Death Claim - Gbic.co.in

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Keeping the educational and economic background of the life assured in mind it ispossible that he had no intention of suppressing this information. However the factcannot be ignored that the assured had not mentioned in the proposal the accident ortreatment for his eye ailment for which there is a specific question in the proposal.Therefore it was decided by the Forum that an amount equal to Rs.15000/- be allowedto the complainant as an ex-gratia payment in full and final settlement of the claim.The complaint is partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.08.2495Smt.R.RaniVsLife Insurance Corporation of IndiaAward Dated : 19.02.2007Sri. R.Suresh obtained a life insurance policy from Chidambaram Branch of LIC ofIndia after submitting a proposal on 25.10.2004. The Insurer issued him a policynumbered 733625253, under their New Jana Raksha Plan for a sum assured of Rs.30000/-. Sri. R.Suresh died on 20.09.2005 due to Pulmonary Tuberculosis. Smt R.Ranithe nominee under the policy preferred the death claim with the Insurer. The Insurerrejected her claim on the grounds that the life assured had withheld correct informationregarding his health at the time of effecting insurance with them.In the hearing the complainant stated that her son was in good health at the time oftaking insurance. She alleged that the certificate stating that her son had jaundice andtyphoid was baseless and her son never had those diseases. She said that they did notknow the cause of death. He would have died probably due to some poisonous bite.When questioned as what occupation her son was engaged in, she said that he was notgoing for any job but used to go to Tiruppur sometime and work. The insurer statedthat the assured was daily wage earner as per proposal form and was 26 years old. Hedied on 20.09.2005 within 10 months of taking the policy due to Pulmonary TB andAcute Respiratory Distress. Dr.T.Paarivalavan of Primary Health Centre, Kumaratchihad addressed a letter to the Zonal Manager of the Insurer on 30.05.2006, wherein hehad confirmed that the assured was treated by him for typhoid on 02.03.2003, jaundiceon 03.06.2004 and only on 19.03.2005 he was treated for Pulmonary T.B.In this case the life assured was severely anemic and died at the young age of 27 andit appeared that even though Typhoid and Jaundice were cured he was prone to fallsick quite often. By suppressing his diseases for which there was a specific question inthe proposal for insurance, the life assured had denied the Insurer a fair chance ofevaluating the risk correctly. However in view of the fact that the Insurer had solelyrelied on the Claim forms and had not obtained documentary evidence to substantiatetheir decision, the Forum found that the repudiation of the complainant’s claim by theinsurer in its entirety was not fully justified. An amount equal to Rs.10000/- wasallowed to the complainant as an ex-gratia payment in full and final settlement of theclaim.The complaint is partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.04.2447Smt.R.PeriakkalVs
Life Insurance Corporation of IndiaAward Dated : 29.01.2007Sri. S.Rasu an agricultural coolie obtained a life insurance policy from LIC of India,Aruppukottai Branch of Madurai Division by submitting a proposal on 31.03.1996. TheInsurer issued him a policy bearing number 741498931 under their Money Back Planwith a Sum Assured of Rs.50000/- and with a premium paying term of 15 years. SriS.Rasu revived the policy three times-on 09.05.2001, on 18.12.2003, and on18.03.2005 by submitting a “Personal Statement of Health” each time. Sri. S.Rasu diedon 19.04.2005. His nominee, Smt. R.Periakkal preferred the death claim with theInsurer. The Insurer rejected her claim on the grounds that the life assured had revivedthe policy on 18.12.2003 by suppressing correct information, regarding his health in the“Personal Statement of Health” of even date. They however offered to pay the paid upvalue with bonus after deducting the outstanding loan and interest.In the hearing the complainant stated that her husband was working as a coolie. Heused to go to the doctor for ordinary fever occasionally. He died on 19.4.2005. Shepreferred the claim with LIC of India. The insurer stated that the assured died on19.4.2005 and the claim arose within 1y 4m of reviving the policy. The cause of deathwas Asthma as per Claim Form. ‘B’ and as per ‘BI’ it was Tuberculosis and the durationof illness was 2 years He further narrated that Dr.Muthusamy of Kariapatti hadconfirmed vide his letter dated 18.9.2005 that the assured was under his treatment forTB for the past 2 years prior to his death. The Insurer contended that the deceased lifeassured was fully aware of the disease and revived the policy and hence the revival ofthe policy was set aside. The claim was admitted for Rs.23,025/- less outstanding loanand interest of Rs.15,850/-.On going through the documents the points are that the Insurer had not obtained thosedocuments like test reports, X-Ray reports or treatment particulars to emphaticallydeclare that the life assured was suffering from Pulmonary Tuberculosis and aware ofthe same on 18.12.2003. Therefore the Forum directed the Insurer to recalculate thepaid up value (and bonus thereon) on the basis that the revival effected on 18.12.2003was valid and rescind the policy money that would have become payable due to therevival effected on 18.03.2005 as the policy holder had died on 19.04.2005 due toBilateral Pulmonary Tuberculosis.The Complaint was partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.07.2447Smt.R.PeriakkalVsLife Insurance Corporation of IndiaAward Dated : 27.02.2007On 25.06.2003, Sri. K.Jeyaraj proposed for insurance on his life at Tenkasi Branch ofLIC of India. He proposed for a sum assured of Rs. 50000/- under T-75 –A Money BackPlan for 20 years term. Sri. K.Jeyaraj committed suicide on 17.09.2005. Smt Suromanithe nominee under the policy preferred the death claim. The Insurer rejected her claimas the life assured had withheld correct information regarding his health at the time ofeffecting insurance with them.At the hearing the complainant said that she had a quarrel with her husband over theirdaughter’s marriage. In a fit of rage, he took poison, was hospitalized and died on the
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Repudiation of Claim for Payor’s
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Award Dated : 27-11-2006Repudiation
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The Complainant’s husband held a
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sniped at Utmost Good Faith that fo
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In view of the above, the decision
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concealment of material facts regar
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The complaint was registered and ne
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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 and 52: application for insurance on 22.12.
Page 53 and 54: preferred a claim with the Insurer.
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: He was also on leave during 11.04.2
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
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LIC that other two policies of Sum
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Branch Office of LICI. It is stated
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We have considered the photocopies
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On the circumstances aforesaid, it
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Life Insurance Corporation of India
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nos.722662607 for Rs.50000/- and 72
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information. The insurer also suspe
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The claim was rejected by LIC stati
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Facts of the Case: (Late) G.Appa Ra
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Head Notes: Life assured availed a
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in English, which suggest that he i
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LIC about usage of herbal medicines
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age proof. She requested for settle
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the owner of the opposite vehicle i
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action was found to be based on pro
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certificate issued by one Dr.H.R.De
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suffering from disease prior to rev
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establish that the LA failed to dis
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The complaint under Rule 12(1)(b) r
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not be blamed entirely. But, the mi
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Life Insurance Corporation of India
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hypertensive before the inception o
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Ltd and expired on 30.09.04. Theref
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Kotak Mohindra Old Mutual Life Insu
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We may mention that the insurance c
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evidence to prove that the DLA was
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The insurance company in their self
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time of taking the policy and that
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the required papers and hence there
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their own guidelines can consider t
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the contract was not complete and e
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and, therefore, she interpreted tha
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cheque No.258433 dt.20.2.2007. Prob
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We were unable to modify the order
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certificates submitted by the claim
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Smt. Phoolpatti had lodged a compla
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dispute the will but contended that
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Jaiswal who in their report confirm
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treated the person but since the si
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31.03.05/11.04.05 issued under the
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Shri Sarvjit Gupta had lodged a com
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complainant awarded payment of full
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with him during the period 02.03.04
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Award dated 31.02.2007Smt. Shakunta
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asis of which proposal was complete
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Consultation/Treatment as proof of
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Smt Shantona Kanaiya Ghosh had take
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ody with altered behavior for few m
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Mumbai Ombudsman CentreCase No. : L
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Diabetes Mellitus since 20 years an
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Jhatingrao Gaikwad to pursue the ca
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into consideration, it would be rea
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Mumbai Ombudsman CentreCase No. : L
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