Death Claim - Gbic.co.in

assured had withheld correct information regarding his health at the time of effectingthe assurance with them.In the hearing as the complainant was absent the Representative of the Insurer wasasked to present his case. The Representative informed that the life assured hadavailed two spells of medical leave. Whereas the nominee had written in his letter thatthe medical leave was availed for house construction the Insurer had proof that at thetime of taking leave the life assured was undergoing treatment in Christian FellowshipHospital, Oddanchatram. The Representative added that they had repudiated the claimbecause the proposer while proposing for insurance had not disclosed material factsregarding his ill-health, the treatment taken and the particulars of medical leaveavailed by him.On going through the documents it is evident that the life assured was admitted inChristian Fellowship hospital for severe anemia, diarrhea and Urinary Tract Infection.This period of hospitalization coincides with the period of medical leave availed andthe illnesses of the life assured tallies with those mentioned in the medical certificate.The doctor with Christian Fellowship Hospital, Oddanchatram, who had signed theDischarge Summary when the life assured got discharged on 12.11.2002 (Date ofadmission into the hospital is 07.11.2002), had diagnosed the life assured as HIV +ve(by ELISA test) with severe anemia and Urinary Tract Infection.Thus a careful and dispassionate study of all the evidences available in the case fileproved beyond any shred of doubt that there was a clear and deliberate suppression ofvital information relating to a very serious ailment the assured suffered from in the preproposalperiod. The decision of the insurer to deny the claim under the policy is heldto factually sustainable and this Forum upholds the same.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.03.2279Smt. N.SaraswathiVsLife Insurance Corporation of IndiaAward Dated : 06.11.2006Sri. A.K.Natarajan, the deceased life assured was employed as Head Constable inChithode Police Station. He signed a proposal under non-medical scheme on23.04.2004, with LIC of India, Erode North branch of Coimbatore Division, to get a lifecover for Rs.75000/-. The policy with number 762207711 was under Jeevan Saral witha 12 year term. The life assured died on 11.04.2005 due to “Pancreatitis with MetabolicEncephalopathy”. Smt. N. Saraswathi, as the Appointee for the minor nominee-MasterN.Sathish Kumar, claimed the money from the Insurer. The Insurer repudiated theclaim under the above policy as the life assured had given incorrect answers toquestion numbers 11a to 11e and 11i in the proposal dated 23.04.2004.In the hearing on 09.10.2006 the complainant replied that her husband was in goodhealth and he availed leave to look after his children whenever they fell sick. Also hisparents were ailing and he used to take leave to take care of them. The Insurer statedthat the deceased life assured had availed 31 days of medical leave prior to the date ofthe proposal for treatment of “Acid Peptic disease” and they had obtained medicalopinion from their Divisional Medical Referee, who opined that “it is likely that the lifeassured had a medical disorder. The Insurer had repudiated the claim for notdisclosing the medical leave availed by the life assured before the date of theproposal.