Death Claim - Gbic.co.in

he had never suffered from any ailment whatsoever in the past and that he wasabsolutely keeping normal health, hence the contention of Complainant is not tenable.Thus, from the foregoing facts it is clear that there is a direct nexus between the causeof death and the ailments suffered by DLA. Hence, it is clear that the DLA intentionallysuppressed the material facts regarding health to the Respondent at the time ofreviving the policy in question.Insurance is a contract of Utmost Good Faith where both parties are required todisclose all the material facts. No party can be allowed to gain any undue advantage bysuppressing any fact. In the instant case, there are sufficient evidential proofs to showthat the DLA was already suffering from serious ailments but suppressed the same inthe proposal form at the time of taking the policy. Thus, the DLA has misled theRespondent by not providing vital information regarding his health at the time ofproposal and hence the Respondent was not able to take proper underwriting decision.Had the facts been brought to the knowledge of the Respondent, its underwritingdecision would have been different.In view of the circumstances stated above, I am of the considered opinion that thedecision taken by the Respondent is just and fair hence does not require anyinterference.The complaint is dismissed without any relief.Bhopal Ombudsman CentreCase No.: LI-1129-21/11-07/INDSmt.Prabha Devi ChhajedVsLife Insurance Corporation of IndiaAward Dated : 18.01.2007Smt.Prabha Devi Chhajed, resident of Neemuch [hereinafter called Complainant] is thewife of Late Shri Tejpal Chhajed, Deceased Life Assured (in short DLA). The DLA hada life insurance policy number 344485756 taken from LIC of India, DO: Indore, BO-Neemuch [hereinafter called Respondent]. The Policy commenced on 02.02.2005 underTable/Term: 149-15 for Sum Assured of 1,00,000/- The DLA expired on 03.06.2005 dueto tumor in Alimentary canal. The death claim was preferred by the Complainant withthe Respondent but the same was repudiated on the grounds of suppression ofmaterial facts regarding health of DLA at the time of taking policy. Aggrieved from therepudiation action of Respondent, the Complainant has lodged a complaint with thisOffice seeking directions to Respondent to settle the claim amount under the policy.The Respondent vide its self-contained note received by this office on 26 thDecember,2006 replied that DLA was suffering from Tumor in Alimentary Canal at thetime of proposing for insurance under the policy. However, DLA had not disclosed hisillness in the proposal forms submitted for insurance and has stated his state of healthwas “GOOD”. Had the history of Tumor in Alimentary Canal been disclosed at the timeof proposing for insurance, decision for acceptance of the case would have beenaffected. Hence, the claim under the policy was repudiated due to non-disclosure ofmaterial facts.The proposal of the policy in question was completed on 03.03.2005 and DLA wassuffering from tumor in Alimentary Canal from 01.03.2005 to 03.06.2005 as per form no3802 submitted by the Dr.Nand Kishore Mangal Neemuch who treated the deceasedassured during his life time. The DLA did not mention any thing about his past illness.Considering all these facts LIC repudiated the claim for the reason “Suppression of