Death Claim - Gbic.co.in

Award Dated : 27-11-2006Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, theAssured had not disclosed the fact of taking treatment for ‘Chest pain (MI)’ and hadundergone Coronary Angiography only a year prior to the date of Proposal. Theassured died due to ‘Left Ventricular Dysfunction in a c/o Ischaemic Cardomyopathy,which proves the nexus between the undisclosed ailment and the cause of death. Claimon death of the deceased Life Assured was repudiated by the Respondent on the basisof Certificate of Hospital Treatment. Non disclosure of this fact denied the opportunityto call for further Special Reports etc. The case could have been sent over to theHigher Offices of the Insurer for decision. As such, the facts being material forunderwriting, the decision of the Respondent to repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. : 21-001-0198Smt. S S ShahVsLife Insurance Corporation of IndiaAward Dated : 7-12-2006Repudiation of Claim for Accident Benefit under Life Insurance Policy: The Assured felldown from the terrace of his house and died. Claim for Accident Benefit was repudiatedon the grounds that the Police Papers reflected the fact that the deceased wassuffering from Parkinson’s Disease which allegedly caused the death. As such, deathwas not an Accidental death. An observance of the Police FIR revealed that eventhough the Police Inspector wrote about the fact of the disease, he had not written thatthe disease contributed to the Accidental fall. The Post Mortem Report also confirmedthat the Death to be due to shock as a result of injuries sustained. In the absence ofany other acceptable indisputable evidence, the Respondent was directed to pay thefull Claim.Ahmedabad Ombudsman CentreCase No. : 21-001-0211Smt. Rinku K RajVsLife Insurance Corporation of IndiaAward Dated : 11-12-2006Repudiation of Claim under Life Insurance Policy: While filling up the forms forReviving a lapsed Life Insurance policy on the life of the deceased, the Assured hadnot mentioned the fact of his suffering from TB for two years before reviving the Policy.The above facts were confirmed by the treating Doctor, in the Certificate of HospitalTreatment, which also noted symptoms of Chest Pain, Cough, Fever and weight loss.The Insured was then put on anti-TB Drugs and severe Anaemia was treated with BloodTransfusion. CNS led to attacks of convulsions with as per the treating Doctor ‘couldhave been fatal’. The Assured died within four days of Revival due to the samedisease. Non disclosure of this material fact denied the Insurer an opportunity to callfor further Medical Reports in order to decide whether to accept the revival of thelapsed Insurance Policy. Thus the Revival was declared void and the decision of theRespondent to repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. : 21-001-0216