Death Claim - Gbic.co.in

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