Death Claim - Gbic.co.in

Repudiation of Claim for Payor’s Benefit under Life Insurance Policy: While proposingfor Insurance, the Assured had not disclosed the fact of having taken treatment forHigh Blood Pressure and raised Cholesterol. The assured died within a year of takingthe Insurance Policy. Claim for Payor’s Benefit on death of the deceased Life Assuredwas repudiated by the Respondent on the basis of Statements given by the Assured’sWife and Brother both of whom were close relatives. Non-disclosure of the fact of HighBlood Pressure denied the opportunity to call for further Special Medical Report etc. Assuch, the facts being material for underwriting, the decision of the Respondent torepudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. : 21-001-0161Mr. A J PatelVsLife Insurance Corporation of IndiaAward Dated : 26-10-2006Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, theAssured had not disclosed the fact of having taken treatment for Chest Pain andDysnea on exertion on an off since 2 years, increased since 2 months, history ofDiabetes since 2 years and history of Hypertension since 6 months. These histories gobeyond the date of the Proposal. The assured died shortly after 2 years of taking theInsurance Policy. Besides on one occasion, the Deceased was admitted to a Hospitalshortly after he filled in the Proposal for Insurance but before the date of acceptance ofthe Risk. Claim on death of the deceased Life Assured was repudiated by theRespondent on the basis of Certificate of Hospital Treatment by reputed CardiacHospitals. Non disclosure of the fact of Hypertension/Diabetes/Chest pain denied theopportunity to call for further Special Medical Report etc. The case could have beensent over to the Higher Offices of the Insurer for decision. As such, the facts beingmaterial for underwriting, the decision of the Respondent to repudiate the Claim wasupheld.Ahmedabad Ombudsman CentreCase No. : 21-001-0189Ms. R J PandyaVsLife Insurance Corporation of IndiaAward Dated : 30-10-2006Repudiation of Claim for Accident Benefit under Life Insurance Policy: As per thecontention of the Complainant, the Assured fell down from a Scooter. Due to theinjuries, he died. The Respondent stated that the Cause of death as given in PostMortem Report is ‘Cardio Respiratory Failure due to pathology present in Heart. Thereis no mention of any major injury. Documents on record do not prove the Death asAccidental. The Newspaper report covering the event ascribed it to have been Heatinduced giddiness leading to the DLA falling down in an unconscious state. The Reportdoes not even mention of the Accident. As such, the decision of the Respondent torepudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. : 21-001-0166Mr. R S ZalaVs