Death Claim - Gbic.co.in

There is no dispute that the Policy No. 201247225 was issued to the DLA by theRespondent on 28.10.2004 and the DLA died on 18-05-2005.During hearing, the Complainant stated that the DLA was illiterate and was sufferingwith paralysis and was not in good health at the time of taking the policy. TheInsurance was done on the basis of declaration of age of the DLA by the Agent whohas filled up the proposal form. The Complainant has further informed that no any otherspecific requirement was called for the age proof either from the agent or from theRespondent during her life time. The Complainant stated that the DLA was not awareabout the information which has been fulfilled by the agent in the proposal forms.The Respondent stated during hearing that at the time of proposal declaration of age ofthe DLA was submitted as age proof where in age was declared as 50 years. But it isobserved from the copy of Voter List of 2003 of “ Vidhan Sabha Kshetra Bhander SerialNo. 665 where in the age of DLA is shown as 62 years in case of proper discloser ofage proposal would not have been completed.It is also seen from the copy of Identity Card issued by the Electoral RegistrationOfficer Bhander where the age of son of the DLA is mentioned as 42 years as on 23-10-2003 which shows that the age of the DLA ( mother of the Complainant ) declaredas 50 years at the time of taking the policy is not tenable.In view of above, it is clear that the DLA has deliberately understated his age todefraud the Respondent in order to accept the proposal and thereby misled theRespondent in taking proper underwriting decision.However, it is further observed that the Respondent has to call for any other alternativedocuments such as copy of Ration Card, copy of Voter list etc.for the verification ofage at the time of underwriting when the DLA was illiterate and submitted thedeclaration of age which the Respondent did not take care.Insurance is a contract of Utmost Good Faith where both parties are required todisclose all the material facts. No party can be allowed to gain any undue advantage bysuppressing any fact. In the present case there is concrete evidence, viz., the copy ofVoter List of 2003 of “ Vidhan Sabha Kshetra Bhander Serial No. 665 to show that theDLA was aged more by 13 years than what was stated by her at the time of takingpolicy. Had the same been brought to the knowledge of the Respondent, theunderwriting decision would have been different.In view of the above, the decision taken by the Respondent in repudiating the deathclaim under Policy No. 201247225 is just and fair hence does not require anyinterference.Bhopal Ombudsman CentreCase No.: LI-1174-21/01-07/BPLSmt. Kailash BaiVsLife Insurance Corporation of IndiaAward Dated : 20.02.2007Smt. Kailash Bai, Resident of Village: Guradiya Rupchand, Tehsil: Ashta, Distt: Sehore(M.P.) (hereinafter called Complainant) is the wife of Late Shri Dev Singh Mewada,Deceased Life Assured (in short DLA). The DLA had a life insurance policy numbered351491649 taken from LIC of India, DO: Bhopal, BO: Sehore (hereinafter calledRespondent). The Policy commenced on 25.12.1997 under Money Back PlanTable/Term: 75-20 for Sum Assured of Rs. 50,000/-. The DLA expired on 18.10.2004due to Vomiting, Diarrhea, and anxiety. Thus the Policy had run for 6 years 9 months &