Death Claim - Gbic.co.in

hypertensive before the inception of the first policy was available and the same wasnot available before the inception of the second policy. They further stated that LICIdepended on the statement made in the OPD tickets that the life assured was a knownpatient of hypertensive and was on medication for treatment of hypertension.Treating the above as non-disclosure of material information at proposal stage, thecase was repudiated by the Divisional authority and later upheld by the Zonal authority.Decision:On going through the facts pertaining to both the policies, it was seen that the firstpolicy was settled due to lack of information with regard to the pre-existing nature ofthe various diseases suffered by the deceased life assured (DLA). By the time thesecond policy was scrutinized, the insurance authorities obtained an OPD ticket andthe analysis, which indicated that the DLA was suffering from hypertension and was onmedication. Whether there could be a connection between the continuous hypertensionor not at the time of taking the second policy, the life assured could have mentioned inthe proposal about his fall, about medication he had been taking for hypertension,which could have then given a proper understanding of the case before the policy isunderwritten. Therefore, keeping in view the totality of the circumstances and the earlydeath of the life assured, it is held that there could have been a continuous case ofhypertension and the accidental fall would have compounded the problems with regardto hypertension and, therefore, had a sudden attack of CRF in a case of myocardialinfarction. From this analysis, it is clear that the proposal form did not contain materialinformation for coming to a proper conclusion with regard to issuance of policy. We donot have any other alternative but to confirm the repudiation made by the insurancecompany on the ground of non-disclosure of material information at the proposal stage.Accordingly, the complaint is dismissed without any relief to the complainant.Kolkata Ombudsman CentreCase No. : 112/21/001/L/05/2006-07Smt. Shiela MahajanVsLife Insurance Corporation of IndiaAward Dated : 20.12.2006Facts & Submissions:The complaint was regarding repudiation of death claim on the ground of nondisclosureof material fact by the proposer under the policy by Life InsuranceCorporation of India.The complainant, Smt. Shiela Mahajan filed a death claim against the policyno.435044248 taken by her husband, late Raj Mahajan who expired on 18.8.2004 dueto sudden cardiac arrest.Late Raj Mahajan took the said policy with date of commencement on 28.7.2003 fromLICI. According to LICI, Howrah D. O., the deceased’s wife submitted her claim on28.9.2004, which was repudiated fully by the concerned Division on 15.12.2004 on theground that they had sufficient proof to suggest that the DLA suffered from Diabetesand Hypertension for the last two years. This was not disclosed in the personal historycolumn of the proposal form by the Insured at the material time. Therefore, it may betreated as ‘suppression of material fact’ before taking the policy. The complainant,thereafter represented against the decision of the LICI and requested for a review ofthe claim stating that her husband was admitted to the hospital on 18.8.2004 at around