Death Claim - Gbic.co.in

We may mention that the insurance company did not attend the hearing fixed nor gaveany reason for non-attendance. This office has to put on record that this type ofbehaviour cannot be tolerated before a senior quasi-judiciary authority. The higherauthorities of the insurance company would henceforth ensure that there is a firmcompliance to the notice issued by this office.From the evidence available on record and from the answers given during the course ofhearing from the complainant, it could be easily presumed that Dr. R. Dubey,Homeopath from Muzaffarpur did not have any prescription of the DLA before hepassed away and the insurance company could not conclusively prove that the DLAwas treated for Prostrate Gland by him. It is clear that the DLA died of cardiac failuredue to diarrhoea, which existed in the area he was living. It is also certified by both theinvestigators that the DLA did not have any bad habit. The statement made by the 2 ndinvestigator in his report that the DLA might have suffered from some old diseasecannot be taken as having evidential value. We, therefore, came to a conclusion thatthere was no misrepresentation in the proposal form made by the DLA before takingthe policy. Accordingly, the insurance company were directed to settle the claim for Rs.2,00,000/- (Rupees two lakhs) only.Kolkata Ombudsman CentreCase No. : 153/21/001/L/06/06-07Smt. Bijoya BiswasVsLife Insurance Corporation of IndiaAward Dated : 31.01.07Facts & Submissions :We dealt with two complaints, but since the nature of complaint and the complainant inboth the cases were same, we proceeded to deal with the complaints as follows:Smt. Bijoya Biswas, wife of Late Tapan Kumar Biswas, filed a petition that LICI did notsettle the death claim of the policies purchased by her deceased husband for sumassured of Rs. 20,000/- with DOC 28.06.01 and Rs. 25,000/- with DOC 28.06.02. ShriTapan Kumar Biswas, DLA died on 09.12.03. LICI repudiated the claim under both thepolicies vide their letter dated 29.03.04 stating that the proposer did not answer thequestion in the proposal form with regard to personal history correctly and the DLAsuffered from hypertension and was a known smoker for many years. The complainantappealed to the insurance company for review but the same was denied.The insurance company in their self-contained note stated that the DLA died ofmyocardial infarction. The duration of the illness was only 6 days. The Case HistorySheet of Uma Medical Research Institute, Kolkata revealed that the DLA was a knownhypertensive, a known smoker for many years and had a history of Duodenal Ulcer withupper GI Bleeding 15 years back.A hearing was fixed calling the complainant and the officials from the insurancecompany.HEARING :During the course of hearing, the complainant Smt. Bijoya Biswas stated that herhusband was a primary School Teacher, who did not have the habit of smoking and didnot suffer from any hypertension during the period of her marriage for 17 years. Fewdays before his death i.e., on 04.12.03, he complained of pain and went to the hospitalwherein he was admitted and her husband’s brother gave some statement to thehospital authorities without her knowledge and subsequently her husband passed away