Death Claim - Gbic.co.in

In the hearing the complainant stated that her husband was only 39 years old at thetime of death. Her husband had normal health. Suddenly one day he complained ofchest pain and she admitted him to the Government General Hospital, Chennai. TheDoctors told her that he was critical and he might not survive. She came to know thathe had a policy only after his death. She was not aware that her husband had highblood pressure. He never used to take medicines. Whenever he got cough, cold andfever he used go and consult doctors. She had not accompanied him any time. Whenquestioned who would have disclosed the history of her husband’s health to theDoctors she said that she did not know how they have recorded. When questionedabout the admission to Government Royapettah Hospital, Chennai in 2004, she saidthat he was not admitted. Since he was admitted to hospital during his terminal illnessthey could not pay the premium in time and hence the policy had lapsed. He died dueto Heart Attack on 28.11.2005. The first unpaid premium was 10.10.2005. The policywas in a lapsed condition. No paid up value had accrued under the policy. Hencenothing was payable as per policy conditions. The life assured had pre-proposalailments as revealed by the discharge summary of Government General Hospital,Chennai. She said that they could not consider the claim even under their Chairman’sRelaxations for payment of ex-gratia as there was pre-proposal illness.In this instance it is evident that the life assured had withheld the information of hishypertension condition in the proposal. This information was very vital to the insuranceas the life assured had finally succumbed to brain hemorrhage with kidney failure. Hadhe mentioned that he was on drugs for hypertension, the Insurer would have called foradditional requirements and the case would have been underwritten at their higheroffice. By suppressing his correct health condition, the life assured had denied theInsurer a fair chance of correct assessment of risk.The complaint is dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.08.2526Smt. S.NirmalaVsLife Insurance Corporation of IndiaAward Dated 28.03.2007Sri. G. Sivasubramanian obtained a life insurance policy fora SA of Rs.40,000/- under the Jeevan Surabhi (Money Back)Plan from LIC of India, Villupuram Branch on 28.12.1995. Sri. G. Sivasubramanian didnot pay the yearly premium due December 2000. He revived the lapsed policy on13.02.2003 by paying all the premiums that were due and after submitting a ‘PersonalStatement of Health’ of even date and medical report dated 8/2/2003. Sri.G.Sivasubramanian. died on 11.09.2004 due to Multiple Myeloma. Smt. S. Nirmala thenominee under the policy preferred her claim with the Insurer. The Insurer rejected herclaim for the full death benefit on the grounds that the life assured had revived thepolicy on 13.2.2003 without disclosing the treatment taken by him for MultipleMyeloma. The Insurer, offered to settle the paid-up value with bonus accrued under thepolicy.In the hearing, the representative and the son of the complainant stated that his fatherwas working in a Govt. College. Since their claim was repudiated they appealed to theZonal Office and since their appeal did not yield results, they appealed to this Forum.He admitted that his father was not having good health from 1999. But he said that thepolicy was taken in 1995 and he fell ill only in 1999. It was pointed out to him that