Death Claim - Gbic.co.in

the contract was not complete and even if the claim was considered, the patient wassuffering from jaundice before the inception of the policy as per the availablecertification. Under these circumstances, the insurance authorities repudiated theclaim.Decision :On going through the evidence available, it could be seen from the death certificateissued by the Military Hospital at Ranchi that the date of death was 28.08.01. Theclaim form ‘B1’ indicated that the patient was brought dead and the cause of death wasjaundice. The hospital authorities relied on the Post Mortem Report (PMR) dated29.08.01and the report stated that there was no evidence of any injury external orinternal and the death was due to jaundice.On scrutiny of proposal papers, it was found that the DLA deposited Rs. 5,057/- on14.08.01 i.e., 14 days before the date of death and he appeared to have signed theproposal papers on 14.08.01. However, the proposal was received by LICI on 28.08.01(Inward No. 912) and registered under proposal no. 1446 on 29.08.01. Proposal wasunderwritten on 29.08.01. It was a known fact that in the case of First Premium thathas been sent with the proposal and the proposal was accepted without anymodification, the insurer normally assumes risk from the date of acceptance,assumption of risk being communicated by a simple receipt issued for the FirstPremium. However, the acceptance is always subject to the condition that if anyadverse event communicated with the risk has occurred between the date of proposaland the date of acceptance, the assurance will be invalid unless intimation of suchevent is given to the insurer and acceptance is re-approved. In this case, although theproposal deposit was converted into premium and the proposal converted into a policy,the proposer had died before acceptance. Therefore, the contract was not concluded.Under these circumstances, the repudiation of claim by the insurance company wasupheld. However, the premium paid in the form of proposal deposit should be refundedto the legal heir since the contract was not concluded. The insurance company weredirected to refund the amount of premium paid.Kolkata Ombudsman CentreCase No. : 891/24/001/L/03/05-06Smt. Romee SarkarVsLife Insurance Corporation of IndiaAward Dated : 08.03.07Facts & Submissions:This petition was filed by Smt. Romee Sarkar for non-settlement of death claim on thelife of her husband Shri Subhasish Sarkar, deceased life assured (DLA) by LICI.Smt. Romee Sarkar, the complainant, in her original complaint dated 23.03.06 and ‘P’form details received on 12.04.06 stated that her husband Shri Subhasish Sarkar diedon 05.03.05 due to cancer, which was detected on 29.08.03. After his death, shesubmitted the claim forms on 21.09.05 along with all the available papers required bythe insurance company. In spite of her several requests, the insurance company didnot respond and death claim of her deceased husband’s policies remained unsettled.Being aggrieved by non-settlement, this petition was filed seeking relief.The insurance company sent a self-contained note stating that the complainantsubmitted death claim intimation along with forms in respect of the following 4 policiestaken by the DLA: