Death Claim - Gbic.co.in

Life Insurance Corporation of IndiaAward Dated : 11.12.2006Shri Shivaji Vishnu Pol had taken a Life Insurance policy bearing no. 907499727 fromLife Insurance Corporation of India, Branch 927 through proposal dated 30.07.2003 forSum Assured of Rs.75,000/ under Plan and Term (14-15). The commencement of thepolicy was 20.08.2003. Shri Shivaji V Pol expired on 29.12.2004. When Smt Rupali SPol wife and nominee under the policy, preferred a claim under the above said policy toLife Insurance Corporation of India, S.S.S Divisional Office of LIC repudiated the claimstating that the deceased life assured had withheld material information regarding hishealth at the time of effecting the assurance and in the proposal form dated 30.7.2003They said they had indisputable proof to show that the Life Assured was suffering fromJuvenile diabetes since age 12-13 years and was on insulin. He was also a case ofchronic pancreatitis. These facts were not disclosed at the time of taking the policy.Hence based on this LIC repudiated the claim. Not satisfied by the said decision, SmtRupali S Pol approached this Forum for redressal of her grievance. After perusal of therecords parties to the dispute were called for hearing. The relevant records pertainingto the case have been perused.It is evident from the history recorded in the casepapers of KEM hospital and Jaslok hospital that Shri Shivaji Pol was javelin diabeticsince age 12/13 years.It can be established that the above facts were not disclosed inhis proposal dated 30 th July, 2003. The analysis of the records leads to the conclusionthat the deceased life assured had fraudulently suppressed material information in hisproposal form; instead, he gave deliberate incorrect statements. Since he was takinginsulin for diabetes, he was very much aware of it. The cause of death, viz.,“Carcinoma, Head of Pancreas”, has a direct nexus with the suppressed materialinformation. “Chronic Pancreatitis may lead to pancreatic failure causing malabsorptionand diabetes mellitus. The pancreas often becomes calcified producing visibleshadowing on X rays”. The above is extracted from the Oxford’s Concise MedicalDictionary, Indian Edition. Had Shri Pol disclosed the correct information about hispast/present history of illness as also the treatment being taken by him, to the Insurerat the proposal stage, the Life Insurance Corporation of India would have called forvarious special reports before underwriting the proposal and taken appropriate decisionin acceptance of the proposal.In the circumstances, this Forum has no justifiable reason to interfere with the decisionof LIC of India to repudiate the claim on the ground of non-disclosure of materialinformation.Mumbai Ombudsman CentreCase No. : LI-232 of 2006-2007Smt JayalaxmiV/s.Tata AIG Life Insurance Company Ltd.Award Dated : 28.12.2006Shri Alva Ramayya Santha had taken a Term Assurance Policy for 20 years with returnof premium plan under policy No.C001840670 from Tata AIG Life Insurance Companylimited for a Sum Assured of Rs. 2,00,000/-. The policy also covered an additionalAccidental death benefit of Rs. 2,00,000/-, The date of proposal for insurance was26.10.2005. Shri Alva Ramayya Santha unfortunately expired on 18.1.2006 due toTerminal Cardiac Arrest in a case of Orbital Mucor-mycosis with Diabetes Mellitus withstroke. When Smt Jayalaxmi preferred a claim under the said policy, the Companyrepudiated the claim stating that Shri Ramayya Santha Alva was on insulin therapy for