Death Claim - Gbic.co.in

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not mention any of the problems, the insurance company repudiated the claim on theground that there was suppression of material facts.Decision :As it was an early claim (1 month 23 days) and there is proof that the DLA wassuffering from gastric problems, it could not be stated that the DLA was not in theknowledge of his ailment at the time of signing the proposal form. Therefore, it had tobe held that there was suppression of material facts. Under these circumstances, I donot have any other alternative but to agree with the decision of repudiation made byLICI. Accordingly, no relief was granted to the complainant.Kolkata Ombudsman CentreCase No. : 268/24/001/L/07/2005-2006Shri Tapan Kumar LahiriVsLife Insurance Corporation of IndiaAward Dated : 28.03.07Facts & Submissions :The Insurance Ombudsman vide his order dated 18.11.2005 had passedrecommendation as under:“We have considered the facts and circumstances of the case as well as the materialsavailable on record. In the instant case the policyholder expired after the date ofmaturity of the claims. The registered nominee pre-deceased the life assured. Thecomplainant is one of the legal heirs of the said claim. The insurer expressed theirinability to settle the claim due to non-submission of the original policy bond and lastpremium receipt. Submission of the policy bond in original and last premium receipt arerequired for the creation of the master and claim proceeds. Only on receipt of thepolicy bond in original, the servicing Branch can proceed in the above matter. We,therefore, direct the complainant to submit the required documents to LICI forsettlement of the claim. LICI will also process quickly and decide the claim afternecessary verification with their record. LICI will decide the claim within a month fromthe date of receipt of the required particulars asked for by them.”The claimant wrote a letter dated 26.07.06 stating that the LICI has not given effect tothe aforesaid order even after he had sent the policy bonds and informed that he wasunable to produce premium receipts. Keeping in view the difficulties expressed by thecomplainant and the insurance authorities, a hearing was fixed for 20.03.07 where boththe parties attended. The claimant stated that the policies were very old. Policy no.9252197 with DOC 23.09.1959 with Sum Assured of Rs. 1000/- was having a monthlypremium of Rs. 6.23 and matured in 1974. Policy No. 9448492 with DOC 15.09.1961with Sum Assured Rs. 2500/-; monthly premium of Rs. 15.69 and matured in 1976.Similarly, policy no. 9459223 with DOC 01.11.1961; quarterly premium of Rs. 47.50and matured in 1976. The complainant stated that the policies had been assigned andreassigned during that period and premium was deducted from the salary of his fatherand, therefore, he was unable to send the last premium receipt. However, he sent theoriginal policy bond to the company.The representative of the insurance company stated that the claim was very old andthey were not able to lay their hands on old records like policy records, ledger folio orclaim papers. According to them, when the policy is matured, the claim operations werecentralized under the then Calcutta Division.
We were unable to modify the order made by the previous Ombudsman. It is suffice tosay that the policy bonds that have been submitted with the information assignmentand reassignment and the fact that premiums were deducted from salary would indicateall premiums have been paid and question of verification, whether the premiums werepaid, now is not possible due to efflux of time. Under these circumstances, theinsurance company is requested to take a decision with regard to the payability of thesum assured to the claimant after taking the above facts into consideration.However, the claimant is at liberty to seek redressal of his grievance with any otherforum including this forum if the decision by the insurance company is not acceptableto him.Kolkata Ombudsman CentreCase No. : 562/21/001/L/11/06-07Shri Sushil GuptaVsLife Insurance Corporation of IndiaAward Dated : 28.03.07Facts & Submissions :This petition was filed by the complainant Shri Sushil Gupta for repudiation of deathclaim on the life of his father Shri Puttu Lal Gupta, deceased life assured (DLA) byLICI.Shri Sushil Gupta, son and nominee of the DLA Late Puttu Lal Gupta, stated that hisfather had taken a policy with DOC 28.03.1999. The life assured died on 15.12.2001.After the death, a claim was raised against the policy and the same was repudiated onthe ground of non-disclosure and suppression of material facts. The representationmade by the complainant did not yield any result. Therefore, this petition has been filedfor relief.The insurance company stated that the policy was allowed to be lapsed by the lifeassured for non-payment of premium due on 28.06.1999 without acquiring any paid upvalue. The policy was revived on 02.07.2001 for full sum assured on the strength ofpersonal statement regarding health made by the deceased on 27.06.2001. The lifeassured had answered question no. 2(a) as “No” and question no. 4 as “Good” in therevival form. The insurance company maintained that they have indisputable proof toshow that the DLA had been suffering from Chronic Obstructive Pulmonary Diseaseand that he had suffered from Pulmonary Tuberculosis with Pulmonary Fibrosis, but hedid not disclose these facts in the personal statement. The policy was revived on02.07.2001 and the life assured died on 15.12.2001 at Marwari Relief Society Hospital,Kolkata. The duration of the policy after revival was only 5 ½ months and the hospitalrecords indicated that the life assured was a known case of COPD with old PulmonaryKoch. These diseases were chronic in nature. Therefore, the insurance company heldthat that there was suppression of material facts in the revival form and repudiated theclaim.A hearing was fixed wherein both the parties attended. The complainant was informedthat though the policy was taken originally w.e.f. 28.03.1999, it got lapsed due to nonpaymentof premium due on 28.06.1999. The policy that was taken up for revival on02.07.2001 would be treated as a fresh policy and any disease prior to this date had tobe mentioned in the personal statement form. He was also informed that theDeclaration of General Health signed by the DLA did not contain any informationregarding his disease because of which the life assured passed away. The
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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
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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
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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
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It has also not been verified by th
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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
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We have considered the photocopies
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On the circumstances aforesaid, it
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Life Insurance Corporation of India
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nos.722662607 for Rs.50000/- and 72
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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
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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
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Page 173 and 174: The insurance company in their self
Page 175 and 176: time of taking the policy and that
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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: cheque No.258433 dt.20.2.2007. Prob
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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