Death Claim - Gbic.co.in

More documents

Recommendations

Info

same evening. The complainant’s son reported the death to the police, as advised byhis friends stating that his father took poison unable to bear the disease. They wereafraid of police action against the family if they told the truth. The Insurer said that theassured was suffering from Asthma for 10 years, was taking treatment in a hospital andunable to bear the severity of the disease, the assured had committed suicide. The FIRand the PIR confirm death due to suicide and the cause being the disease. The Insurerdid not conduct any investigation and proceeded with repudiation of claim forsuppression of material fact.The insurer in their wisdom did not conduct any enquiry to find out the veracity of thestatement made in the FIR and PIR and they have also not got any evidence to provethat the deceased life assured did suffer from Asthma for more than 10 years and thathe had suppressed this information while taking the policy in June 2003. Insurance wasgiven to the life assured based upon the medical examination conducted by theinsurance company’s panel doctor who has certified that life assured was enjoyinggood health at the time of taking the policy. The insurer was directed to settle the claimaccording to the conditions of the policy.The complaint is allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.07.2427Sri.I.Gurumurthy & OthrsVsLife Insurance Corporation of IndiaAward Dated : 27.02.2007Smt.I.Muthuvelammal, a milkmaid and aged 47 years submitted a proposal to KovilpattiBranch of LIC of India on 19.03.2004. The Insurer issued her a policy numbered321556533 for Rs. 100000/- Sum Assured, under their Endowment Plan. She hadnamed her husband, Sri.Iranan, as the nominee. Smt.I.Muthuvelammal died on09.01.2005. Sri.Iranan preferred his claim with the Insurer. The Insurer rejected hisclaim as the life assured had withheld material information regarding her health at thetime of effecting insurance with them. Sri.Iranan also died on 31.08.2006.In the hearing the complainants were represented by Sri.Sivakumar. He said that allthe family members got insured. At that time, they took a policy for their mother also.When asked about the illness his mother suffered from, he said that she used to availtreatment whenever she visited her daughter. When asked about the pre-proposaltreatment, he told that he was not aware of the same as he was away at Tirupur. Hepleaded ignorance of her illness as he was away from the family at that time. Thecomplainant requested that the premium paid at least be refunded to him.The Insurer informed that the assured died of heart attack on 9.1.2005 and the preproposaltreatment at R.S.P. Hospital for cancer was not disclosed in the proposalform. The Insurer also mentioned that the assured’s husband had first approached oneagent for insurance on the deceased life assured in March 2004. As the agent did notoblige, the policy was taken through another agent.It is therefore clear that the life assured was in hospital for more than a month and hada surgery performed on her before she proposed for insurance. By answering question11(a), (b), (d), (e) and (i) in her proposal dated 19.03.2004 incorrectly the life assuredhad denied the Insurer a fair chance of evaluating her risk appropriately and misguidedthem in issuing this policy.The complaint is dismissed.
Chennai Ombudsman CentreCase No. : IO (CHN)/21.005.2523Smt Kanchana SampathVsHDFC Standard Life Insurance CompanyAward Dated 27.02.2007Sri M.Sampath Kumar had taken from HDFC Life Insurance Company LTD. a policybearing No. 10101297 for a sum assured of Rs.50000/- under “Unit linked Young StarPlan with Health Option” for a term of 10 years as per his application dated17.10.2004. The life assured died on 17.07.2006. The complainant, who was thenominee under the policy, approached the insurer for the settlement of claim benefits.But the Insurer refused to honour the claim on the plea that the assured suffered fromDiabetes and Hypertension and which fact he did not disclose in his application forinsurance and therefore the policy was declared null and void. The claim for the fullsum assured was repudiated.In the hearing the complainant stated that her husband was a retired IOB LegalOfficer. She said that the agent of the insurer came in person and collected the filled inproposal form. At the time of proposal they had disclosed the facts i.e. the life assuredwas a HT, DM patient for past 10 years and occasionally used to take alcohol etc., tothe agent. But the agent insisted not to reproduce the same in the proposal form. Shealso said that they knew the agent only at the time of inception of the policy. Hercontention was that the agent had misguided them at the time of proposal. Therepresentative of the Insurer stated that the deceased life assured was covered undera HDFC Unit Linked Young Star Plan. She stated that the deceased life assured hadfailed to disclose that he was a known HT, DM patient for 10 years and used tooccasionally take alcohol. Had that been disclosed they would have extended thepolicy after satisfactory medical examination. They had believed in the disclosedstatement made by the deceased life assured and had not insisted on medicalexamination.The DLA being a legally qualified person himself it is difficult to accept that he hadsuppressed material information due to the advice of an agent whom he had just met.Such being the case, the contention of the complainant that they had informed theagent of the Insurer who had only advised them against revealing the real healthcondition is not tenable.The repudiation of the complainant’s claim for the death benefits by the insurer on theground that the insured had withheld material information regarding his health issustainable. However the premium collected by the Insurer included an amount to beinvested in units and it was only fair that this component which did not rely on anymortality chart be paid to the complainant. The Insurer was directed to pay thepermissible value of the allotted units as on 07.02.2007The complaint is partly allowedChennai Ombudsman CentreCase No. : IO (CHN)/21.06.2496Sri A.RamaiyanVsLife Insurance Corporation of IndiaAward Dated 28.02.2007
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 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 and 70: He was also on leave during 11.04.2
Page 71: Life Insurance Corporation of India
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?