Death Claim - Gbic.co.in

cheque No.258433 dt.20.2.2007. Probably, only due to that reason the complainant didnot attend the hearing held on 8. 3.2007.Decision :As the Insurance Company satisfactorily redressed the grievance, no furtherintervention was called for. Hence, the petition was closed at our end and the samewas disposed of accordingly.Kolkata Ombudsman CentreCase No. : 213/21/001/L/06/06-07Smt. Bimala JangalwaVsLife Insurance Corporation of IndiaAward Dated : 23.03.07Facts & Submissions:This was a petition filed by the complainant against repudiation of death claim by LICI.Shri Keshri Chand Jangalwa (Soni), deceased life assured (DLA) purchased a LICIpolicy by submitting his proposal on 24.08.2003. He expired on 21.10.2003 atSujangarh, Rajasthan. The duration of the policy was 1 month 23 days. Smt. BimalaJangalwa, wife and nominee of the DLA filed death claim intimation and submitted therequired documents, but the LICI repudiated the claim on the ground of deliberatemisstatement and withholding of material information. The complainant furtherrepresented before the insurance company, which was of no avail. According to her,the DLA had no prior serious illness and the death was due to sudden cardiac failure.She has filed this petition for relief before the Insurance Ombudsman.The insurance company sent a self-contained note. According to them, they haveindisputable proof that the DLA suffered from gastric problem and was under treatmentfrom a Medical Practitioner. LICI, Bikaner Division obtained a certificate from anAyurvedic Practitioner Dr. Ghewar Chand Gujar at Sujangarh that the DLA was underhis treatment for last 4 months prior to death. According to them, the DLA suppressedthese facts at the time of proposal. Had the DLA disclosed the above information priorto taking the policy, the underwriting decision would have been otherwise. LICI,therefore, contended that there was misrepresentation and deliberate misstatementand hence, the repudiation decision was in order.HEARING :A hearing was fixed wherein only the representative of the insurance companyappeared. The complainant did not appear nor did she send any request foradjournment. However, a hearing was fixed once again for 20.03.07 requesting thepetitioner to attend. The complainant attended with her relative. The complainant wasinformed that the policy was taken on 24.08.03 and the DLA expired on 21.10.03.Therefore, the insurance company made enquiries due to early claim. In thoseenquiries, it has been found that the DLA was suffering from gastric problem since 4-5months as per the certificate issued by Dr. Ghewar Chand Gujar, Ayurvedic Doctor.Apart from that they have also made enquiries from the neighbour, who gave in writingthat the DLA was suffering from gastric problem and was attended to by the abovedoctor. The statements were read out and she could understand the contents of thesame. The relative was also informed that due to the certificate given by the Doctorthat he was suffering from gastric problem since 4-5 months, the period falls before theinception of the policy and, therefore, the proposal form should have contained theinformation with regard to ailment the DLA was suffering. Since the proposal form does