Death Claim - Gbic.co.in

stating that the deceased life assured had withheld material information regarding hishealth at the time of effecting the assurance. Not satisfied by the said decision SmtSamradevi Patel appealed to the Zonal Manager aggrieved at their decision, SmtSamradevi Patel approached this Forum for redressal of her grievance. After perusal ofall the records submitted to this Forum parties to the dispute were called for hearing .Itis evident from the above case papers that the deceased Life Assured, Shri Patel, wassuffering from Hypertension since three years before his death and the SonographyReport dated 27.8.2003 from Sadguru Daskishan Saibaba Mandal Charitable Polyclinicrevealed that there was stone in his left kidney. The fact that the had undergonevarious pathological tests on 23.8.03 and Ultrasonography on 27.8.2003 as is evidentfrom the history noted in the KEM hospital case papers which were not disclosed byShri Patel at the time of filling up his proposal for insurance. The analysis of the entirerecords leads to the conclusion that Shri Patel had the knowledge that he was sufferingfrom some health problem for which he underwent sonography and some pathologicaltests. He suppressed this material information in his proposal form and gave deliberateincorrect statements. Going by the primary cause of death, i.e., Hypertension withrenal calculi, both the diseases were pre-existing, i.e., they were present even beforethe proposal date as is evident from the KEM hospital case papers. This clearlyindicates that the deceased life assured, with malafide intention, suppressed hismedical history thereby denying LIC an opportunity to take a proper underwritingdecision.In view of this legal position, LIC cannot be put to fault for repudiating theclaim on the life of Late Shri Ramlakhan Patel. In the circumstances, this Forum has nojustifiable reason to interfere with the decision of LIC to repudiate the claim.Mumbai Ombudsman CentreCase No. : LI-150 of 2006-2007Smt Dhan Razia DeviV/s.Life Insurance Corporation of IndiaAward Dated : 29.11.2006Shri Ram Prasad Gupta had taken a Life Insurance policy bearing no. 192533832 fromLife Insurance Corporation of India, Branch 159 of Jaipur Divisional Office throughproposal dated 28.03.2004 for Sum Assured of Rs.51,000/. The commencement of thepolicy was 28.04.2004. Shri Ram Prasad Gupta expired on 01.06.2004 due to Chronicliver disease with Portal hypertension. When Smt Dhan Razia Devi, wife and nomineeunder the policy, preferred a claim under the above said policy to Life InsuranceCorporation of India, S.S.S Divisional Office of Life Insurance Corporation of Indiarepudiated the claim stating that the deceased life assured had withheld materialinformation regarding his health at the time of effecting the assurance Not satisfied bythe said decision, Smt Dhan Razia Devi appealed to the Zonal Manager and beingaggrieved at their decision, Smt Dhan Razia Devi approached this Forum for redressalof her grievance. After perusal of the records parties to the dispute were called forhearing.On an analysis of the entire records, it is observed that the Life Assured hadtwo policies and LIC had settled the claim under policy no.192443156 but for the policyNo. 192533832 which is under dispute at this Forum it is found that LIC had repudiatedthe claim based on the Medical Attendant’s Certificate i.e. Form ‘B’ and the certificateof treatment issued by Dr. P.K.Sanma of Guwhati Medical College.In the claim Form B(Medical Attendant’s Certificate) dated 11.6.2005, Dr. P.K.Sanma has mentioned thePrimary cause of death as Chronic liver disease with Portal Hypertension and for thequestion how long had he been suffering from this disease before his death he replied“for few months exact time not noted”. He has also stated that there was swelling of the