Death Claim - Gbic.co.in

and, therefore, she interpreted that her husband’s health was in good condition. Inview of the above, she requested that her claim may be considered sympathetically.Decision :The plea of the complainant as signing the proposal form blank without verifying thedetails was not acceptable, as an educated person is required to satisfy himself beforea document is signed by him. If that is so, the answers to the questions should havebeen answered appropriately. The proposal forms for the 3 policies were dated18.03.02, 28.02.03 and 28.02.03 respectively. The DLA was admitted for SynovialSarcoma left knee joint with secondaries chest at Apollo Hospital between 19.08.03 to30.08.03 and discharge summary of that hospital indicated that he underwent anoperation in the year 1997. Such a major operation was not mentioned in the proposalform for the policy taken on 18.03.02 and in the proposal forms submitted for the othertwo policies on 28.02.03. He had not answered correctly to question no. 11(b), which isas under:“Have you ever been admitted to any Hospital or Nursing Home for general check up,observation, treatment or operation?”The complainant’s plea that the operation that was done in 1997 was approximatelybefore 5 years does not have any relevanceThe evidence that has been collected by the insurance authorities was irrefutable inthe sense that the complainant’s husband had not given any detail of his health withregard to knee operation. This was itself a misrepresentation and suppression ofmaterial facts. Therefore, it has to be held that the policy contract between theinsurance company and the insured is vitiated. Under these circumstances, it was heldthat the repudiation of the death claim has been done after proper verification. In fact,the LICI authorities had been just when they paid the death claim for one of thepolicies as it was beyond the limitation of time period fixed. We were, therefore,constrained to state that the petition was dismissed without any relief to thecomplainant.Kolkata Ombudsman CentreCase No. : 385/24/001/L/08/2006-07Smt.Sabitri DeviVsLife Insurance Corpn. of IndiaAward Dated : 09.03.07Facts & Submissions :This petition was filed by the complainant for non-settlement of death claim under apolicy issued by the LICI authorities.The complainant, Smt.Sabitri Devi was the wife and nominee of her late husband,Mahesh Prasad with regard to Policy No.513003171. The DLA died on 16.2.2004. Thecomplainant submitted the Claim Form and the Insurance Company issued the DispatchVoucher for a payable amount of Rs.1,02,718/-. However, the claim remained pending.A hearing was held on 8.3.2007 where only the representative of the InsuranceCompany attended and the complainant did not turn up. The representative of theInsurance Company gave a letter dt.7.3.2007 wherein they stated that a cheque wasissued in favour of the complainant for Rs.99,384/- vide cheque No.130184dt.7.11.2006 which was encashed on 15.11.2006. The cheque included interest fordelay in payment after deduction of the uncollected premium.Decision :