife of the complainant. The policy was reportedly issued by the insurer inMarch 2003 without accident benefit and no loading for the said benefit was alsoincluded in the instalment premium. The life assured had died on 17.8.2005 in a trafficaccident. However, the proposal for insurance was on non-medical basis and the life