Death Claim - Gbic.co.in

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Case No. : L-672/21/001/06-07Smt. Vijay LaxmiVsLife Insurance Corporation of IndiaAward dated 12.02.2007Smt. Vijay Laxmi had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.214715916 on the life ofher husband Shri Arjun Prasad on the ground that he had suppressed his illness ofdiabetes and hypertension with which he was suffering prior to the date of proposaland had been taking treatment also. The insurer in support of its contention submittedcopy of death certificate which stated the cause of death amongst others as ‘highsugar, Blood pressure’ and further a letter from her son in his handwriting confirmingthat his father, the deceased life assured was suffering from diabetes and hypertensionfor last few years and taking treatment also. Although he retraced from his havingadmitted the above and stated that it was at the instance of the investigating officer butit appears to be an after thought. The insurer, although, could not submit any directevidence of illness of the life assured but in the circumstances of the case, it wasdecided not to interfere with the decision of the insurer repudiating the claim under thepolicy no. 214715916.Lucknow Ombudsman CentreCase No. : L-553/21/001/06-07Smt. Madhulika SrivastavaVsLife Insurance Corporation of IndiaAward dated 14.02.2007Smt. Madhulika Srivastava had lodged a complaint with Insurance Ombudsman foralleged unjustified repudiation of claim by LIC of India under policy no.231753819 onthe life of her husband Shri Anil Kumar Srivastava on the ground of suppression ofmaterial facts regarding his illness (Ischaemic Heart Disease & Hypertension). ThePolicy had lapsed on account of nonpayment of premium due yearly July, 1998 andagain on July, 2001. It was revived on 02.02.99 and again on 09.07.02 on the strengthof personal statement regarding health made by the life assured on 02.02.99 and03.07.02. On both the occasions the life assured had not disclosed any thing about hisillness and declared himself to be in sound health. The insurer, however, submitted thestatement of leave from his employer alongwith the medical certificates whichestablished that the deceased was on sick leave from 04.06.98 to 20.06.98 forIschaemic Heart Disease, unstable Angina & mild Hypertension. He had again sufferedfrom the same disease and had to be on leave from 16.08.99 to 20.08.99 and 21.10.99to 29.10.99. Since the disease had its onset prior to the date of execution of personalstatement regarding health dated 02.02.99 and the diseases were not disclosed in thepersonal statement regarding health, the repudiation of the claim on the ground ofmaterial misstatement regarding health was held to be in order. The complainantnominee was, however, awarded payment of paid up value acquired after payingpremium up to July 1997.Lucknow Ombudsman CentreCase No. : L-635/21/001/06-07Smt. Shakuntala DeviVsLife Insurance Corporation of India
Award dated 31.02.2007Smt. Shakuntala Devi had lodged a complaint with Insurance Ombudsman for allegedunjustified repudiation of claim by LIC of India under policy no.283869308 on the life ofher son Shri Anand Kumar Soni on the ground that since death had taken place withinone year from the date of commencement of risk under the policy, the suicide clausewas operative and hence nothing was payable. The insurer did not lead any directevidence to establish suicide but from the circumstances contended that the death ofthe life assured was nothing but a case of suicide. It was no doubt established that thedeath of life assured had been caused by taking some poisonous substance. No FIRwas lodged. The punchnama was done and in the opinion of panches he might haveconsumed some poisonous substance by mistake as he was keeping poisonoussubstances with him for cleaning/washing ornaments. However, the complainant’sversion was that he was engaged at a gold smith shop and doing polishing (fNykbZ dkdke) of ornaments and that somebody else would have served him some poisonoussubstance causing his death. However, she could not explain satisfactorily as why noFIR was lodged if she had such a suspicion. Taking an overall view and in the factsand circumstances of the case and that no contrary evidence was produced by thecomplainant, the repudiation of the claim was held to be in order.Mumbai Ombudsman CentreCase No. : LI-221 of 2005-2006Smt Anuradha Ashok DesaiV/s.Life Insurance Corporation of IndiaAward Dated : 04.10.2006Shri Ashok D Desai had proposed for a Money Back Children’s Assurance policywithout profits for his son Mast. Akash Ashok Desai from Life Insurance Corporation ofIndia for a Sum Assured of Rs. 50,000/- with Term Rider Benefit and Premium WaiverBenefit. The date of proposal under the policy was 23.3.2001 and On 21.02.2004 ShriDesai was assaulted while he was on his official duty which caused him serious headinjuries and he finally succumbed on 24.02.2004. The cause of death was Head injurywith Fracture frontal bone with frontal contusion. When Smt Anuradha Ashok Desaiwife of Shri Ashok Desai preferred a claim for premium waiver benefit and Term Riderbenefit under the policy, Life Insurance Corporation of India Goa Divisional Officerejected the benefit stating that Shri Ashok Desai had withheld material informationregarding his health at the time of effecting the assurance. They held indisputableproof to show that Life Assured was suffering from Hypertension, Urinary Calculus,acute gastritis, ureteric stone, growth in urinary bladder, post bely cystitis and urinarytract infection for which he had consulted a medical men and had taken treatment in ahospital and also that he was on medical leave on various occasions for the saidailments. These facts were not disclosed at the time of proposing for the above saidpolicy instead Shri Desai had given false answers as above. Hence LIC rejected theclaim for Premium Waiver Benefit and Term Rider benefit under the policy. Notsatisfied with the decision of the Company, Smt Anuradha A Desai represented to theWestern Zonal Office of the Corporation which was also turned down. Hence beingaggrieved she approached the Office of the Insurance Ombudsman seekingintervention of the Ombudsman for justice. The records were perused and parties tothe dispute were called for hearingIt is evident from the medical certificates on record which were submitted by the LifeAssured to his employer for securing leave on health grounds that he had been
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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
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the owner of the opposite vehicle i
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action was found to be based on pro
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certificate issued by one Dr.H.R.De
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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 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: with him during the period 02.03.04
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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