Death Claim - Gbic.co.in

tests done on 3.4.2006 were normal and he was in good health at that time is nottenable in the absence of the referring doctor’s recommendations and the findings.It is clear from the information given by Dr.Asmita N Shah and also the informationgiven by the complainant herself in the statements mentioned above, that the deceasedlife assured was suffering from Diabetes and Hypertension when he proposed forassurance. The complainant in her oral deposition also admitted that her husband hadbeen taking ½ tablet daily for diabetes, on the advice of Dr. Asmita Shah. The lifeassured did not disclose this material information in the proposal form and before theMedical Examiner of the Insurer or in the Diabetes questionnaire Form. Had hedisclosed the correct status of his health at the time of proposal, Insurer would haveprobed further and taken appropriate underwriting decision.Thus the repudiation of death claim by Bajaj Allianz Life Insurance Company on theground of deliberate misstatement and suppression of material facts regarding healthof the life assured at the time of proposal is held sustainable.Mumbai Ombudsman CentreCase No. : LI-033 of 2006-2007Smt Ranjana Anilrao DhandoleV/s.Life Insurance Corporation of IndiaAward Dated : 28.02.2007Shri Anil Daultrao Dhandole had taken a Life Insurance policy bearing no.820882530from Life Insurance Corporation of India, Yavatmal Branch 991 of Amravati DivisionalOffice through proposal dated 26.08.2003.Unfortunately Shri Anil Daultrao Dhandoleexpired on 03.04.2005. The primary cause of death was Ca Penis (operated) and thesecondary cause was secondaries in pleural and lungs, pleural effusion, Septicaemia,multi organ failure. When Smt Ranjana Anilrao Dhandole, wife and nominee under thepolicy, preferred a claim under the above said policy to Life Insurance Corporation ofIndia, Amravati Divisional Office of Life Insurance Corporation of India repudiated theclaim stating that the deceased life assured had withheld material informationregarding his health at the time of effecting the assurance After perusal of all therecords submitted to this Forum parties to the dispute were called for hearing. It isevident from the case papers dated 27.9.2004 of Dr. Ravi Deshmukh that the deceasedlife assured had health problems viz penile growth before he proposed for theinsurance under the above policy for which he had undergone pathological test in 6/03as noted by the doctor. Though the complainant has denied the history of cancer, sheadmitted that the life assured was operated for growth in penis in March, 2003 atKawalkar hospital and again in October, 2004. The fact that he was suffering fromgrowth in penis was further confirmed from the histopathology report dated 2.6.2003submitted by the complainant herself, which ultimately turned out to be cancer leadingto the death of the Life Assured. The analysis of the entire records leads to theconclusion that the Insured had experienced frequent complications for which he hadconsulted medical man and undergone pathological tests and surgery before applyingfor assurance which were not disclosed. In the above case there was clear suppressionof material fact by the deceased life assured and hence LIC’s decision to repudiate theclaim cannot be faulted.In the circumstances, this Forum has no justifiable reason to interfere with the decisionof LIC to repudiate the claim.