Death Claim - Gbic.co.in

The complaint was registered & necessary forms were issued to both the parties.Replies were received from both the parties.The Respondent vide its self-contained noted dated 26-02-2007 received by us on 28-02-2007 replied that Policy numbered 201211195 was issued to DLA on 28.12.95 for asum assured of Rs. 100000/-. Then, the policy lapsed and the same was revived on03.01.2000. Thus the Policy has run for 4 years 1 month and 10 days from the date ofcommencement and only for 5 days from the date of revival. The matter was underinvestigation as there is a difference in the signature of DLA on DGH for revival andthe death certificate was prepared after 9 months of death of DLA. Owing to the abovereasons, the claim settlement was delayed and now they have repudiated the deathclaim on the ground that the signature done on DGH dated 03-01-2000 is not of theDLA.Observations of Ombudsman : I have gone through the materials on records andsubmissions made during hearing and summaries my observations as follows:There is no dispute that the Policy No. 201211195 was issued to DLA by theRespondent under Money Back Plan on 28-12-1995 for sum assured of Rs. 100000/-.The Policy was revived by DLA on 03.01.2000 and the DLA died on 08.01.2000 due toheart attack.During hearing the complainant contended that the DLA was throughout keeping normalhealth and has a kirana shop at Dinara where he used to go there daily. TheComplainant has further informed that the DLA never suffered from any disease nortaken treatment or was admitted in any hospital before reviving the policy. The death ofDLA was due to heart attack.During hearing the Respondent stated that the policy was commenced on 28-12-1995.The policy was lapsed since Hly due 06/96 and was revived by paying arrears ofpremium for due 06/96 to 12/99 on 03-01-2000 on the basis of DGH. The respondentfurther informed that the signature of DLA on the DGH dated 03-01-2000 was nottallied with the signature on the proposal of policy in question. Hence the death claimwas repudiated by the Respondent.It is observed from records that the claim was repudiated by the Respondent due to thereasons that the signature of DLA differs in DGH for revival. On scrutiny, it is observedthat the Date of Death of DLA is 08.01.2000 and the death certificate is dated22.09.2000 but the Respondent has not raised any objection about the issue of deathcertificateIt is observed that the Respondent has taken the decision of repudiation on 11-02-2006on the basis of report of hand writing expert dated 30-12-2005 which was already lyingwith them and not any extra efforts were made to establish the signature of DLA fromany other admitted proof of his signature such as bank account, school records, rationcards etc. and the decision of repudiation was taken only after the order from thisforum issued on 31-01-2006. If the decision was to be taken merely on the HandWriting Expert’s they could have taken the decision earlier, which shows unreasonabledelay in deciding the claim.It is seen from records that when the DLA was ready to revive his policy by paying theamount of Rs 32232=80 then there is no point that he could have not signed the DGHsubmitted at the time of revival with 3 ½ years premium in arrears, even the originalclaim forms were also misplaced. It may also possible that the DGH originallysubmitted by the DLA is replaced by the Respondent to strengthen the repudiationaction.