Death Claim - Gbic.co.in

In the self-contained note the insurance company stated that the proposer signed theproposal form on 27.12.2004 and opted for back dating of the risk to 28.11.2004.Originally the proposal was accepted as risk date 27.12.2004 and after the proposersent a letter dated 18.01.05, the risk date was corrected from 27.12.04 to 28.11.04.The life assured died on 10.01.06 as per the death certificate submitted by theclaimant. As per the policy condition, the premiums are payable half yearly and thepremium has been paid up to 28.05.05 and, therefore, the policy was running with thecover up to 28.11.05. Had the DLA paid the premium before 27.12.05 for the next Halfyearlyperiod, the date of death would have fallen during the course of cover of thepolicy. Since the premium for hly. due in November’05 was not paid, according toinsurance company, only grace period was available, which was over by 27.12.05.Since the death occurred after that date i.e., on 10.01.06, the question of paying thedeath benefit did not arise.Decision :On going through the evidence available on record, it could be seen that the proposalwas dated 27.12.04 and the proposer opted for DOC of risk to be from 28.11.04, asback dating was permitted under the LICI Rules. However, inadvertently, the insurancecompany gave the date of risk from 27.12.04. The proposer did not keep quite butrequested LICI to change the DOC of risk from 27.12.04 to 28.11.04, which was dulycomplied by the LICI on 18.01.2005. The life assured paid hly. premium due on28.05.05 on 08.10.2005 and thereby the life cover was operative up to 28.11.05. Therewas no evidence to show that premium due 28.11.05 has been paid. Therefore, thegrace period comes into operation. Had he paid the premium before 27.12.05, thepolicy would have been in-force at the time of death of the life assured on 10.01.06.Now, coming to the argument of the complainant that the risk date should be taken as27.12.04, as was inadvertently done by the LICI, could not be accepted as it had beencorrected at the volition of the insured by his letter. Therefore, the grace period wouldstart only from 28.11.05 and not from 27.12.05. Under these circumstances, we wereunable to agree with the arguments of the complainant and accordingly, the petitionwas disposed without any relief to the complainant.Kolkata Ombudsman CentreCase No. : 423/21/001/L/09/06-07Shri Pradip Ranjan DeyVsLife Insurance Corporation of IndiaAward Dated : 20.02.07Facts & Submissions:This was a petition filed by Shri Pradip Ranjan Dey on repudiation of death claim byLICI.Smt. Smriti Dey, deceased life assured (DLA), a 36 year old self-employed lady,purchased a LICI policy for Rs. 1 lakh with DOC 23.04.03, date of proposal being30.06.03 and she expired on 24.01.04. Cause of death being CRF due to ruptureduterus in a case of terminated pregnancy.Shri Pradip Ranjan Dey, husband and nominee of the DLA, submitted claim forms toLICI, but the claim was repudiated due to suppression of fact of pregnancy whilesubmitting the proposal form. The claimant represented before the insuranceauthorities, but they confirmed the repudiation as the question no. 13(A) was notcorrectly answered. According to the complainant, his wife was not pregnant at the