Death Claim - Gbic.co.in

that the patient did not die in that hospital. On careful scrutiny of this certificate it isobserved that question no. 5(e) was replied as “7.3.2005 four months” and questionno.7 as “ 7.3.2005.” and the handwriting clearly indicates that this information waswritten subsequently and is not of one and the same person.LIC repudiated the claimon the ground that the life assured had been suffering from CRF, HTN, ESRD andAnaemia before the date of proposal which were not disclosed in the proposal form. Itis observed from the medical papers on record that the life assured consulted medicalman within a month from the inception of the policy and was diagnosed to have ChronicRenal Failure. He was admitted to Medical Post Graduate Institute, Super SpecialityHospital, Nagpur just after two months from the date of proposal with Chronic RenalFailure and End Stage Renal Disease (ESRD) among other complications which clearlypoints to the fact that the invasive progress of the disease could not have developedwithin a month from the date of proposal. However, LIC has not discharged the burdenof proof adequately by providing any proof of treatment before the date of proposal orproved that the life assured had knowledge of the illness, instead they produced theforged hospital records with a view to prove that the life assured was suffering from theillness and was taking treatment prior to the date of proposal. But the Insured was afarmer from a rural area without an easy access to the medical facilities and perhapshe had ignored all the symptoms of the illness in a casual approach and hence notdisclosed in the proposal form.Considering the totality of the case, I am inclined to grant an ex-gratia payment of 50%of the Sum Assured under the policy by invoking power under Rule 18 of the RPGRules, 1998.Mumbai Ombudsman CentreCase No. :LI-187 of 2006-2007Smt Pratidnya Prabhakar GoregaonkarV/s.Life Insurance Corporation of IndiaAward Dated : 25.01.2007Shri Prabhakar Ramchandra Goregaonkar had taken a policy bearing no.923071389from Life Insurance Corporation of India, of Thane Divisional Office through proposaldated 30.01.2004 for a Sum Assured of Rs.30,000/- under Table and Term (91-15)-New Janaraksha Plan with Profits and Accident Benefit. The commencement of thepolicy was from 25.01.2004. Unfortunately, Shri Prabhakar R Goregaonkar expired on14.04.2005 due to Cirrhosis of liver with Ascites and encephalopathy. When SmtPratidnya P Goregaonkar, wife of Late Shri Prabhakar R Goregaonkar preferred a claimunder the above said policy to Life Insurance Corporation of India, Thane DivisionalOffice of 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 Pratidnya PGoregaonkar appealed to the Zonal Manager and aggrieved by their decision, SmtPratidnya Prabhakar Goregaonkar approached this Forum for redressal of hergrievance. The analysis of the entire records leads to the conclusion that the insuredhad an attack of Chronic Hepatitis with cirrhosis of liver disease with ascites andencephalopathy. The word Ascites means the accumulation of fluid in the peritonealcavity, causing abdominal swelling. Causes include infections such as tuberculosis,heart failure, portal hypertension, cirrhosis and various cancers (particularly of theovary and the liver) and Chronic hepatitis continues for months or years, eventuallyleading to cirrhosis. It may be caused by persistent infection with a hepatitis virus(usually hepatitis B, C or D) which may respond to treatment.Taking all the certificates