Death Claim - Gbic.co.in

material facts” on 31.03.2006. Further the case was referred to the Claim ReviewCommittee at LIC Zonal Office Bhopal. The ZO CRC in its meeting upheld the DOdecision of repudiation on 01-09-2006.Observations of Ombudsman:I have gone through the materials on records and submissions made during hearingand summaries my observations as follows:There is no dispute that the policy number 344485756 was issued to DLA by theRespondent on 02.02.205 and death of DLA occurred on 03.06.2005 due to tumor inAlimentary canal.It is observed from the record that the Complainant has submitted the forms P-2 and P-3 duly filled up but without her signature. Further the Complainant was absent on thedate of hearing in spite of proper service, which shows that the Complainant is notinterested in resolving his grievances. In view of the above, the complaint is dismissedwithout any relief.Bhopal Ombudsman CentreCase No.: LI-1133-21/12-07/BPLSmt. Kamini PahareVsLife Insurance Corporation of IndiaAward Dated : 19.01.2007Smt. Kamini Pahare, resident of Gram Nimsadiya Distt.: Hoshangabad (M.P.)[hereinafter called Complainant] is the wife of late Shri Dinesh Chand Pahare,Deceased Life Assured [in short DLA]. The DLA took a life insurance policy numbered351860961 from LIC of India, DO: Bhopal, BO Hoshangabad [hereinafter calledRespondent]. The Policy commenced on 10.03.2002 lapsed due to non-payment ofpremiums. The policy was revived by DLA on 24.06.2005 by paying the arrears ofpremiums. The DLA died on 21.07.2005 due to Complicated Malaria c ARDS c ARF.The death claim was preferred by Complainant with the Respondent, which wasrepudiated by the Respondent on the grounds of suppression of material factsregarding health of DLA at the time of revival. The complainant had referred the caseto Respondent’s Claims Review Committee for reconsideration which was also upheldby them on 01.11.2006. Aggrieved by the repudiation action of Respondent, theComplainant has lodged a complaint with this Office seeking directions to Respondentto settle the claim amount.The complaint was registered and necessary forms were issued to both the parties.Replies were received from both the parties.The Respondent vide its self-contained note dated 12.012.2006 replied that the Policyhad run for 3 years 4 month and 11 days from date of commencement (DOC) and onlyfor 27 days from the date of revival. The DOC under the policy is 10.03.2002 and dueto non payment of premiums the policy got lapsed since quarterly premium due12/2004. The same was got revived on 24.06.2005 by paying the arrears of premiumsand by submitting the Declaration of Good Health (DGH). In the DGH, the question no7 viz “Have you suffered from any diseases requiring treatment for more than 7 days?”has been answered as “NO”. However, the employer has confirmed in claim form-E thatthe DLA had taken leave on medical grounds during the period from 04.10.2003 to15.03.2003 (71 days), 01.12.2003 to 31.01.2004 (62 days), 16.02.2004 to 30.0402004(75 days), 16.07.2004 to 30.07.2004 (15 days) and 01.08.2004 to 30.09.2004 (61days).The medical certificate dated 16.02.2004 confirmed that the DLA was suffering