Death Claim - Gbic.co.in

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