Death Claim - Gbic.co.in

application for insurance on 22.12.2005. His son had not disclosed his past illness inthe application because he was in normal health when he took the policy. The insurerstated that the life assured had not disclosed in his application for insurance dated22.12.2005 the details of his treatment for Acute Lymphoblastic Leukemia since 2000and undergoing Orchidectomy in 2003 for relapse. The assured was a SoftwareEngineer and a highly educated person and it was not acceptable that he has justsigned the proposal without going through the contents in the proposal. Whenquestioned about Citi Financial and the nature of insurance policy sold by them, heclarified that it was not a group policy or a collateral security policy.It is therefore clear that the life assured was affected by a serious disease; which couldbe controlled but not cured. It is therefore difficult to accept the argument of therepresentative of the complainant that the life assured was normal on the day hesigned the application. Perhaps the life assured had no fraudulent intention when heapplied for insurance as it was taken at Citi Financials, the financial company he hadapproached to advance him funds to buy a car. However there is clear medicalevidence to show that he was suffering from Leukemia well before signing theapplication for insurance.Chennai Ombudsman CentreCase No. : IO (CHN)/21.05.2353Smt. D.AnguVsLife Insurance Corporation of IndiaAward Dated : 22.12.2006Sri. S. Duraisamy signed a proposal for the Insurance Policy on 27.07.2003, andsubmitted it to LIC of India, Salem North Branch. He was issued a policy bearingnumber 701356661 for a SA Rs.30,000/- under Endowment Plan. Sri. S. Duraisamydied at his residence on 02.05.2004, due to Chest Pain. Smt. D. Angu, his wife andnominee under the policy preferred her claim with the Insurer. The Insurer rejected herclaim on the grounds that the life assured had suppressed the Major Road TrafficAccident met by him in 1995, in which he had sustained severe injuries to his left armand leg.In the hearing on 15.11.2006, Smt. D. Angu was not present and her representationwas read out. In that letter, she had stated that her husband Mr. Duraisamy had metwith an accident on 23.06.1995. Smt. Angu also stated in her letter that her husbandwas going to his office from 1995 to 2004 regularly and he was healthy. The Insurerstated that as death occurred within 9 months from the date of commencement of thepolicy they had arranged for an investigation and by that they learnt that during theyear 1995 the life assured had met with a major road accident. However, it was notdisclosed by the life assured at the time of proposal.The Insurer had repudiated the claim merely because the life assured had notrevealed the accident that had occurred 8 years ago as on the date of the proposal.The Insurer had not produced any evidence to conclusively prove that the accident wascausing the life assured medical discomfort and had hastened his death. The Insurerhad not produced any prescription to show that the medicines taken for the injuriescaused in the accident had reduced the normal life span of the life assured. Thus therewas no justification for the insurer to repudiate the claim. Thus their decision torepudiate the claim does not stand the text of ethical and legal scrutiny and the sameis untenable in law and as well on facts.The complaint was allowed.