Death Claim - Gbic.co.in

suffering from Hypertension, Urinary Calculus, Acute Gastritis, Ureteric Stone, Growthin urinary bladder, Urinary Tract Infection and Cystitis for which he had consultedmedical men and took treatment for the same and remained absent from his place ofwork on medical grounds before he proposed for assurance. The additional benefitsviz. Term Rider Benefit and Premium Waiver Benefit were granted on the basis ofinformation given by him at proposal stage in the proposal form and other documents.It would appear from the documents on record that the statements made by the lifeassured were inaccurate, false and he deliberately suppressed the facts which it wasmaterial to disclose. Had he disclosed the correct information, additional benefitswould not have been granted under the policy or policy would have been issued withdifferent terms. It is pertinent to note that immediately after the policy was taken ShriAshok Desai suffered from Carcinoma of Bladder and was operated for the same andremained absent from his work place on this ground on many occasions which clearlyindicates the positive existence of the disease before the policy was taken. Thecontention of the Complainant that the cause of death was head injury due to assaultand has no nexus with the illnesses suffered by the life assured before the policy wastaken is not acceptable because it is proved from the documents on record that the lifeassured took the policy suppressing the material facts regarding his health status andwhen the very basis of the contract was on suppressed material facts, the contractbecame void from inception. Based on the facts and the documents produced, thisForum does not find any valid reason to interfere with the decision of LIC. However,the role of the Agent who introduced the business should be examined and appropriateaction should be taken.Mumbai Ombudsman CentreCase No. : LI-147 of 2006-2007Shri Rohidas R SanvordekarV/s.Life Insurance Corporation of IndiaAward Dated : 04.10.2006Miss. Rakhi R Naik Sanvordekar had taken a Life Insurance policy from Life InsuranceCorporation of India, Vasco Branch- 91E,Goa Divisional Office through proposal dated23.03.2001 for a Sum Assured of Rs.40,000/- . Miss Rakhi Naik Sanvordekar (SmtShruti Shesh Shirodkar) expired on 14.04.2005 at KLE Society’s Hospital and MRC,Belgaum, Karnataka Department of Clinical Immunology and Rheumatology due toAcute Respiratory Distress Syndrome with FTC SLE with Pulmonary Tuberculosis.When the claim for the policy moneys was preferred to Life Insurance Corporation ofIndia by her father Shri Rohidas R Sanvordekar who was the nominee under the policyit was held by Goa Divisional Office that they had indisputable evidence to show thatthe deceased life assured was suffering from Systemic Lupus Erythematosus beforeshe proposed for the policy which was not disclosed while filling the proposalformAggrieved by this decision, Shri Sanvordekar approached this Forum for redressalof his grievance. After perusal of the records parties to the dispute were called forhearing on 27.9.2006 at Ombudsman’s Camp at Goa. It is evident from the claim formB and Claim Form B1 issued by Dr. Arun Shrivastava of KLE Society’s Hospital and thedischarge summaries of the same hospital on record that the deceased life assuredhad been suffering from Systematic Lupus Erythematosus since 1993. She did notdisclose this material information in her proposal dated 23-3-2001, instead, she gavedeliberate incorrect statements. The proposal was on non-medical basis and nomedical examination was conducted and as such LIC solely relied on the informationgiven in the proposal form and the health declaration given by the insured and on the