Death Claim - Gbic.co.in

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