Death Claim - Gbic.co.in

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subsequently accepted the proposals, there is no letter from the Proposer on record toshow that he had accepted the counter proposal of LIC. . The general rule is that thecontract of insurance will be concluded only when the party to whom an offer has beenmade accepts it unconditionally and communicates to the person making the offer.Even in cases where first premium has been sent with the proposal and the insureraccepts the proposal without any modification, assumption of the risk being indicatedby a separate receipt issued for the first premium. But any acceptance is alwayssubject to the condition that any adverse event connected with the risk has occurredbetween the date of proposal and date of acceptance, the assurance is invalid unlessintimation of such event is given to the insurer and acceptance is reapproved. Theacceptance to be complete must be communicated to the proposer, either directly or bysome definite act, such as placing the contract in the mail. Mere delay in giving ananswer cannot be construed as an acceptance, as , prima facie, acceptance must becommunicated to the proposer.It is very clear that the amount paid and kept in deposit towards first premium wasconverted as Premium which is evident from the copy of the premium adjustment sheeton record. The First Premium Receipt, in respect of the policies under dispute wereissued after the death of the life assured on 11.5.2005. The delay in concluding thecontract could be attributed to unwillingness of the proposer to revive all the lapsedpolicies. The proposals were dropped by LIC and perhaps decided to accept the samelater on as per the oral request of the proposer. The premium adjustment was done andconsequently First Premium Receipt was printed and issued after the death of theproposer as the intimation of death had not reached the Insurer. Since the acceptanceof the contract was not communicated to the proposer before his death, there was noconcluded contract. However, LIC has paid claim of Rs. 2 lacs each on ex-gratia basisbased on the merit of the case which seems reasonable. In view of this, there is noreason to interfere with the decision of LIC.Mumbai Ombudsman CentreCase No. : LI-184 of 2005-2006Shri Govindrao Jhatingrao GaikwadV/s.Life Insurance Corporation of IndiaAward Dated : 02.01.2007Shri Dipak Kumar Nivrattirao Sonkamble had taken a Life Insurance policy from UdgirBranch Office of Life Insurance Corporation of India, Aurangabad Divisional Office,under Life Insurance Policy No.982045427 under Plan and Term 75-20 ( Money BackPolicy with profits + Accident Benefit) for sum Assured of Rs.50,000/-.The date ofproposal and the commencement of the policy was 15.02.2001. The said policy lapseddue to non payment of premium from February,2003 and the policy was revived on03.03.2004 based on the Personal Statement regarding health given by ShriDipakkumar Nivrattirao Sonkamble. Shri Dipakkumar Nivrattirao Sonkambleunfortunately expired on 9 th September, 2004, due to Hypertension c Heart disease.When Smt Vijaymali, wife and nominee under the policy, preferred a claim to LifeInsurance Corporation of India, LIC of India, Aurangabad D.O. repudiated the liabilitystating that the deceased life assured had withheld correct information regarding hishealth at the time of revival, and hence, in terms of the policy contract and declarationin the proposal form and personal statement, they were not liable for any paymentunder the policy. In the meanwhile Smt Vijaymali who was suffering from cancer andwas not able to move from her bed gave authority to her father, Shri Govindrao
Jhatingrao Gaikwad to pursue the case but unfortunately she also expired on31.12.2004. Shri Govindrao Jhatingrao Gaikwad made a representation and aggrievedby their decision, Shri Govindrao Jhatingrao Gaikwad approached this Forum forjustice. After perusal of the records parties to the dispute were called for hearing. Theentire records pertaining to the case have been scrutinised. The primary cause ofdeath was Hypertension with Heart Disease and the life assured had no other disease.He has also mentioned that the patient died at home due to heart attack, and he hadnot attended to him earlier and was not treated in any hospital. A bare perusal of themedical certificates would reveal that the leave was obtained on account of someailment like enteric fever, colic pain with severe dehydration/anaemia. There was nohospitalisation nor such ailment was the cause of his death. He died at home due tohypertension with heart disease. Obviously the cause of death had no nexus with thecasual illnesses on the basis of which he secured the leave from the employer. It willnot be out of place to mention that in Government employment/public sector,employees obtain medical certificate many a times falsely, only to secure leave. In thiscase the DLA was working in Government Milk Scheme, Parbani and his wife wassuffering from cancer. Under the circumstances, the suppression of the instant casewas wholly inconsequential having no bearing on the ultimate cause of death of theinsured. The death was sudden due to heart attack at home. LIC repudiated the claimon the basis of the medical certificates submitted by the life assured to his employerfor securing leave. In the claim form ‘B’ he has stated that no other disease precededor co-existed with that which immediately caused death. The medical certificates onwhich LIC relied on to repudiate the claim are not supported by copies of theprescriptions, chemists bills etc. pertaining to the treatment taken by the Life Assured.In view of the above analysis, Life Insurance Corporation of India is hereby directed tosettle the claim under policy No. 982045427 on the life of late Shri Dipak KumarNivrattirao Sonkamble and pay the claim amount as per the terms of the policyconditions to the legal heir of the life assured. The case is disposed of accordingly.Mumbai Ombudsman CentreCase No. : LI-178 of 2006-2007Smt Bebi Namdeo KalbandeV/s.Life Insurance Corporation of IndiaAward Dated : 11.01.2007Shri Namdev Sonaji Kalbande had taken a Life Insurance policy bearing for a SumAssured of Rs.1,00,000/- under Plan and Term (75-20)– a Money Back Policy withProfits and DAB. The commencement of the policy was from 28.02.2005. Unfortunately,Shri Namdev Sonaji Kalbande expired on 25.06.2005 due to CGN/HTN/CRF/ESRD withAnaemia. When Smt Bebi N Kalbande, wife and nominee under the policy, preferred aclaim Life Insurance Corporation of India repudiated the claim stating that thedeceased life assured had withheld material information regarding his health at thetime of effecting the assurance. Not satisfied by the said decision, Smt Bebi NamdevKalbande approached this Forum. After perusal of all the records submitted to thisForum parties to the dispute were called for hearing. The records pertaining to thecase have been examined. As per the Certificate of Hospital Treatment dated 8.9.2005issued by Asst. Professor of Nephrology, S.S.N & P.G.L., Nagpur, Shri NamdeoKalbande was admitted to the hospital on 12.5.2005 (Indoor admission no. 2553) withcomplaints of nausea, loss of appetite, oliguria – 3 months as reported by the patienthimself. The diagnosis arrived at the hospital was CGN/HTN/CRF/ESRD/Anaemia. Inthe Medical Attendant’s Certificate issued by the same doctor, it has been mentioned
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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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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
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hypertensive before the inception o
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Ltd and expired on 30.09.04. Theref
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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 and 212: Consultation/Treatment as proof of
Page 213 and 214: Smt Shantona Kanaiya Ghosh had take
Page 215 and 216: ody with altered behavior for few m
Page 217 and 218: Mumbai Ombudsman CentreCase No. : L
Page 219: Diabetes Mellitus since 20 years an
Page 223 and 224: into consideration, it would be rea
Page 225: Mumbai Ombudsman CentreCase No. : L
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