Death Claim - Gbic.co.in

from Chronic Hepatitis c Cirrhosis. Since these facts, which are material forunderwriting of risk, were not disclosed in the DGH of dated 24.06.2005 submitted forgetting the policy revived, revival was set aside. As prior to the revival, the policy hasremained in force for only 2 years and 9 months, nothing stands payable under thepolicy. The duration of policy after revival has been only for 27 days.The leave record given by the Dy. Director, Satpuda Tiger Research, Pachmadi statesthat the DLA had been on sick leave during the period from 04.10.2003 to 15.03.2003(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 (61 days). All theseperiod of leave fall prior to the date of revival of policy but he has not mentioned abouthis suffering from any illness in the DGH dated 24.06.2005 and has stated himself tobe in very good health.Observations of Ombudsman : I have gone through the materials on records andsubmissions made during hearing and summarize my observations as follows:There is no dispute that the Policy No. 351860961 was issued to DLA by theRespondent on 10.03.2002; the same was revived on 24.06.2005 and death of DLAoccurred on 21.07.2005.During hearing, the complainant informed that the DLA was not suffering from anydisease and was in good health at the time of revival of the policy in question.During hearing, the Respondent contended that there is enough evidence confirmingthat the DLA was diagnosed as Complicated Malaria c ARDS c ARF and was sufferingfrom suffering from Chronic Hepatitis c Cirrhosis. However, these facts have beensuppressed in the DGH dated 24.06.2005 submitted for revival of the policy. As suchthe revival under the policy was set aside and as prior to the revival, the policy hasremained in force for only 2 years and 9 months, nothing stands payable under thepolicy.The DLA was diagnosed for aforesaid diseases/ailments and hence the claim wasrepudiated due to concealment of material facts regarding health of DLA. Had theDLA’s ill health and treatment details been brought to the knowledge of theRespondent during revival in DGH submitted by the DLA, the underwriting decision ofthe Respondent would have been different.On scrutiny, it is observed from the Medical Attendent Certificate’s issued by Dr.V.K.Sharma , MD,WHO FELLOW (USA) , Hamidia Hospital , Bhopal has under questionno-4(a) in claim Form B-1 , stated that the primary cause of death is ComplicatedMalaria c ARDS c ARF and secondary cause as Cardio Respiratory Failure, whereas inthe Declaration of Good Health (DGH) report signed by DLA on 24.06.2005 duringrevival shows that the he had never suffered from any ailment whatsoever in the pastand that he was absolutely keeping normal health, hence the contention ofComplainant is not tenable.It is also observed from the leave record given by the Dy. Director, Satpuda TigerResearch, Pachmadi that the DLA had been on sick leave during the period from04.10.2003 to 15.03.2003 (71 days), 01.12.2003 to 31.01.2004 (62 days), 16.02.2004to 30.0402004 (75 days), 16.07.2004 to 30.07.2004 (15 days) and 01.08.2004 to30.09.2004 (61 days). Hence, it is clear that the DLA intentionally suppressed thematerial facts regarding health to the Respondent at the time of reviving the policy inquestion.Insurance is a contract of Utmost Good Faith where both parties are required todisclose all the material facts. No party can be allowed to gain any undue advantage bysuppressing any fact. In the instant case, there are sufficient evidential proofs to show