Death Claim - Gbic.co.in

Chandigarh Ombudsman CentreCase No. : LIC/333/Ludhiana/Jagraon/21/07Charanjit KaurVsLife Insurance Corporation of IndiaOrder dated: 24.1.07FACTS : Smt. Charanjit Kaur’s husband Late Shri Sardar Surjit Singh had taken apolicy bearing no. 161493098 from Branch Office, Jagraon for sum assured of Rs.25,000/- with DOC 28.12.2002. The policy was revived on 24.05.2005. He died on27.06.2005. She stated that the premiums were paid regularly under the policy. Shelodged death claim with relevant documents which was repudiated on the ground ofsuppression of material facts at proposal stage. She vehemently denied allegation thather husband was habitual of consuming drugs and selling them. She came to know ofthis allegation when a fake case was registered against him.FINDINGS : The insurer informed vide letter dated 18.12.2006 the DLA died in policecustody on 27.06.2005. He was detained by the police under section 15 of N.D.P.S.Act. He was also detained by the police on 12.08.2000. It was further informed that aninvestigation was conducted which revealed that DLA was in the habit of taking excessliquor and drugs. He was admitted in Rajindra Hospital, Patiala for treatment ofdiseases because of excess liquor and drugs. The policy was revived on 24.05.2005.However, these facts were not disclosed by him at the time of revival of the policy. Theinsurer stated that the policy was in force on the date of death. There was intimationgiven by police authorities that the DLA was a habitual alcoholic and consumer ofdrugs etc. It was found that no proof of pre-existing disease could be established bythe representative of insurer. The record given in the claim form by the medicalauthorities was based on the information furnished by police attendant who was not amedical practitioner. While it may be a fact that the DLA was selling drugs etc., but thatrelated to his activities for which the police had already registered a case against himand it had no relevance with the insurance policy as the terms of insurance policy donot mention that insured should not indulge in illegal activities at the time of taking upthe insurance policy for basic sum assured.DECISION : Held that the claim of the complainant for payment of admissible amountunder the basic sum assured was tenable. Hence ordered that the insurer should makepayment of admissible amount for basic sum assured along with accrued bonus.Chandigarh Ombudsman CentreCase No. : LIC/356/Chandigarh/Malerkotla/21/07Smt. SariyaVsLife Insurance Corporation of IndiaOrder dated: 27.2.07FACTS : Smt. Sariya who happens to be the nominee under the policy stated that herhusband had taken two policies; one for himself and the other on the life of his son inthe month of June 2004. He had submitted driving licence as age proof for himself andration card for his son. Both the age proofs were accepted by the insurer and policieswere issued. Unfortunately, the complainant’s son died on 03.05.2005 due to heartattack. During investigation, the insurer procured his date of birth from the schoolrecord which differed from his actual date of birth. She further stated that there was noadverse family history or health problem in her entire family. The insurer had declined