Death Claim - Gbic.co.in

ody with altered behavior for few months. Regarding any reason to suspect thedisease was caused or aggravated by his intemperate habits, the doctor has mentionedthat it ‘may be’ and there was no definite proof regarding the history of alcoholism. Asper the Medical Case sheet if 165 MH C/o 99 APO Hospital there is a noting made on18.5.04 that Shri Ram Prasad was a case of Ascites for one month and an old historyof chronic alcohol intake. The proposal is dated 28.3.04 and was accepted by LIC onlyon 28.04.04 on receipt of first premium. The notings made in the hospital case sheeton 18.5.04 clearly proves that life assured was not in good health and was sufferingfrom ascites before the proposal was accepted by LIC. This information was neitherdisclosed in his proposal form dated 28.3.2004 nor thereafter before acceptance of theproposal. He had furthermore not declared in the proposal form that he used toconsume alcohol. Had he disclosed these material facts at the time of proposing forassurance, LIC would have called for relevant reports and taken appropriate decisionbefore accepting the risk. This opportunity was not given to LIC.Thus rejection of death claim by LIC for the sum assured under the policy for deliberatemisstatement and withholding material information at the time of proposing forassurance is held sustainable. Hence, this Forum finds no justifiable reason tointerfere with the decision of LIC of India.Mumbai Ombudsman CentreCase No. : LI-137 of 2006-2007Smt Jayshree N DhadwadV/s.Life Insurance Corporation of IndiaAward Dated : 04.12.2006Shri Nandkumar Lumaji Dhadwad had taken a Life Insurance policy bearingno.908841608 from Life Insurance Corporation of India, Branch 902 of MumbaiDivisional Office through proposal dated 05.01.2005 for a Sum Assured ofRs.2,00,000/-. The commencement of the policy was from 08.01.2005. Unfortunately,Shri Nandkumar L Dhadwad expired on 24.06.2005 due to Abdominal Koch’s andRetroviral disease. When Smt Jayshree N Dhadwad, wife, preferred a claim under theabove said policy to Life Insurance Corporation of India, SSS Divisional Office, Mumbaiof Life Insurance Corporation of India repudiated the claim stating that the deceasedlife assured had withheld material information regarding his health at the time ofeffecting the assurance.Not satisfied by the said decision Smt Jayshree Dhadwadappealed to the Zonal Manager and aggrieved by their decision, Smt JayshreeDhadwad approached this Forum for redressal of her grievance. After perusal of all therecords submitted to this Forum parties to the dispute were called for hearing. Theentire documents on records and respective submission of the parties have been gonethrough. It is also evident from the certificate by the employer and the medicalcertificates submitted by the life assured for securing leave that he consulted doctorsand remained absent on medical grounds on four occasions before he submitted theproposal. The history recorded in Nair hospital as recorded by the doctor reveals thathe was a chronic alcoholic and smoker. Since the proposal was made under nonmedicalscheme, LIC solely relied on the information given by the life proposed in theproposal form and declaration dated 05.01.2005 for considering the proposal. He didnot disclose the above information in the proposal form which were material insteadreplied the relavant questions negatively. Had he disclosed the true and correctinformation to the Insurer, they would have called for medical reports and relevantquestionnaire and probed further and taken appropriate underwriting decisionaccordingly.