Death Claim - Gbic.co.in

More documents

Recommendations

Info

was mentioned as ‘Malignancy’ and the Life Assured was taking treatment since16.06.1999 i.e., well before the date of Proposal. As per the reports received fromArvind Hospital, the Life Assured was suffering from Secondary Metastasis to left Orbitand had undergone lateral orbitotomy on 06.08.1999 and also received 6 cycles ofChemotherapy. The life assured had also taken Radiation treatment for Cancer atMeenakshi Mission Hospital and Research Centre, Madurai from 04.01.2000 to17.02.2000.There is nexus between the cause of death and illness suppressed. The Insurer hasproved with clinching evidence that the life assured had furnished wrong informationabout his state of health in the proposal and suppressed that he was suffering fromCancer even before proposing for insurance. By withholding information that was verymaterial, the life assured has misguided the insurer in wrongly issuing the policies.The Complaint was dismissed.Chennai Ombudsman CentreCase No. : IO(CHN)/21.04.2278/2006-07Smt.R.MasilaVsLife Insurance Corporation of IndiaAward Dated : 06.11.06Sri.M.Rajangam had taken an Endowment policy bearing no. 743811003 forRs.100,000/- and nominated his wife Smt. R.Masila as nominee. He died on03.07.2005. The Insurer denied the death claim payments on the ground that theassured had suppressed the material facts of his suffering from Urolithiasis with rightureteric vesical junction calculus with ARF, his ischemic heart disease, his consultationwith the doctor and the treatment availed three years prior to his proposing forinsurance and hence the policy was declared void and hence the complaint preferredwith this Forum by the nominee Smt. R.Masila.On 15.09.2006, a personal hearing of both the parties was held. The complainant wasnot present. Her letter was read out. In that she said that her husband had taken thepolicy for income-tax purpose. As the Madurai office had rejected her claim she wantedthe Ombudsman to mediate and get her the claim proceeds. The insurer stated that thedeceased life assured took a policy in February 2005 by submitting a proposal on25.02.2005. As the claim was a very early claim, death having taken place within 4months and 8 days of taking the policy they got a ‘Claim Investigation’ done by one oftheir Officials. The Official had noted in his report that the life assured had takentreatment at Meenakshi Mission Hospital and Research Hospital, Madurai. Whereas thelife assured in his proposal had not mentioned his illnesses or that he had takentreatment in the hospital.On a careful study of the representation of the complainant and the case presented bythe insurer along with the Forms and certificates of treatment taken by the life assured,it was proved that the life assured had been hospitalized and he was treated for hisCalculi and also advised about his heart condition in early 2002 itself. However he hadnot disclosed his correct health condition in his proposal dated 25.02.2005. Bysuppressing information that was very essential for the Insurer to assess his risk, thelife assured has misled the Insurer in issuing the policy at normal rates. Therefore therepudiation of the complaint’s claim for the assured sum and its ancillary benefits by
the Insurer on the ground that the insured had withheld material information regardinghis health is sustainable.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.04.2268Smt. S.BalamaniVsLife Insurance Corporation of IndiaAward Dated : 08.11.2006.Sri. P.Sakthivel took an Endowment policy bearing No.742683462 for Rs.100000/- fromLIC of India, Dindigul Branch (under Madurai Division). The date of commencementwas 20.03.2001 with the half-yearly premium being Rs.3969/-. On 20.11.2004 herevived the policy (which was lapsed due to non-payment of the premium due in March2004) on the strength of a “Personal Statement of Health” which was dated 10.11.2004.The life assured died on 16.01.2005 and Smt.S.Balamani, wife of the LA claimed thedeath benefit. The Insurer repudiated the claim on the ground that the LA had notdisclosed the fact, at the time of revival that he had suffered from Comminuted LateralCondyle Fracture, that he was a hypertensive and that he had taken treatment at CMC,Vellore for Inferior Wall Myocardial Infarction.In the hearing the complainant Smt. S.Balamani, said that her husband had died ofheart attack. She added that he was not well for 6 months before his death. She alsoinformed that he had met with an accident three years back for which he was operatedthrice. She replied that her husband had availed medical leave during 2003& 2004 ondoctor’s advice and to help during their daughter’s delivery. The Insurer informed thatthey had repudiated the claim as the life assured had not disclosed the treatment takenin various spells at different hospitals, during the pre-revival period, in his “PersonalStatement of Health” dated 10.11.2004. However they had offered to pay Rs. 37400/-which was the paid-up value and the bonus thereon.Keeping in mind the health background of the insured as evidenced from records, thefalse answers to question 2a),2b) and 2c) and question 4 of the “Personal Statement ofHealth” signed on 10.11.2004 was a clear case of suppression of “material facts” andthe repudiation was justified. There is also a nexus between the cause of death and theillness suppressed. Therefore the decision of LIC of India to pay Rs.37400/- as thepaid-up value with the accrued bonus is valid.Chennai Ombudsman CentreCase No. : IO (CHN)/21.04.2307.Sri.M.SelvarajVsLife Insurance Corporation of IndiaAward Dated : 14.11.2006Sri. S.Inbaraj, submitted a proposal to LIC of India, Periyakulam Branch under MaduraiDivision, to get life insurance cover.The policy numbered, 742820583, was for a sum assured of Rs.50000/-, under theEndowment Plan with a term of 16 years. Premiums were deducted from his salary andpaid to LIC by his employer. As he was not married he had nominated his father. Thelife assured died on 15.03.2005. Sri M.Selvaraj, father of the life assured claimed thebenefit under the above policy. The Insurer repudiated the claim stating that the life
Page 3 and 4: Repudiation of Claim for Payor’s
Page 5 and 6: Award Dated : 27-11-2006Repudiation
Page 7 and 8: The Complainant’s husband held a
Page 9: sniped at Utmost Good Faith that fo
Page 12 and 13: In view of the above, the decision
Page 14 and 15: concealment of material facts regar
Page 16 and 17: The complaint was registered and ne
Page 18 and 19: he had never suffered from any ailm
Page 20 and 21: from Chronic Hepatitis c Cirrhosis.
Page 22 and 23: same till death claim arises. The R
Page 24 and 25: adhikar ewam Rin pustika ” for Ag
Page 26 and 27: 10 days from date of commencement a
Page 28 and 29: grounds of suppression of material
Page 30 and 31: the claim for the reason “Suppres
Page 32 and 33: It is observed from the Medical cer
Page 34 and 35: It has also not been verified by th
Page 36 and 37: disbursement of salary as reported
Page 39 and 40: There was no dispute that the DD fo
Page 41 and 42: proposal the contract remains uncon
Page 43 and 44: the claim stating that her son bein
Page 45: states that no common poison was fo
Page 49 and 50: On perusing the documents it is obs
Page 51 and 52: application for insurance on 22.12.
Page 53 and 54: preferred a claim with the Insurer.
Page 55 and 56: the time of taking the policies. In
Page 57 and 58: in January 2000. The policy was rev
Page 59 and 60: Subsequently he was referred to Tir
Page 61 and 62: All the spells of medical leave hav
Page 63 and 64: In the hearing, the complainant sta
Page 65 and 66: KTVR Group Hospital due to “Hepat
Page 67 and 68: Chennai Ombudsman CentreCase No. :
Page 69 and 70: He was also on leave during 11.04.2
Page 71 and 72: Life Insurance Corporation of India
Page 73 and 74: Chennai Ombudsman CentreCase No. :
Page 75 and 76: found in the body. It was further r
Page 77 and 78: family doctor. He admitted that his
Page 79 and 80: Smt.S.Shanthi obtained a life insur
Page 81 and 82: act. She stated that as per the sta
Page 83 and 84: evival was almost like a fresh cont
Page 85 and 86: contended that the deceased life as
Page 87 and 88: Sri J. Hussain Mohammed submitted a
Page 89 and 90: and his wife was sitting after her
Page 91 and 92: In the hearing the complainant stat
Page 93 and 94: VsLife Insurance Corporation of Ind
Page 95 and 96: Jodhpur on 11.11.2002 and was disch
Page 97 and 98:
He had concealed the material fact
Page 99 and 100:
They further needed claim forms No.
Page 101 and 102:
on life of her husband Late Shri. R
Page 103 and 104:
Delhi Ombudsman CentreCase No. : LI
Page 105 and 106:
The representative from Life Insura
Page 107 and 108:
3 months and 14 days of taking poli
Page 109 and 110:
09.06.2003 and the proposal was sub
Page 111 and 112:
Leukemia. Bone Marrow Report dated
Page 113 and 114:
Thus, he withheld facts and was gui
Page 115 and 116:
questions provided in item no.11 of
Page 117 and 118:
the claims excepting the present on
Page 119 and 120:
The submission of LIC is that the p
Page 121 and 122:
LIC that other two policies of Sum
Page 123 and 124:
Branch Office of LICI. It is stated
Page 125 and 126:
We have considered the photocopies
Page 127 and 128:
On the circumstances aforesaid, it
Page 129 and 130:
Life Insurance Corporation of India
Page 131 and 132:
nos.722662607 for Rs.50000/- and 72
Page 133 and 134:
information. The insurer also suspe
Page 135 and 136:
The claim was rejected by LIC stati
Page 137 and 138:
Facts of the Case: (Late) G.Appa Ra
Page 139 and 140:
Head Notes: Life assured availed a
Page 141 and 142:
in English, which suggest that he i
Page 143 and 144:
LIC about usage of herbal medicines
Page 145 and 146:
age proof. She requested for settle
Page 147 and 148:
the owner of the opposite vehicle i
Page 149 and 150:
action was found to be based on pro
Page 151 and 152:
certificate issued by one Dr.H.R.De
Page 153 and 154:
suffering from disease prior to rev
Page 155 and 156:
establish that the LA failed to dis
Page 157 and 158:
The complaint under Rule 12(1)(b) r
Page 159 and 160:
not be blamed entirely. But, the mi
Page 161 and 162:
Life Insurance Corporation of India
Page 163 and 164:
hypertensive before the inception o
Page 165 and 166:
Ltd and expired on 30.09.04. Theref
Page 167 and 168:
Kotak Mohindra Old Mutual Life Insu
Page 169 and 170:
We may mention that the insurance c
Page 171 and 172:
evidence to prove that the DLA was
Page 173 and 174:
The insurance company in their self
Page 175 and 176:
time of taking the policy and that
Page 177 and 178:
the required papers and hence there
Page 179 and 180:
their own guidelines can consider t
Page 181 and 182:
the contract was not complete and e
Page 183 and 184:
and, therefore, she interpreted tha
Page 185 and 186:
cheque No.258433 dt.20.2.2007. Prob
Page 187 and 188:
We were unable to modify the order
Page 189 and 190:
certificates submitted by the claim
Page 191 and 192:
Smt. Phoolpatti had lodged a compla
Page 193 and 194:
dispute the will but contended that
Page 195 and 196:
Jaiswal who in their report confirm
Page 197 and 198:
treated the person but since the si
Page 199 and 200:
31.03.05/11.04.05 issued under the
Page 201 and 202:
Shri Sarvjit Gupta had lodged a com
Page 203 and 204:
complainant awarded payment of full
Page 205 and 206:
with him during the period 02.03.04
Page 207 and 208:
Award dated 31.02.2007Smt. Shakunta
Page 209 and 210:
asis of which proposal was complete
Page 211 and 212:
Consultation/Treatment as proof of
Page 213 and 214:
Smt Shantona Kanaiya Ghosh had take
Page 215 and 216:
ody with altered behavior for few m
Page 217 and 218:
Mumbai Ombudsman CentreCase No. : L
Page 219 and 220:
Diabetes Mellitus since 20 years an
Page 221 and 222:
Jhatingrao Gaikwad to pursue the ca
Page 223 and 224:
into consideration, it would be rea
Page 225:
Mumbai Ombudsman CentreCase No. : L
show all

Death Claim - Gbic.co.in

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?