Death Claim - Gbic.co.in

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This was a petition filed by Smt. Bharati Kumari for non-settlement of death claim onthe life of her father by LICI.Shri Ram Narayan Mahato, deceased life assured (DLA), purchased a policy with dateof commencement (DOC) 28.03.03. He expired on 18.12.03 and duration of the policywas 8 months 21 days. The cause of death was not mentioned in the claim form. All thedocuments were submitted to LICI, but even after 3 years the insurance company didnot settle her claim. Hence, this petition for relief.LICI, Muzaffarpur Division stated that the DLA had understated his age in the proposalform by 10 years. They also suspected that some tampering was done in the RationCard submitted by the DLA as another proof of actual age, as the original policy wasissued as a non-standard policy. In the self-contained note, LICI informed that theycould not take any decision with regard to the claim, as there was a doubt with regardto suppression of the actual age.HEARING :A hearing was fixed. None attended on behalf of the complainant while therepresentative of LICI attended. The representative of LICI was directed to take adecision with regard to claim and convey the same before 26.02.07.Decision :This office received a fax dated 20.02.07 from LICI, Muzaffarpur Division stating thatthey could not procure further evidence of suppression of age or ill health of the DLA.Therefore, they admitted the claim for basic sum assured in favour of the nominee. Thenominee also sent a letter dated 16.02.07 stating that she could not attend the hearingat Kolkata due to distance. Since LICI had already admitted the claim, we directed theinsurance company to settle the claim. We also requested the complainant to complywith the requirements of LICI.Kolkata Ombudsman CentreCase No. : 214/24/001/L/06/06-07Shri Padma Narain SinhaVsLife Insurance Corporation of IndiaAward Dated : 06.03.07Facts & Submissions :This was a petition filed by Shri Padma Narain Sinha for non-settlement of death claimby LICI.Shri Padma Narain Sinha filed his complaint for non-settlement of death claim on thepolicy taken on the life of his deceased wife Smt. Sumitra Devi, DLA. From the ‘P’ formand allied papers submitted by the complainant, it was found that the life assured diedon 15.06.1989 due to heart attack at the age of 49. The complainant did not furnish anyfurther detail.LICI did not furnish any self-contained note, but we find from the complainant’s ‘P’ formthat LICI sent a letter dated 12.02.1990 requesting the complainant to submit deathcertificate.HEARING :A hearing was fixed. Nobody attended on behalf of the complainant, whilerepresentatives of LICI attended. During the hearing, the representatives of LICI statedthat the complainant has been informed of the requirement with regard to the deathclaim and relevant forms have been issued through their agent and it is found that theclaimant has received the forms because he approached the Branch officials forassistance in filing the claim forms. It is understood that the complainant did not submit
the required papers and hence there was delay in settling the claim since LICI were notin a position to ascertain whether the claim is tenable or not. They further stated thatthough the policy docket was not available, there would not be any problem in settlingthe claim.Decision :It was found that the claim has been made long after the death of the life assured.Unless the forms are filed, as required by LICI, the claim could not be processed.Under these circumstances, we requested the complainant to cooperate with LICI infiling the required forms and LICI officials were directed to take up the matter withregard to allowability of the claim on submission of the documents. The complainant isat liberty to go to any other forum including this forum, if he is not satisfied with thedecision of LICI.Kolkata Ombudsman CentreCase No. : 180/24/001/L/06/06-07Shri Mahi Narayan JhaVsLife Insurance Corporation of IndiaAward Dated : 06.03.07Facts & Submissions:This was a petition filed by Shri Mahi Narayan Jha for non-settlement of death claim byLICI.Shri Viswanath Jha, deceased life assured (DLA), purchased an LIC policy no.534167808. Shri Mahi Narayan Jha, nominee and father of the DLA, submitted thedeath claim forms on 22.03.05 on the expiry of his son Late Viswanath Jha on15.09.04. He had been pursuing with the LICI authorities for settlement of death claim,but the claim was not settled. Hence, this petition was filed for redressal.LICI stated that the policy commenced on 28.07.03 and the duration of the policy wasless than 1 year 2 months. As the DLA was living in Noida, the insurance company didnot have the correct address. LICI entrusted Marketing Manager, Meerut DO to enquireinto the case and, therefore, no self-contained note could be filed.A hearing was fixed. Both the complainant and representatives of LICI attended.According to the representatives of LICI, delay occurred due to lack of proper addressand non-receipt of enquiry report. They further stated that on receipt of InvestigationReport (IR), they admitted the death claim for basic sum assured and additional sum asper policy conditions and sent the discharge voucher (DV) vide their letter dated26.02.07. The complainant, who was present at the time of hearing, was informed ofthis matter.Decision:The complainant was requested to return the DV duly executed immediately on receiptand LICI officials were requested to send the cheque immediately on receipt of DV. Asthe complaint was redressed to the satisfaction of the complainant, no further actionneed be taken.Kolkata Ombudsman CentreCase No. : 309/24/001/L/07/06-07Smt. Tillottama PrasadVsLife Insurance Corporation of India
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Repudiation of Claim for Payor’s
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Award Dated : 27-11-2006Repudiation
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The Complainant’s husband held a
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sniped at Utmost Good Faith that fo
Page 12 and 13:
In view of the above, the decision
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concealment of material facts regar
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The complaint was registered and ne
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he had never suffered from any ailm
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from Chronic Hepatitis c Cirrhosis.
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same till death claim arises. The R
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adhikar ewam Rin pustika ” for Ag
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10 days from date of commencement a
Page 28 and 29:
grounds of suppression of material
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the claim for the reason “Suppres
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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
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There was no dispute that the DD fo
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proposal the contract remains uncon
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the claim stating that her son bein
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states that no common poison was fo
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the Insurer on the ground that the
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On perusing the documents it is obs
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application for insurance on 22.12.
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preferred a claim with the Insurer.
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the time of taking the policies. In
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in January 2000. The policy was rev
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Subsequently he was referred to Tir
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All the spells of medical leave hav
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In the hearing, the complainant sta
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KTVR Group Hospital due to “Hepat
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Chennai Ombudsman CentreCase No. :
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He was also on leave during 11.04.2
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Life Insurance Corporation of India
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Chennai Ombudsman CentreCase No. :
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found in the body. It was further r
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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
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He had concealed the material fact
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They further needed claim forms No.
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on life of her husband Late Shri. R
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Delhi Ombudsman CentreCase No. : LI
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The representative from Life Insura
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3 months and 14 days of taking poli
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09.06.2003 and the proposal was sub
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Leukemia. Bone Marrow Report dated
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Thus, he withheld facts and was gui
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questions provided in item no.11 of
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the claims excepting the present on
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The submission of LIC is that the p
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LIC that other two policies of Sum
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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 and 160: not be blamed entirely. But, the mi
Page 161 and 162: Life Insurance Corporation of India
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: time of taking the policy and that
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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