Death Claim - Gbic.co.in

Sri. R.Kothandapani submitted a proposal dt 29.07.1999 at Thiruvarur Branch ofThanjavur Division and obtained a policy bearing number 752190040 for a SumAssured of Rs.25000/- under Endowment Plan for a term of 15 years. Sri.R.Kothandapani revived the lapsed policy on 09.08.2004 by submitting a “PersonalStatement of Health” of even date. Sri. R.Kothandapani died on 18.11.2004. Sri.A.Ramaiyan, the nominee of the policy preferred a claim for the benefit under thepolicy. The Insurer repudiated his claim on the grounds that Life Assured had failed todisclose in the “Personal Statement of Health” dated 09.08.2004 that he was sufferingfrom Malignant Tumour/ Prostatic Sarcoma and that he had taken treatment at JIPMERHospital.In the hearing the complainant had expressed his inability to attend the hearing. Hehad written in his letter that his son had revived the policy only because the Insurerwould not settle claim if the policy was in a lapsed condition. The complainant’s appealwas read out to the Insurer. The Insurer said that the Investigating Official hadfurnished all details of pre revival hospitalization of the assured. The assured wasdiagnosed for Prostatic Abscess, was admitted in JIPMER Hospital on 10.2.2004,operated upon on 12.2.2004 and was discharged on 15.2.2004. He was readmittedthere with complaints of retention twice with Tender Enlarged Prostate and biopsyrevealed Leiomyosarcoma. Explorative Laparotomy was done on 7.4.2004 followed byChemotherapy. The Insurer said that all these pre-revival treatments were notdisclosed by the assured in the Personal Statement of Health, at the time of revival on9.8.2004. This led to repudiation of claim, the Insurer concluded.In the present case, since the Insurer had established that the deceased life assuredwas suffering from Prostate Cancer and had taken treatment before he revived thepolicy.The complaint was dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.07.2454Sri A.RamaiyanVsLife Insurance Corporation of IndiaAward Dated : 28.02.2007Sri. V.Aathankaraiyan submitted a proposal on 09.04.2002 to LIC of India, VallioorBranch under Tirunelveli Division and obtaineda policy bearing number 321225885, for a Sum Assured of Rs. 84,000/- under theInsurer’s Money Back Plan. The policy was issued with accident benefit. Sri.V.Aathankaraiyan died on 18.10.2005. Sri.V.Vallivel Konar, the nominee under thepolicy preferred a claim for the death benefits, with the Insurer. The Insurer paid thebasic sum assured with bonus but rejected accident benefit on the grounds that noconcrete proof was available to prove accident.In the hearing Smt.V.Krishnaveni who represented the complainant told the Forum thather brother was a milk vendor and also used to graze the cattle. He was bitten by asnake, was given first aid and was hospitalized by a relative at Asaripallam. He wasconscious at that time. The Insurer had settled the claim of Rs.91,381/-. However, theAccident Benefit was not settled. The Insurer said on 11.11.2005, the basic claim ofRs.91,381/- was settled. Though the FIR and PIR confirmed that the death was due tosnake bite, the Post-Mortem Report and the Final Chemical Analysis did not point outany poisonous substance in the viscera and also no internal or external injuries were