Death Claim - Gbic.co.in

In the hearing the complainant stated that her father’s house was in Kerala and herhusband i.e. deceased life assured was related to her and she was staying with herhusband before his death at Kadayanallur. She said that her husband died suddenly on21.09.2005 due to heart attack. The wife of the deceased life assured replied that theyknow the reason for repudiation was related to her husband’s HIV illness. She came toknow about his illness only after their marriage. The letter written by the complainant tothe deceased life assured was shown to her, which contained the statement narratingthe HIV infection of the deceased life assured and her awareness on that. She agreedthat it was her letter to her husband when she was in her father’s house. The Insurerstated that the Date of commencement of risk was 15.3.2004. The Insurer produced theletter written by the complainant to her husband, which clearly stated the existence ofHIV in the deceased. The letter proved that she was aware of his illness.On a careful and dispassionate study of the entire case file, this Forum comes to theconclusion that even though there were no medical prescriptions or lab reports relatingto AIDS, the Insurer had obtained a letter written by the complainant to the lifeassured. In the letter dated 01.12.2004 the complainant had written that the lifeassured had been aware of his AIDS illness for the past one year. The complainantalso speaks of visiting Madurai to collect medicines. However the Insurer had notobtained treatment particulars from the concerned hospital in Madurai. Therefore theForum finds that the repudiation of the complainant’s claim by the insurer in its entiretyis not justified. To be fair and equitable to both the parties, given the circumstances ofthe case, the Forum allowed an amount equal to Rs.30,000/- to the complainant as anex-gratia payment.The complaint is partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.02.2561Smt. Jeyanthi KothandaramVsLife Insurance Corporation of IndiaAward Dated : 22.03.2007Mr.V.Kothandaraman had seven life insurance policies from LIC of India that hadaccident benefit as a rider along with life cover. Of these seven policies one wasserviced by City branch-IX of Chennai Division-I and the rest by Branches of ChennaiDivision-II. Mr. V.Kothandaraman died on 21.04.2004, while going to work. SmtJeyanthi Kothandaraman, the nominee under the policies preferred the claim with theInsurer. Chennai Division-I paid the basic claim and AB whereas Chennai Division-IIwhile admitting the death claim rejected to pay AB on the grounds that the life assuredhad met with an accident while crossing the track which is a breach of law underSection 147 of the Railways Act 1989. On her representation to the higher office of theInsurer, the Zonal Office allowed Rs. 56500/- on an ex-gratia basis.In the hearing on 23.02.2007 the complainant Smt. Jeyanthi Kothandaraman stated thather husband was not well before the accident. Since, the deceased life assured oughtto join his office; he left for his office on 21 st of April 2004. On his way to his Office, hewas run over by a train and died on 21.4.04. She claimed for the benefit under thepolicy and got the benefits settled under the policy from Chennai Division I. Since, shegot only 50% of the benefits from Chennai Division II, she has approached this Forumfor the full benefits under the policy. Her main contention was that when she got theentire benefits from Branch 9 why not from other branches of the same Insurer. TheInsurer stated that crossing the Railway Track is an offence and punishable under the