Death Claim - Gbic.co.in

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