Death Claim - Gbic.co.in

Consultation/Treatment as proof of past illnesses i.e. Bronchitis & Asthma allegedlysuffered by the life assured since 25 years. It is to be noted that as per the informationgiven by the above doctor, he had been practicing in that area since 5 years and hewas first consulted by the deceased on 2.2.2002. Though the doctor has mentionedthat past history was given by him as reported by the patient himself, LIC has notbrought on record any additional material to prove the history of Bronchitis andAsthma, prior to the date of proposal by way of treatment particulars/ pathologicalreports/doctor’s prescription/hospitalisation record for the said illnesses or even thesick leaves from the employer. When two statements are obtained from the samedoctor regarding the life assured, one in favour and one against, the one which isprejudicial to the interest of the person cannot be relied upon, unless there aresupportive evidences. Hence the history of 25 years stated by Dr. Pawar cannot betaken cognizance of.As the statutory period of two years had clearly expired when LICrepudiated the claim, Section 45 of the Insurance Act, 1938 applies in the present caseand policy cannot be called in question only on the ground of misstatement.In view of the above analysis, I find that the repudiation of the claim by LIC of India isnot sustainable on the basis of the documents produced before this Forum by them insupport of their decision to repudiate the claim under policy no. 902027528 for nondisclosureof material facts and hence the said decision of LIC is sustainable.Mumbai Ombudsman CentreCase No. :LI-141 of 2006-2007Smt Meena S PangareV/s.Life Insurance Corporation of IndiaAward Dated : 15.11.2006Shri Shantaram Gangaram Pangare had taken a Life Insurance policy through proposaldated 02.02.2005 for a Sum Assured of Rs.50,000/-.Shri Shantaram G Pangare expiredon 03.10.2005 due to Cardio Respiratory Arrest. When Smt Meena Pangare, wife andnominee under the policy, preferred a claim under the above said policy to LifeInsurance Corporation of India, Mumbai Divisional Office-I repudiated the claim statingthat the deceased life assured had withheld material information regarding his health atthe time of effecting the assurance. Aggrieved by this decision of LIC even afterrepresentation, Smt Meena Pangare approached this Forum seeking intervention of theOmbudsman in the matter of settlement of her claim. After perusal of all the recordssubmitted to this Forum, parties to the dispute were called for hearing. On scrutiny ofthe records it is noted that the diagnosis arrived at the hospital was Cor Pulmonale in ak/c/o right destroyed lung with RVH with LRTI which is corroborated by the DischargeCard of the hospital on record. As per the Medical Attendants Certificate (Claim FormB) dated 9 th February, 2006 completed by Dr. Rajesh M. Binyala, the cause of deathwas Cardio-respiratory arrest and the patient had been suffering from the last illnesssince one year, date of first consultation being 5.1.2005. The doctor in a separatecertificate mentioned that the life assured had been suffering from COPD (ChronicObstructive Pulmonary Disease) since one year.” It is also established from the claimform B and BI completed by Dr. Rajesh M. Binyala that he was treated by him for aboveailments before he proposed for assurance. In the instant case , the life assured didnot disclose the material facts regarding his past illness and hospitalisation for thesame, which were especially within his personal knowledge and it deprived LIC ofasking leading questions to probe into the matter. In view of this, L.I.C cannot befaulted for repudiating the death claim for deliberate misstatement and suppression of