Death Claim - Gbic.co.in

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illness by the life assured and hence the claim was allowed within the financial limits ofthe policy setting aside the repudiation.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-185/2006-07Smt.Judy FermineVs.Life Insurance Corporation of IndiaAward Dated : 01.2.2007The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 arose outof revival repudiation of a life insurance claim under Pol.No.773512167 held by thehusband of the complainant. The life assured died on 16.7.2004 due to Cardiopulmonaryarrest, septicaemia etc. at Lourdes hospital, Kochi. The policy had lapsedfrom Nov.2003 and it was revived on 26.5.2004 on the strength of a personal statementwhere under the life assured was declared to be hale and hearty. But, the investigationof early claim proved the facts to be otherwise. The life assured was an inpatient ofPVS Hospital, Kochi from 24.4.2004 to 5.5.2004 and again from 26.5.2004 to23.6.2004. The final diagnosis of the problem at the hospital was cirrhosis ofliver/portal hypertension/alcohol related disease and Diabetes. In fact, the second spellof admission of the life assured at PVS Hospital, Kochi was from 26.5.2004 and on thesame day the policy was revived on the strength of the DGH. The concealment ofmaterial facts being abundantly clear, the insurer had repudiated the revival. ThisForum found the action of the insurer justifiable in every respect and therefore thecomplaint was dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-253/2006-07Shri.K.G.Narayana KurupVs.Life Insurance Corporation of IndiaAward Dated : 07.03.2007The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 arose outof repudiation of a life insurance claim by the respondent under Pol. No. 391946562issued to Smt. Syamalamma - wife of the complainant. The life assured died on25.6.2005 while the policy had commenced only on 5.3.2004. The early claiminvestigations proved that the life assured was diagnosed of “carcinoma pancreas” atthe Lakeshore Hospital, Kochi on 23.2.2004 itself and since then she was undergoingvarious treatments including palliative therapy. The insurer had obtained all documentsfrom the hospital. The life assured was an employee of the Alappuzha Dist.Co.Op.BankLtd.and on 20.2.2004 she had applied for commutation leave from 23.2.2004 to28.2.2004 for the purpose of consultations at the hospital. The insurance proposal wassubmitted on 6.3.2004 suppressing all these serious health conditions and hence theclaim was repudiated by the insurer. On going through the records, it was revealed thatthe insurer had clinching evidence to substantiate the repudiation, which was thereforeupheld by this Forum as fully justifiable. The complaint was accordingly dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-251/2006-07Smt.Usha RamachandranVs
Life Insurance Corporation of IndiaAWARD DATED 08.03.2007The 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.391907728 held by thehusband of the complainant late Sri.Ramachandran. The deceased life assured was aCash Peon in the South Indian Bank and he was under treatment for hypertension forabout 20 years. The life assured expired on 29.6.2005 at the Amritha Hospital, Kochidue to complications arising out of renal failure, septicaemia and systemichypertension. The systemic hypertensive heart problem was detected by a Doctor evenas early as on 26.12.2003 whereas the insurance proposal was submitted on 15.7.2004without disclosing the serious health problems being suffered by the life assured. Theinsurer had conducted an investigation and they had solid proof to support therepudiation which was upheld by this Forum too. However, there were certainextenuating circumstances in the case. The widow was no in penury after the death ofher husband and her house itself is under threat of attachment by the creditors of herhusband. The complainant has two young daughters pursuing education and they haveno means of livelihood except for the meagre salary of her son. The earlier insurancepolicies of her husband were all surrendered during his life time. Considering theseagonizing circumstances, even while upholding the order of repudiation passed by theinsurer, this Forum allowed an ex-gratia of Rs.5000/- to the complainant under RuleNo.18 of the RPG Rules 1998 and the complaint was disposed of.Kochi Ombudsman CentreCase No. : IO/KCH/LI/21-001-245/2006-07Smt.BeenaVs.Life Insurance Corporation of IndiaAward Dated : 21.03.2007The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 relates torevival repudiation of a life insurance claim by the insurer under Pol.No.773030477held by the husband of the complainant. The policy had commenced from 15.12.1998and it was lapsed from 6/2003 due to non-payment of premium. The policy wassubsequently revived on 23.2.2004 on the basis of a personal statement regardinghealth dated 20.2.2004 whereunder the life assured had declared himself to be haleand hearty. However the facts of the case were otherwise. The early claiminvestigation due to revival had shown that the life assured was under treatment at theJubilee Mission Hospital, Trichur from 19.9.2003 for chronic renal failure. There were anumber of reports confirming the disease and treatment from 19.9.2003. All these factshaving been suppressed in the DGH, the insurer had repudiated the revival which wasfound fully justifiable by this Forum. However, the insured had offered the paid upvalue under the policy. The repudiation of the claim barring the paid-up value wastherefore upheld and the complaint was disposed of.Kolkata Ombudsman CentreCase No. : 184/21/001/L/06/06/07Shri Ashok BeraVsLife Insurance Corporation of IndiaAward Dated : 12.12.2006Facts & Submissions:
Page 3 and 4:
Repudiation of Claim for Payor’s
Page 5 and 6:
Award Dated : 27-11-2006Repudiation
Page 7 and 8:
The Complainant’s husband held a
Page 9:
sniped at Utmost Good Faith that fo
Page 12 and 13:
In view of the above, the decision
Page 14 and 15:
concealment of material facts regar
Page 16 and 17:
The complaint was registered and ne
Page 18 and 19:
he had never suffered from any ailm
Page 20 and 21:
from Chronic Hepatitis c Cirrhosis.
Page 22 and 23:
same till death claim arises. The R
Page 24 and 25:
adhikar ewam Rin pustika ” for Ag
Page 26 and 27:
10 days from date of commencement a
Page 28 and 29:
grounds of suppression of material
Page 30 and 31:
the claim for the reason “Suppres
Page 32 and 33:
It is observed from the Medical cer
Page 34 and 35:
It has also not been verified by th
Page 36 and 37:
disbursement of salary as reported
Page 39 and 40:
There was no dispute that the DD fo
Page 41 and 42:
proposal the contract remains uncon
Page 43 and 44:
the claim stating that her son bein
Page 45 and 46:
states that no common poison was fo
Page 47 and 48:
the Insurer on the ground that the
Page 49 and 50:
On perusing the documents it is obs
Page 51 and 52:
application for insurance on 22.12.
Page 53 and 54:
preferred a claim with the Insurer.
Page 55 and 56:
the time of taking the policies. In
Page 57 and 58:
in January 2000. The policy was rev
Page 59 and 60:
Subsequently he was referred to Tir
Page 61 and 62:
All the spells of medical leave hav
Page 63 and 64:
In the hearing, the complainant sta
Page 65 and 66:
KTVR Group Hospital due to “Hepat
Page 67 and 68:
Chennai Ombudsman CentreCase No. :
Page 69 and 70:
He was also on leave during 11.04.2
Page 71 and 72:
Life Insurance Corporation of India
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Chennai Ombudsman CentreCase No. :
Page 75 and 76:
found in the body. It was further r
Page 77 and 78:
family doctor. He admitted that his
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Smt.S.Shanthi obtained a life insur
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act. She stated that as per the sta
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evival was almost like a fresh cont
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contended that the deceased life as
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Sri J. Hussain Mohammed submitted a
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and his wife was sitting after her
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In the hearing the complainant stat
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VsLife Insurance Corporation of Ind
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Jodhpur on 11.11.2002 and was disch
Page 97 and 98:
He had concealed the material fact
Page 99 and 100:
They further needed claim forms No.
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on life of her husband Late Shri. R
Page 103 and 104:
Delhi Ombudsman CentreCase No. : LI
Page 105 and 106:
The representative from Life Insura
Page 107 and 108:
3 months and 14 days of taking poli
Page 109 and 110: 09.06.2003 and the proposal was sub
Page 111 and 112: Leukemia. Bone Marrow Report dated
Page 113 and 114: Thus, he withheld facts and was gui
Page 115 and 116: questions provided in item no.11 of
Page 117 and 118: the claims excepting the present on
Page 119 and 120: The submission of LIC is that the p
Page 121 and 122: LIC that other two policies of Sum
Page 123 and 124: Branch Office of LICI. It is stated
Page 125 and 126: We have considered the photocopies
Page 127 and 128: On the circumstances aforesaid, it
Page 129 and 130: Life Insurance Corporation of India
Page 131 and 132: nos.722662607 for Rs.50000/- and 72
Page 133 and 134: information. The insurer also suspe
Page 135 and 136: The claim was rejected by LIC stati
Page 137 and 138: Facts of the Case: (Late) G.Appa Ra
Page 139 and 140: Head Notes: Life assured availed a
Page 141 and 142: in English, which suggest that he i
Page 143 and 144: LIC about usage of herbal medicines
Page 145 and 146: age proof. She requested for settle
Page 147 and 148: the owner of the opposite vehicle i
Page 149 and 150: action was found to be based on pro
Page 151 and 152: certificate issued by one Dr.H.R.De
Page 153 and 154: suffering from disease prior to rev
Page 155 and 156: establish that the LA failed to dis
Page 157 and 158: The complaint under Rule 12(1)(b) r
Page 159: not be blamed entirely. But, the mi
Page 163 and 164: hypertensive before the inception o
Page 165 and 166: Ltd and expired on 30.09.04. Theref
Page 167 and 168: Kotak Mohindra Old Mutual Life Insu
Page 169 and 170: We may mention that the insurance c
Page 171 and 172: evidence to prove that the DLA was
Page 173 and 174: The insurance company in their self
Page 175 and 176: time of taking the policy and that
Page 177 and 178: the required papers and hence there
Page 179 and 180: their own guidelines can consider t
Page 181 and 182: the contract was not complete and e
Page 183 and 184: and, therefore, she interpreted tha
Page 185 and 186: cheque No.258433 dt.20.2.2007. Prob
Page 187 and 188: We were unable to modify the order
Page 189 and 190: certificates submitted by the claim
Page 191 and 192: Smt. Phoolpatti had lodged a compla
Page 193 and 194: dispute the will but contended that
Page 195 and 196: Jaiswal who in their report confirm
Page 197 and 198: treated the person but since the si
Page 199 and 200: 31.03.05/11.04.05 issued under the
Page 201 and 202: Shri Sarvjit Gupta had lodged a com
Page 203 and 204: complainant awarded payment of full
Page 205 and 206: with him during the period 02.03.04
Page 207 and 208: Award dated 31.02.2007Smt. Shakunta
Page 209 and 210: asis of which proposal was complete
Page 211 and 212:
Consultation/Treatment as proof of
Page 213 and 214:
Smt Shantona Kanaiya Ghosh had take
Page 215 and 216:
ody with altered behavior for few m
Page 217 and 218:
Mumbai Ombudsman CentreCase No. : L
Page 219 and 220:
Diabetes Mellitus since 20 years an
Page 221 and 222:
Jhatingrao Gaikwad to pursue the ca
Page 223 and 224:
into consideration, it would be rea
Page 225:
Mumbai Ombudsman CentreCase No. : L
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