Death Claim - Gbic.co.in

More documents

Recommendations

Info

Chennai Ombudsman CentreCase No. : IO (CHN)/21.003.2430Smt.M. NavamaniVsTATA AIG Life Insurance Co. Ltd.Award Dated : 22.12.2006Sri. M. Murugesan signed an application on 06.08.2003 to obtain a Life InsurancePolicy-Assure 20 years Security and Growth Plan from Tata AIG Life Insurance Co. Thesum assured under the plan was Rs.1 lakh and he paid an amount of Rs.1852/-. TheInsurance Company issued a policy on 10.10.2003 with quarterly premium as Rs.1928/-. Sri. M. Murugesan died on 27.07.2004. Smt. M. Navamani, the nominee under thepolicy, preferred the claim with the Insurer. The Insurer repudiated the claim on theground that the life assured had been hospitalized and diagnosed to have Carcinoma ofBladder in Sept. 2003, which was before the policy issue date of 10 th Oct. 2003.In the hearing the Insurer stated that though the life assured’s application for insurancewas dated 06.08.2003, the premium was paid on 28.08.2003. The application wasreceived by them on 29.08.2003. Balance of premium was called for on 30.08.2003.The balance of premium was received on 01.10.2003 and the policy was issued on10.10.2003. The life assured was hospitalized on 19.09.2003. The assured had noticedblood in urine 2 months back viz. July 2003. The life assured died on 27.07.2004. Thelife assured had not given correct answers for Question No.4 (h) viz. urine abnormality.After submission of the application and before acceptance of the policy there waschange in the health of the life assured which he had not informed to the insurer.A perusal of relevant documents reveal that policy issue was delayed due to nonreceiptof extra premium charged by them for the life assured’s occupation (Whereas inthe application itself the life assured had mentioned his occupation). Also there is noclear guidelines for LA to inform the insurer changes in health condition, before policyis issued. The life assured was only a mason (application is in English and he hadsigned in Tamil). The insurer had not obtained medical evidence to substantiate theirstand. However, the fact cannot be ignored that the assured had not mentioned thebladder disorder that he was suffering or the diagnostics test that he had undergoneabout which there are specific questions in the application for insurance. As such, thisForum decides that an amount equal to 20% of basis sum under the policy i.e. anamount of Rs.20,000/- be made available to the complainant as full and final settlementof the claim under the policy on an ex-gratia basis.The complaint was partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.02.2306Sri. Munusamy ReddiarVsLife Insurance Corporation of IndiaAward Dated : 20.12.2006Smt. M. Sarasammal obtained policy bearing number 716 240 071 under T-133 (JeevanMitra-Triple Cover- According to this plan the maturity benefit is basic Sum Assuredwith Bonus and the death benefit is three times the Sum Assured plus Bonus) for a sumassured of Rs.25000/- with a monthly premium of Rs.123/- from LIC of India,Villivakkam Branch under Chennai DO-II by submitting a proposal on 13.06.2000. Inthe proposal she had mentioned that she was working as an helper to mason. Smt. M.Sarasammal died on 31.05.2004. Her husband and the nominee Sri Munusamy Reddiar
preferred a claim with the Insurer. The Insurer settled basic sum assured and theaccrued bonus, as the life assured was not eligible for this high risk plan (T-133). Sri.Munusamy Reddiar’s appeal to the Zonal Office of the Insurer, fetched him enhancedSum Assured for the extra premium paid for T-133.In the hearing on 14.11.2006 the representative of the complainant stated that theagent, who had sold this policy to his mother, had sold it to nearly 13 or 14 peoplewhich included a few ladies as well. He argued that if it was the mistake of the agent,then the office also had allowed that plan to his mother. As there was no suppressionof any material fact, the non-payment of full amount of claim was not correct. TheInsurer stated that in underwriting the female lives were classified into three categoriesbased on their source of income and level of economic independence. In thatclassification, the Life Assured was classified under category III and this plan could nothave been given to her. It was a genuine mistake. He said that the parties to theagreement were not entitled to get the benefits of apparent mistakes.A scrutiny of the papers reveals that the policy was in force, the life assured had notsuppressed her occupation, she had paid 48 monthly premiums andThe Insurer has not brought any evidence to show that the life assured had willfullysuppressed material facts with a fraudulent intention to gain out of the contract.The Complaint is allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.08.2384Smt. E.SelvamVsLife Insurance Corporation of IndiaAward Dated : 22.12.2006Sri A.Elayappan submitted a proposal on 12.03.2004 to LIC of India, KallakurichiBranch under Vellore Division to obtain the policy bearing number 733457151 underTable –143 (Bima Nivesh Triple Cover Plan) for Rs.3 Lakhs (Death Benefit would be 9Lakhs) after paying single premium of Rs.284034/-. Sri A.Elayappan died on20.04.2004, due to heart attack. Smt.E.Selvam, the nominee under the policy preferredthe claim with the Insurer. The Insurer rejected the claim on the grounds that the lifeassured had withheld correct information regarding his health at the time of effectingthe assurance. Smt.E.Selvam, represented to the Zonal Manager of the Insurer, whooffered Rs.3 Lakhs as ex-gratia.In the hearing on 28.11.2006 Sri E. Jeyakarthic, son of the complainant, said his fatherSri A.Elayappan had complained of chest pain and initially thought that it was due togastric problem. Since the pain grew, he had called him and he in turn instructed himto come to Chennai for treatment. When his father was about to start to Chennai hecollapsed in the toilet due to heart attack. His father had paid a Single Premium ofRs.284034/- for the Bima Nivesh Triple Cover plan (Table 143) and the Date ofcommencement of the policy was 12.03.2004. His father died due to massive heartattack on 20.04.2004. His father had undergone Master Check up twice – once in theyear 2001 at Vijaya Hospitals, Chennai and again in the year 2003 at Apollo Hospitals,Chennai. On 28 th April 2005 LIC had repudiated the claim in full including the lump sumpremium paid and the reasons stated were his father had suffered from CervicalSpondylosis and Pruritus with old fracture of right clavicle and the information hadbeen withheld in the proposal. After a painful follow up for 283 days with personalvisits, LIC sent a communication that the decision has been reconsidered and prepared
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 and 46: states that no common poison was fo
Page 47 and 48: the Insurer on the ground that the
Page 49 and 50: On perusing the documents it is obs
Page 51: application for insurance on 22.12.
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

Create successful ePaper yourself

Delete template?

Save as template?