Death Claim - Gbic.co.in

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the abdomen for last 2 years was stated by her to the doctor which was incorrect butno reasons were ascribed nor this was supported by the discharge summary of thehospital. The repudiation of the claim therefore on the ground of nondisclosure ofmaterial was held to be in order.Lucknow Ombudsman CentreCase No. : L-405/21/001/06-07Shri Nidhish Kumar GuptaVsLife Insurance Corporation of IndiaAward dated 30.10.2006Shri Nidhish Kumar Gupta had lodged a complaint with Insurance Ombudsman forallegedly unjustified repudiation of claim by LIC of India under policy no.271221053under Jeevan Sathi policy. The claim was repudiated on the ground that there wasmaterial nondisclosure about the ailment of breast cancer with which the life assuredSmt. Taruna Gupta was suffering from for last 3 months. Besides although she hadconsulted the doctors as an OPD patient at Himalayan Institute Hospital, Dehradunafter submitting the proposal but before it was accepted she had failed to intimate thestate of her health after knowing that she was suffering from cancer. The insurersubmitted the copy of OPD card and discharge summary from Himalayan InstituteHospital, Dehradun. On a perusal of the certificates it was established that thedeceased life assured had consulted first the doctors of the hospital authorities as OPDpatient on 24.05.03. Since the history stated by her was to the effect that she washaving the problem of breast cancer for last 3 months, it was obvious that she hadfailed to discharge the obligation of intimation of the state of health before acceptanceof the proposal which was a breach of warranty as contained in the proposal form. Therepudiation of the claim was, therefore, held to be in order.Lucknow Ombudsman CentreCase No. : L-411/21/001/06-07Smt. Maduri DeviVs.Life Insurance Corporation of IndiaAward dated 09.11.2006Smt. Maduri Devi had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.311300555 on the life ofher husband Shri Mewa Lal on the ground that the life assured four years back prior tothe date of proposal was suffering from diabetes mellitus and had consulted doctors forthe purpose. The insurer in support of its contention submitted the copy of BHT fromSGPGI, Lucknow and the copy of certificate of Hospital treatment from SGPGI,Lucknow based on the evidence submitted the repudiation of the claim was held to bein order.Lucknow Ombudsman CentreCase No. : L-379/21/001/06-07Smt. PhoolpattiVsLife Insurance Corporation of IndiaAward dated 09.11.2006
Smt. Phoolpatti had lodged a complaint with Insurance Ombudsman for allegedlyunjustified repudiation of claim by LIC of India under policy no.283418294 on the life ofher husband Shri Ram Kumar Pandey on the ground that the life assured was sufferingfrom cancer and fistula in ano and was also a smoker and addicted to chewing Khaini.The insurer submitted the copy of BHT from SSS hospital, BHU Varanasi wherein itwas clearly stated that the deceased was a follow up case of BronchoalveolarCarcinoma cancer with Fistula in ano. Since the death of the life assured had takenplace within less then 4 months of taking the insurance, as per BHT it was a follow-upcase and in the opinion of the DMR the Bronchoalveolar Carcinoma takes minimum oneyear to cause death, it was established that the deceased life assured had suppressedmaterial facts regarding his illness with which he was suffering prior to the date ofproposal and hence the repudiation action taken by the insurer was held to be in order.Lucknow Ombudsman CentreCase No. : L-429/21/001/06-07Smt. Manju ChaturvediVsLife Insurance Corporation of IndiaAward dated 13.11.2006Smt. Manju Chaturvedi had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.214695948 on the life ofher husband Shri Sanjay Chaturvedi on the ground that in the proposal dated 11.02.05he had not disclosed about the illness of Myocardial Infarction With which he hadsuffered in the past and had also undergone Coronary Angiography and had remainedadmitted in the hospital. The insurer having established the above nondisclosure ofmaterial facts by submitting a copy of BHT and certificate of Hospital treatment andcertificate of medical attendant from SGPGI, Lucknow, the nondisclosure being withintwo years from the date of effecting the insurance, the repudiation of claim underpolicy no.214695948 was held to be in order.Lucknow Ombudsman CentreCase No. : L-297/21/001/06-07Shri Anupam Kumar DubeyVsLife Insurance Corporation of IndiaAward dated 14.11.2006Shri Anupam Kumar Dubey had lodged a complaint with Insurance Ombudsman forallegedly unjustified repudiation of claim by LIC of India under policy nos.283653924 &284675668 on the life of his father Shri Sudama Dubey on the ground that he wassuffering from diabetes and kidney diseases prior to the date of the proposal. Theinsurer, however, did not submit any evidence in support of its decision except theinvestigation report of the two officers who had also not collected any evidence insupport of their findings. Since no evidence was submitted by the insurer, therepudiation of the claim by the insurer was set aside and the claimant awarded fullpayment of claim amount under both the policies by the insurer.Lucknow Ombudsman CentreCase No. : L-344/21/001/06-07Smt. Shahida BegumVs
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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
Page 36 and 37:
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
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The claim was rejected by LIC stati
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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
Page 163 and 164: hypertensive before the inception o
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
Page 171 and 172: evidence to prove that the DLA was
Page 173 and 174: The insurance company in their self
Page 175 and 176: time of taking the policy and that
Page 177 and 178: the required papers and hence there
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 and 186: cheque No.258433 dt.20.2.2007. Prob
Page 187 and 188: We were unable to modify the order
Page 189: certificates submitted by the claim
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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