Death Claim - Gbic.co.in

More documents

Recommendations

Info

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
Smt.S.Shanthi obtained a life insurance policy by submitting a proposal to LIC of India,Salem South Branch on 30.04.2003. The Insurer issued her a policy numbered701663354 for a sum assured of Rs.1 Lakh under their Jeevan Anand plan and thequarterly premium was Rs.2004/- which the life assured had agreed to pay for 15years. The policy lapsed due to non-receipt of premium due April 2004. Smt.S.Shanthirevived the policy on 10.01.2005 by submitting a Personal Statement of Health dated09.01.2005. Smt.S.Shanthi died on 19.05.2005. Smt.S.Mallika, who was the Appointeefor the minor nominee under the policy, preferred the death claim with the insurer. Theinsurer repudiated her claim on the ground that the life assured had not revealed hercaesarian operation and miscarriage in her Personal Statement of Health dated09.01.2005.In the hearing the representative of the complainant stated that he was an Engineerand engaged in business. He admitted that his first son was born through Caesarianoperation Subsequently in the year 2000 she had a miscarriage during her 2 nd or 3 rdmonth of her second pregnancy. At the time of death also she was pregnant. Theprevious night she complained of stomach pain and they had consulted Dr.Babyusha,their family doctor. The next day around 04.30 a.m. she complained of very severestomach pain and she was taken to the Doctor. She died on the way to the hospital.The importance of the specific questions for female lives in the proposal form waspointed out to him. It was also pointed out that the date of last menstruation in thePersonal Statement of Health has been mentioned as 29.12.2004 as against07.12.2004 recorded in the case sheet maintained by Dr.Babyusha. The insurer the LAwas a housewife. The LA died on 19.05.2005 within 4 months from the date of revival.On investigation they found that the life assured had undergone caesarian operationfor the delivery of her first child. She also had a miscarriage. The details aboutcaesarian operation were not mentioned in the proposal and the details of miscarriagewere not given in the Personal statement of Health. Had she disclosed the details theywould have called for the special reports and assessed the risk properly.It emerges that even though the life assured could not have known about herpregnancy on 09.01.2005 when she signed her personal statement of health, she hadmisled the Insurer by wrongly stating her Date of Last Menstruation as 29.12.2004.Had she noted correctly the Date of Last Menstruation as 07.12.2004 the Insurer wouldhave postponed the revival till the menstruation had commenced. Thus by this wronginformation the life assured had denied the insurer in correctly assessing her risk.14. The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.07.2556Smt. E.ShanmugathaiVsLife Insurance Corporation of IndiaAward Dated 22.03.2007Sri P.Ithaya Kani aged 27 years submitted a proposal on 08.03.2004 to LIC of India,Tenkasi Branch and obtained a life insurance policy numbered 321748671. The policywas for Rs.1.6 Lakhs under the Insurer’s Money Back Plan. Sri P.Ithaya Kani had topay an annual premium of Rs.10091/- for 20 years. On 25.09.2005 Sri P.Ithaya Kanidied at the age of 28 years due to heart attack. Smt.E.Shanmugathai, his wife andnominee under the policy, preferred her claim with the Insurer. The Insurer rejected herclaim on the grounds that Sri P.Ithaya Kani, the life assured, had withheld materialinformation regarding his health at the time of effecting insurance with them.
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 and 72: Life Insurance Corporation of India
Page 73 and 74: Chennai Ombudsman CentreCase No. :
Page 75 and 76: found in the body. It was further r
Page 77: family doctor. He admitted that his
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?