Death Claim - Gbic.co.in

All the spells of medical leave have been for the same reason-“Acid Peptic Disease”.However no further details such as diagnostic tests done, and the exact medicinesprescribed etc were available. The insurer was also not able to produce any suchdetails. It is worth observing here that it is not uncommon among employees to availleave on medical grounds even for attending to personal work. However, the factcannot also be ignored that the assured did not mention in the proposal the medicalleave availed by him, about which there is a specific question in the proposal. Thesame disease is mentioned in all the medical certificates even though the doctors whosigned them are different. The life assured was working in a Co-operative Bank whereit may not be possible to avail leave unless there is a genuine need measure. As such,this Forum decided that an amount of Rs.15000/- be made available to the complainanton an ex-gratia basis.The complaint was partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.07.2391Smt. Amali Asha ChitraVsLife Insurance Corporation of IndiaAward Dated : 25.01.2007Sri Arockia Selvam submitted a proposal for Life Insurance on his life on 20.9.1999 toNagercoil City Branch of LIC of India. The Insurer issued him a policy for a SumAssured of Rs. 1 lakh bearing number 320678764 under Jeevan Mitra Plan. He revivedthe policy twice- once on 04.09.2001 and once on 14.12.2002. The LA submitted a“Personal Statement of Health” dated 13.12.2002. On 05.08.2004 Sri. G. ArockiaSelvam committed suicide by hanging. Smt. Amali Asha Chitra his wife and nomineepreferred the claim with the insurer. The Insurer rejected her claim on the grounds thatthe life assured had made deliberated misstatements and withheld material informationregarding his health at the time of reviving his policy.In the hearing, the complainant reported that the assured, a constable with BSFdisliked working in the border area and often used to avail leave to be with the family.The Forum enquired about the deceased’s health and behavioral patterns, details oftreatment that he had undergone and grounds of termination of his services from BSF.The insurer informed that the death was due to suicide. The policy was revived twiceinMarch 2001 & September 2002 on the basis of “Declaration of Good Health. Thetreatment taken for mental depression before the date of revival was not disclosed bythe deceased.From the available documents it is evident that the life assured was suffering frommental illness from the year 2000 and was not keeping good mental health. Bysuppressing this important and material fact in his “Personal Statement of Health” thelife assured had misguided the Insurer in reviving the policy on existing rates. Had theInsurer been aware of the LA’s mental condition then their underwriting decision wouldhave been different and they perhaps may not have accepted to revive at all. Also thecause of death is suicide. There is a definite nexus between the illness suppressed andcause of death. Thus the life assured by misrepresenting his real state of healthdeprived the Insurer a fair chance of correctly appraising the risk.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.04.2344