Death Claim - Gbic.co.in

Life Insurance Corporation of IndiaAward Dated : 28.02.2007Sri. B.Netharaman had three life insurance policies from LIC of India. All the threepolicies were issued with accident benefit.These policies were serviced by the Insurer’s Ambattur Branch of Chennai Division - IIas the premiums were recovered from Sri. B. Netharaman’s salary by his employer andremitted to LIC of India Ambattur Branch. Sri. B.Netharaman died on 03.04.2005, whilereturning home from work. His wife and nominee under the policies, Smt N.Vijaya,preferred the claim with the Insurer. While admitting the death claim the Insurerrejected to pay accident benefit as the life assured had died while crossing the railtrack.In the hearing the complainant was represented by her brother, Sri. Ramesh. The lifeassured was working in M/s. Devon Machines Pvt. Ltd., Ambattur, Chennai. He usuallyworks in night shifts. The second shift used to be till 11.00 p.m. and he used to returnhome around 12.00 or 12.30 in the midnight. The previous night of the accident hecalled his wife and told that he would return home the next morning. The next morningthey received a call at 09.00 a.m. regarding his death in a railway accident. SriRamesh went to identify the body along with the brother of the life assured. With hisbag and slippers he could identify that he was his brother-in-law. The police told himthat he died while crossing the track. But no one had seen the accident that took place.The insurer stated that the accident benefit claim was repudiated as the life assuredhad committed breach of law. He died while crossing the railway track. He read out thePolice Inquest Report where the police had observed that he had trespassed therailway track and met with the accident. As per the Railway Act crossing the track waspunishable offence. He read out the excerpts of the act and the punishment given forthe same. He also said that as per Section 123 of the Railway Act, death due tocrossing track was not an accident. As per policy conditions also they could not pay thesame since crossing the railway track was breach of law.It is therefore evident that the Insurer has not been able to conclusively prove that thelife assured had committed any breach of law. All the documents that the Insurer hasrelied upon have noted cause of death as “Accident” only.The Complaint was allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.003.2474SRI R. M. AngusamyVsTATA AIG Life Insurance Co. Ltd.Award Dated : 12.03.2007Smt.A.Padmavathi aged about 42 years submitted an application to Tata AIG LifeInsurance Co.LTD. on 22.11.2005 and obtained a Maha Life Policy from the Insurer forRs.2 lakhs after she had paid an annual premium of Rs.14000/-. Smt.A.Padmavathidied on 13.05.2006. Sri. R.M.Angusamy, her husband and nominee under the policy,preferred the claim with the Insurer. The Insurer repudiated the claim on the groundthat the life assured had been under treatment for menstrual disorder and anaemiabefore the date of application and which was not revealed in the application forinsurance dated 22.11.2005.In the hearing the complainant stated that the life assured was a housewife. She wasquite alright except for her menstrual problems for which she used to consult their