Death Claim - Gbic.co.in

disbursement of salary as reported by CDPO, Balikuda, the employer. It is evident fromthe statement received from the employer that they were careless and most irregular indrawal and disbursement of the salary. The employer was never bothered to intimatethe insurer about irregular drawal and disbursement of salary. The bi-partite agreementdoes not also whisper a word about arrangement for payment of premium in the eventof delayed drawal and disbursement.It is the duty of the employer to draw and disburse salaries of their employees in time.Delayed payment and disbursement of assured’s salary from Nov’01 to Sept’02 is agross negligence on the part of the employer. Hence the blame for non payment ofpremium can not be laid at the door of a low paid employee like the assured. TheInsurer also should not side track the laws set down by the apex court on this issue inthe case of DESU vrs. Basanti Devi and Another(1999) NJC SC 539. It is thereforefound to be a fit case for ex-gratia award.An ex-gratia award of Rs.25000/- under Rule 18 of RPG Rules’98 is given to theComplainant.Bhubaneshwar Ombudsman CentreCase No. : 21-001-0165Sri Achutananda SwainVsLife Insurance Corporation of IndiaAward Dated : 12.10.06The deceased life assured Biswaranjan Swain had obtained a Jeevan Mitra(TrippleCover) Endowment Assurance with Profit Policy under T & T 133-25 for anassured sumof Rs.50000/- commencing from 27.11.02 nominating his brother Manas Ranjan Swainas beneficiary in event of his death vide Policy No.585022415.As ill luck would have it, the assured died on 4.6.2003. The nominee lodged deathclaim with the Insurer. The Insurer repudiated the claim on the ground interalia that theassured committed suicide within the operative period of suicide clause.The complaint was taken up for hearing on 19.6.2006 in presence of both parties. TheComplainant contended that the assured died out of suspected poisoning whereas therepresentative of the Insurer dubbed it as a case of suicide.Admittedly on 3.6.2003 the assured traveled from Bhubaneswar by a Cuttack boundbus and while alighting at Pratapnagari at about 7pm fell down unconscious. He wasrushed to SCB Medical College & Hospital, Cuttack where he died at 3.45 a.m on4.6.2003 while taking treatment. Doctor conducting autopery over the dead body of theassured reserved opinion as to cause of death. Consequent upon death of the assuredManglabag P.S. U.D. Case No.516 dtd.4.6.2003 was registered. The investigatingofficer submitted final report stating it to be a case of suspected poisoning.Ordinarily nobody commits suicide inside a bus during a short journey. The insurer hasnot made any investigation in to the matter nor they have produced any proof insupport of their contention that the assured committed suicide. In the absence of anyevidence to the contrary, Final Report submitted in the U.D.Case No. 516 dtd.4.6.2003, holding the death of the assured as a case of suspected poisoning isaccepted.The repudiation is set aside.Bhubaneshwar Ombudsman Centre