Death Claim - Gbic.co.in

There was no dispute that the DD for the premium amount Rs. 4409/- was prepared on29.3.2004 by SBI Nowrangpur which is the nodal agency of the Insurer. The assureddied on 30.8.2004 after payment of premium. The assured had no role to play and theball was on the court of the insurer. In spite of repeated requests and longadjournment, the nodal agency ( SBI Nowrangpur ) avoided to furnish date of despatchof draft to the Insurer.Explanation to Section 64 VB of Insurance Act 1938 provides “ where the premium istendered by M.O. or cheque sent by post, the risk may be assumed on the date onwhich the money order is booked or the cheque is posted as the case may be.In the present case premium DD was prepared on 29.3.2004 and the assured died 5months thereafter. The nodal agency avoided to state the date on which the DD wasdespatched to the Insurer. Therefore the adverse presumption u/s 114(g) of IndianEvidence Act is to be drawn against the Insurer.The TPA is not a party to the contract. The assured is in no way concerned with a thirdparty. The Assured has performed his part of the contract. The contract therefore cannot be dubbed as unconcluded for the remissness of the law. The repudiation istherefore not sustainable in law.The Insurer is directed to settle the claim by liquidating the outstanding loan withinterest.Bhubaneshwar Ombudsman CentreCase No. : 21-009-0172Smt. Modulu EpiliVsBajaj Allianz Life Insurance Co.Ltd.Award Dated : 30.01.07The Complainant is the widow of deceased life assured Epili Judhisti who had obtaineda Risk-Care- Economy non participating policy for 15 years term for an assured sum ofRs.4,50,000/- commencing from 13.11.2003 from Bhubaneswar Branch of Bajaj AllianzLife Insurance Co. Ltd. vide Policy No. 3277432 nominating the Complainant asbeneficiary in the event of his death. Unfortunately the life assured died on 29.11.2003due to accidental fall from the stair case of the house. The Complainant as nomineelodged the death claim which was repudiated by the Insurer on the ground interalia thatit was an unconcluded contract.The Complaint was taken up for hearing in presence of both parties. It was contendedon behalf of the Complainant that the assured died on 29.11.2003. The date of riskstated in the policy document being 21.11.2003, the contract was concluded andbinding on the Insurer.It was submitted by the Insurer that though the SUC was Rs.4,50,000/- the TASAincluding previous policies comes toRs.9,00,000/- for which medical examination ismandatory before acceptance of the proposal. In response to their letter dt.23.12.2003, the medical examination report of the assured was submitted in theprescribed format issued by Dr. R.K.Mohapatra of Berhampur certifying good healthwhere upon the policy document in question was issued on 14.4.2004 stating date ofrisk as 21.11.2003. Subsequently on lodging of claim , it came to light that the assuredhad died on 29.11.2003 i.e prior to the alleged medical examination. The Complainantpracticed fraud in obtaining the policy by producing a created medical examinationreport on 12.4.2004 i.e after death of the assured for which the claim was repudiated.