Death Claim - Gbic.co.in

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material facts by the life assured. Hence the decision of L.I.C does not warrant anyinterference from this forum.Mumbai Ombudsman CentreCase No. : LI-151 of 2006-2007Shri Kevalchand R JainV/s.Life Insurance Corporation of IndiaAward Dated : 17.11.2006Shri Sanjay Kewalchand Jain had taken two Life Insurance policies bearing nos.881094565 and 881094566 from Life Insurance Corporation of India through proposaldated 28.09.2002 for Sum Assured of Rs.3,00,000/- and Rs. 1,00,000 under Plan andTerm (149-25) and (105-30) (25) respectively. The commencement of the policies werefrom 01.10.2002. Unfortunately Shri Sanjay K Jain expired on 28.09.2003 due toTerminal Cardio Respiratory Arrest being the primary cause and the secondary causebeing Bilateral extensive Koch’s . When Shri Kevalchand Jain, father and nomineeunder the policy, preferred a claim under the above said policies to Life InsuranceCorporation of India, Mumbai Divisional Office-II, Life Insurance Corporation of Indiarepudiated both the claim vide letters dated 31.03.2004 stating that the deceased lifeassured had withheld material information regarding his health and that the LifeAssured was admitted to Radhibai Watumull Global Hospital on 29.8.2002 i.e. beforethe date of proposal and was diagnosed to have HIV positive for which he consulted amedical man and had taken treatment from him. This fact was not disclosed at the timeof taking the policy. Hence based on this LIC repudiated the claim. Not satisfied by thesaid decision, Shri Kevalchand Jain appealed to the Zonal Manager and aggrieved ShriKevalchand Jain approached this Forum for redressal of his grievance. Afterscrutinizing the records produced to this Forum, parties to the dispute were called forhearing.The entire records pertaining to the case have been gone through. It is evidentfrom the Radhibhai Watumall Global Hospital Case Papers on record that the deceasedLife Assured was admitted to that hospital on 29.08.2002 and discharged on24.09.2002 and was diagnosed HIV+ and was treated for the same. The fact that duringhis hospitalisation and immediately before that he had undergone various pathologicaltests and was in the hospital for 27 days continuously points to the serious nature ofthe illness he had been suffering. From the above analysis, it is established beyonddoubt that the deceased life assured suppressed material information and mademisstatements regarding his health status at the time of proposal and also suppressedthe material information regarding his health status at time of proposing for assurance.Had he disclosed these facts to the Insurer, they would have probed further and calledfor relevant special reports before taking appropriate decision in acceptance of therisk.In the circumstances, this forum finds no valid reason to interfere with the decision ofLIC of India to repudiate the claim for the sum assured under the policy.Mumbai Ombudsman CentreCase No. : LI-192 of 2006-2007Shri Kanaiya GhoshV/s.Life Insurance Corporation of IndiaAward Dated : 23.11.2006
Smt Shantona Kanaiya Ghosh had taken a Life Insurance policy bearing no. 881033788from Life Insurance Corporation of India through proposal dated 22.02.2002 for a SumAssured of Rs. 1,00,000 under Plan and Term (75-20). The commencement of thepolicy was from 1.01.2002 under half-yearly mode of payment. However the said policylapsed due to non payment of premium due in July, 2003 & January,2004. The policywas revived by LIC on 16.02.2004.Smt Shantona K Ghosh expired on 10.09.2004 dueto Chronic Renal Failure and when Shri Kanaiya Ghosh, husband and nominee underthe policy, preferred a claim under the above said policy to Life Insurance Corporationof India, Mumbai D.O.II of Life Insurance Corporation of India repudiated the claim videletter dated 26.11.2005 stating that the deceased life assured had withheld materialinformation regarding her health in the Personal Statement. After scrutinizing therecords produced to this Forum, parties to the dispute were called for hearing. It isevident from the Certificate of Treatment issued by Dr.Vaishali R Sankholkar that thedeceased life assured was suffering from recurrent attacks of urinary tract infectionsince the last eight to nine months prior to the date of her death and had consulted thedoctor in December, 2003. It is established that she was under treatment for the sameat the time of reviving her lapsed policy The analysis of the entire records leads to theconclusion that the insured had experienced frequent complications of urinary tractinfection which were giving enough signals to contact medical practitioner fortreatment. Riddhi Diagnostic Centre’s receipt indicates that she was indoor patient inWard 4 of KEM Hospital and was referred by the hospital for HCV Elisa test on 9-3-2004. As the Complainant has not produced the details of the first hospitalisation inKEM hospital, it is difficult to ascertain the exact date of admission and the history ofthe illness reported to the hospital. But, the date of reference for HCV test by Ward 4of KEM Hospital was 9-3-2004 which is close to the date of revival of the policy on 13-2-2004. From the above analysis, it would be reasonable to conclude that she hadhealth problems at the time of revival of the policy and it was known to her. All thesewere material facts, which should have been disclosed at the time of revival of thepolicy. Had she disclosed the correct information to the Insurer at the revival stage,LIC of India would have considered the revival with different criteria on the basis of thespecial medical reports, which would have been called for. The information suppressedin this case was material since the diseases connected with organs such as Kidney,Heart and Brain affect the longevity of a person.In the facts and circumstances of the case, decision of LIC to treat the revival of thepolicy as null and void is sustainable. Hence this Forum has no justifiable reason tointerfere with the decision of LIC.Mumbai Ombudsman CentreCase No. : LI-246 of 2006-2007Smt Samaradevi PatelV/s.Life Insurance Corporation of IndiaAward Dated : 28.11.2006Shri Ram Lakhan R Patel had taken a Life Insurance policy bearing no.892632594 fromLife Insurance Corporation of India, Branch 891 of Mumbai Divisional Office-III throughproposal dated 11.12.2003 for a Sum Assured of Rs.1,00,000/-. The commencement ofthe policy was from 21.08.2003. Unfortunately, Shri Ram Lakhan Patel expired on28.09.2005 due to Hypotension due to chronic renal failure in case of Diabetes Mellitusand Hypertension. When Smt Samradevi Patel, wife and nominee under the policy,preferred a claim under the above said policy to Life Insurance Corporation of India,Mumbai Divisional Office-III of Life Insurance Corporation of India repudiated the claim
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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
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establish that the LA failed to dis
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The complaint under Rule 12(1)(b) r
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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
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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 and 206: with him during the period 02.03.04
Page 207 and 208: Award dated 31.02.2007Smt. Shakunta
Page 209 and 210: asis of which proposal was complete
Page 211: Consultation/Treatment as proof of
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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