Death Claim - Gbic.co.in

In view of the fact that the Insurer had solely relied on the Claim forms and had notobtained documentary evidence to substantiate their decision, the Forum found that therepudiation of the complainant’s claim by the insurer in its entirety was not fullyjustified. To be fair and equitable to both the parties, given the circumstances of thecase, the Forum decided that an amount equal to Rs.20000/- be allowed to thecomplainant as an ex-gratia payment in full and final settlement of the claim.The complaint is partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.03.2545Smt M. ParameswariVsLife Insurance Corporation of IndiaAward Dated : 16.03.2007Sri.V.Muthusamy had two insurance policies with LIC of India -763612870 under Plan149 for SA of 1,00,000/- for which he submitted proposal on 14.08.2003 & 762208279under Plan 14 for SA of 50,000/- for which he submitted proposal on 28.02.2004Thelife assured died on 10.09.2005. The Complainant Smt. M.Parameswari claimed thedeath benefits under the above policies. The Insurer repudiated the claim under boththe policies on the ground that the life assured had revived the first policy on19.10.2004 by submitting a ‘Personal Statement of Health’ and obtained the secondpolicy without informing either in the Personal Statement of Health’ dated 19.10.2004or in the proposal dated 28.02.2004 about his renal failure for which he had takentreatment in 2003.In the hearing the complainant stated that her husband was alright till one year oftaking the policy. She said that her husband was taking treatment for blood pressure.When the records of her husband’s pre-proposal illness were shown to her sheadmitted that he was suffering from renal disease. She said that her husband’s sisterwas about to donate her kidney but her husband died before the surgery for kidneytransplantation. She however, pleaded for sympathetic consideration of her claim onhumanitarian grounds since she had two children to be taken care of. The Insurer didnot attend hearing as it was intimated to them that the hearing was cancelled owning tonon-submission of Proforma PIII by the complainant. However the insurer hadsubmitted their ‘Self Contained Note’ where they had enclosed the relevant hospitalrecords to prove that the life assured had suffered from renal disease prior toproposing for insurance.In this case the life assured had suffered from renal disease from 13.08.2003 itself. Bynot disclosing this important information to the Insurer in his proposals and ‘Personalstatement of Health’ submitted at the time of revival the life assured had denied theInsurer a fair chance of evaluating the risk correctly.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.05.2544Smt S.MallikaVsLife Insurance Corporation of IndiaAward Dated : 22.03.2007