Death Claim - Gbic.co.in

treated the person but since the signatures of the doctor on the affidavit did not tallywith his signature on the certificate and that original of the affidavit was not producedand also that it was submitted by the complainant himself, the certificate submitted byinsurer appeared to be reliable and complainant’s version are after thought, therepudiation of the claim, therefore, was held to be in order.Lucknow Ombudsman CentreCase No. : L-451/21/001/06-07Smt. Sarojini SainiVsLife Insurance Corporation of IndiaAward dated 15.12.2006Smt. Sarojini Saini had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.232261766 on the life ofher Husband Shri Jagdish Chandra Saini on the ground that there was non-disclosureof the old T & D Kock’s infection in lungs with which deceased life assured wassuffering prior to revival of policy. The policy was lying in lapsed condition since11/2003 and was revived on 14.06.05 on payment of premium due 11/2003 and11/2004 on the basis of personal statement regarding health dated 19.04.05. Theinsurer in its support submitted copy of prescription dated 11.08.05 from one Dr. A.N.Chaturvedi which stated that the deceased life assured had consulted him for acuteBronchitis and CHF and was suffering from old T & D Kock’s infection in lungs on11.08.05. The pathological reports also suggested that he had a high creatinine value.Although the insurer could not submit any document establishing ailments of thedeceased life assured prior to the date of revival but since he had died within 2 monthsfrom the date of revival and that just after two months from the date of revival he hadconsulted Dr. A.N. Chaturvedi for serious ailments it was suggestive that he wassuffering from these ailments prior to the date of revival and that he had knowledge ofthe same and that he did not disclose the ailments in the Personal statement regardingworth to gain unfair advantage. The repudiation of claim and offer of paid up value tothe complainant was, therefore, held to be in order.Lucknow Ombudsman CentreCase No. : L-380/21/001/06-07Shri Ram PrasadVs.Life Insurance Corporation of IndiaAward dated 19.12.2006Shri Ram Prasad had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.214488494 on the life ofhis wife Smt. Dayawati on the ground that there was suppression of material factrelating to the disease of bleeding piles with which she was suffering from prior to thedate of the proposal. The insurer in his contention submitted the copy of a certificate ofHospital treatment from District Hospital where at the time of admission the lifeassured herself had stated the history of the disease to be for last 3 years. Since thisperiod ranged prior to the date of proposal and that no evidence to contradict this wassubmitted by the complainant, the repudiation of the claim by the insurer was held tobe in order.Lucknow Ombudsman CentreCase No. : L-593/21/001/06-07