Death Claim - Gbic.co.in

Chennai Ombudsman CentreCase No. : IO (CHN)/21.08.2431Sri. G.NarayananVsLife Insurance Corporation of IndiaAward Dated : 15.02.2007Smt. N. Saroja submitted a proposal dated 19.07.2003 at Arakkonam Branch, VelloreDivision and obtained a policy bearing number 733135932 for a Sum Assured ofRs.50,000 under Endowment Plan for a term of 20 years. Smt. N. Saroja died due toDiabetic Foot with Sepsis and Cardio respiratory arrest. Sri. G. Narayanan, thenominee of the policy preferred a claim for the benefit under the policy. The Insurerrepudiated his claim on the grounds that Life Assured had failed to disclose that shewas suffering from DM and further that she had consulted a doctor and availedtreatment from him in a hospital.In the hearing the complainant stated that his wife was 45 years old at the time ofdeath. He is working for TWAD Board. He was not aware that his wife had taken apolicy. She used to consult Dr.Booshna Prakash whenever she suffered from anillness. One day she had stepped on a small sharp stone and that caused pain. Only atthat time he came to know that she was suffering from Diabetes. When questionedabout his statement in his letter addressed to the Branch Manager of LIC of India thathis wife was affected by sugar for 2 years and was availing treatment from Dr.BooshnaPrakash of Arokonam, he said that he had approximately stated that she was sufferingfrom diabetes for 2years. The insurer stated that the policy was taken in July 2003 fora Sum Assured of Rs.50,000/- under Endowment Plan for a term of 20 years. Thepolicy had run for 1 year and 10 months. The cause of death was Diabetes Mellituswith ulcer foot. On their investigation they came to know that she was suffering fromDiabetes and was treated by Dr.Booshna Prakash of Arakonam. The complainanthimself had given a letter to the Branch Manager about the treatment undergone by hiswife and that she was suffering from Diabetes for 2 years. The cause of death wasDiabetic Foot with Sepsis.On going through the relevant documents, it is clear that the Life Assured was diabeticfor 5 years before her death (which is before the date of proposal), there is nexusbetween the cause of death and disease that was suppressed and the Insurer hadobtained clinching evidence to prove that the life assured had been suffering fromDiabetes Mellitus before proposal date.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.08.2429Smt. D.RoopavathiVsLife Insurance Corporation of IndiaAward Dated 15.02.2007Sri. K. Devaraj submitted a proposal dated 1 st March 2002 to LIC of India, VaniyambadiBranch under Vellore Division on 04.04.2002 and obtained a policy bearing number731650996 with a date of commencement from 28.03.2002 for a Sum Assured of Rs.1lac under Jeevan Anand Plan. Sri. K. Devaraj died due to heart attack on 7 th February2005. Smt. Roopavathi, his wife preferred a claim for the death benefits, with the