Death Claim - Gbic.co.in

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Smt. Kusum Lata SrivastavaVsLife Insurance Corporation of IndiaAward dated 22.12.2006Smt. Kusum Lata Srivastava had lodged a complaint with Insurance Ombudsman foralleged unjustified repudiation of claim by LIC of India under policy no.310923320 onthe life of her husband Shri Alakh Nath Srivastava on the ground that he hadwithheld/suppressed material information regarding the disease of diabetes with whichhe was suffering from last 13 years and disease of hypertension with which he wassuffering from last 3 years. The insurer in support of its contention submitted the copyof certificate of last medical attendant from KG Medical College, Lucknow (claim form‘B’) and certificate of hospital treatment (claim form ‘B1’) from KG Medical college,Lucknow. As per these certificates the deceased life assured was admitted in thehospital on 13.03.02 and died on 14.03.02. The patient was a known case of diabetesmellitus with which he was suffering from last 13 years and hypertension with which hewas suffering from for last 3 years. The history was narrated by relative as the patientwas unconscious. This fact was further corroborated by the complainant’s ownadmission in her representation to the Zonal Manager and by the complainant’srepresentative during personal hearing. However, she stated that this was brought tothe knowledge of the concerned agent by her husband and that her husband wascompletely hale and hearty performing his normal duties.Since the fact that the life assured was suffering from diabetes and hypertension hasbeen established by the evidences submitted by the insurer and also by thecomplainant own admission it was immaterial that the deceased life assured hadbrought this fact to the knowledge of the agent who had filled in the proposal form as itis well established that the agent while filling in the proposal form represents the lifeassured and not the insurer. Further the life assured has signed the declarationwherein he had declared that he is signing the proposal form and the questioncontained therein after fully understanding the same and that these were correct andcomplete in all respect and that nothing was withheld. Looking to the above therepudiation of the claim by the insurer was held to be in order.Lucknow Ombudsman CentreCase No. : L-272/21/001/06-07Shri Shree Pal SinghVsLife Insurance Corporation of IndiaAward dated 22.12.2006Shri Shree Pal Singh had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.221577679 on the life ofhis Uncle Shri Pahalwan Singh on the ground of understatement of age in the proposalform dated 07.05.2000. The insurer relied on the copy of Pariwar register but thecomplainant produced another Pariwar register and the Ration Card as per which therewas no understatement of age. Besides he also produced the original of these twodocuments and the affidavit in support of the age of the life assured from the presentGram Panchayat Vikas Adhikari and the Gram Pradhan, whereas the insurer’srepresentative failed to produce the original of the Pariwar register or an affidavit fromthe Ex or the present Gram Panchayat Vikas Adhikari stating any understatement ofage by the life assured. The repudiation was, therefore, held to be not sustainable inthe absence of any evidence and as such the letter of repudiation dated
31.03.05/11.04.05 issued under the policy was set aside and the complainant wasawarded his share of the claim amount under the policy as per rules of the insurer.Lucknow Ombudsman CentreCase No. : L-408/21/001/06-07Smt. Anita MishraVsLife Insurance Corporation of IndiaAward dated 29.12.2006Smt. Anita Mishra had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.231238050 on the life ofher husband Shri Sohan Lal Mishra on the ground of material suppression of factsregarding his illness of Gasteroenteritics prior to the date of proposal. The insurer’srepresentative submitted copy of prescription of Dr. A.K. Omar dated 27.11.02, receiptof pathological reports from Parakh Diagnostic Centre dated 28.11.02, receipt ofmedicines dated 28.11.02 and medical certificate of Dr. A.K. Omar for availing leave onmedical ground between 27.11.02 to 29.11.02. It was the insurer’s contention thatdeceased life assured had suffered from illness of Gasteroenteritics from 27.11.02 andthat he was under continous treatment since then till his death. No evidence was,however, adduced in support of its contention except the above. The complainantdenied the above allegations and submitted even the copy of the pathological report ofParakh Diagnostic Centre. On perusal of the pathological reports it was observed thatthe deceased life assured was suffering from low haemoglobin and high SGPT on28.11.02. Further on the basis of pathological reports taken few days before his death,low haemoglobin and high SGPT were observed as persisting. Looking to the above,the repudiation of the claim by the insurer was held to be in order. However, to be justand fair to the complainant, the payment of basic sum assured was awarded as exgratia.Lucknow Ombudsman CentreCase No. : L-387/21/001/06-07Shri Raj Kumar VermaVsLife Insurance Corporation of IndiaAward dated 09.01.2007Shri Raj Kumar Verma had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.283804474 on the life ofhis mother Smt. Suhuti Devi on the ground that the life assured had misstated heroccupation as vegetable vendor in the proposal form whereas she was a house holdlady only and could not have been granted insurance without having an equivalentpolicy on the life of her husband. In support of its contention the insurer submittedstatements from her husband and father-in-law signed on a plain paper. Thecomplainant nominee, the son of the life assured on the other hand disputed theallegations as well as the statements submitted by the insurer and submitted anaffidavit from Gram Pradhan and statement from two residents from the locality to theeffect that her mother, the late life assured was engaged in growing and sellingvegetables. The insurer was given 30 days time to submit an affidavit from the husbandand father-in-law of the life assured who had given statement on plain paper but theinsurer failed to submit that within the stipulated time. Since these statements given onplain paper have got no evidentiary value, the repudiation of the claim by the insurer
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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
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The claim was rejected by LIC stati
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Facts of the Case: (Late) G.Appa Ra
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Head Notes: Life assured availed a
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in English, which suggest that he i
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LIC about usage of herbal medicines
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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
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
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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 and 186: cheque No.258433 dt.20.2.2007. Prob
Page 187 and 188: We were unable to modify the order
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: treated the person but since the si
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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