Death Claim - Gbic.co.in

the claim stating that her son being a minor at the time of proposal was not legallyqualified to contract. Being an illiterate family, they were not aware of the complicationdue to overstatement and there was no intention to deceive the insurer.FINDINGS : The insurer informed that Shri Iyameen (DLA) was issued a money backpolicy for sum assured of Rs. 1,05,000/- with DOC 23.06.2004. It was further informedthat in the policy papers DLA stated his date of birth as 05.01.1984 and submitted theration card dated 05.07.1995. Accordingly, the age nearer birthday comes to 20 yearson the date of proposal. Just after 10 months 10 days, LA died due to heart attackwithout any medical aid. Being an early claim, bonafides were investigated and it wasfound to be a case of overstatement of age by three years. As per school record, dateof birth is 09.01.1987 and not 05.01.1984 as stated by DLA in his proposal papers.Hence, accordingly age nearer birthday as on date of risk commenced comes to 17years 05 months 14 days i.e. minor. Therefore, as per policy contract, minor had nocapacity to enter into any contract. Hence, the contract was void ab initio. Therefore,considering all facts of the case, the Competent Authority decided to repudiate theclaim and the same was duly conveyed to complainant vide letter dated 31.12.2005. Ona query whether any certificate from registrar of birth or death is available, the replywas in the negative. The complainant pleaded that the actual date of birth was notknown and assessed date of birth was given both in ration card and to schoolauthorities. The DLA had given a declaration without fully comprehending thequestionnaire regarding the age proof. It was found that the basic issue was correctage of DLA at the time of taking insurance cover. The complainant could not produceany documents from the office of registrar of deaths and births. The insurer wasadvised to depute a responsible officer to the village/ hospital where the DLA was bornto ascertain the correct age and obtain a proof to that effect.DECISION : Held that based on above document the claim be settled on merits within45 days. In case no document was made available as proof of date of birth the presentrepudiation should hold good.Chandigarh Ombudsman CentreCase No. : LIC/407/Ludhiana/Khanna/21/07Kulwant KaurVsLife Insurance Corporation of IndiaOrder dated: 30.3.07FACTS : Smt. Kulwant Kaur’s husband Late Shri. Kulwant Singh purchased a policybearing no. 300175685. He expired on 14.4.05. The requisite documents pertaining toclaim were submitted in the insurer’s office for settlement of claim, but the same wasrepudiated in February’06. She urged intervention of this forum in settlement of claimin her favour.FINDINGS : The insurer informed that the DLA submitted proposal dated 20.12.04 forRs. 1,50,000 and stated that he had no problem of sugar and BP at the time ofproposal and even earlier. However, DLA had high BP since last 5 years and sugarsickness since 1.1.2002. The insurer informed that they had sufficient proof fromtreating doctor which confirms that DLA was suffering from sugar and high BP. Hencethe claim was repudiated accordingly as DLA misstated and concealed facts regardinghis adverse physical history knowingly. Hence Section 45 of Insurance Act was alsooperative in this death claim under the policy.DECISION : Held that the repudiation of claim by the insurer was in order. No furtheraction is called for and the complaint was dismissed.