Death Claim - Gbic.co.in

Sri J. Hussain Mohammed submitted a proposal for life insurance on 15.09.2003 toTirunagar Branch of Madurai Division of LIC of India. The Insurer issued him a JeevanSurabhi policy for Rs.1 Lakh. Sri J.Hussain Mohammed died on 13.09.2005. Smt. H.Hameela Begum, his wife and nominee under the policy, submitted her claim papers tothe Insurer. The Insurer rejected her claim on the grounds that the life assured hadwithheld correct information regarding his health at the time of effecting insurance.In the hearing the complainant stated that her husband had itching in his fingers for thefirst time during May, 2004. Later he had also breathing problem from 2005. They usedto consult Dr.Kamaludeen, their family doctor, for all types of illness of their familymembers like cough, cold, fever etc Dr.Kamaludeen referred her husband toDr.Vivekanandan who was a specialist. The first consultation with Dr.Vivekanandanwas in the clinic of Dr.Kamaludeen and subsequently in Dr.Vivekanandan’s clinic. Theyhad also taken treatment from Dr.Jagannathan. He was not cured even after treatmentin the Government Hospital, Madurai. He died at home. She denied that her husbandwas suffering from either skin disease or lung disease prior to proposing for thisinsurance policy. She was not aware of the contents of the form.The Insurer stated as per claim form B and B1, the life assured was suffering fromInterstitial Lung Disease and Peripheral Vascular Disease for the last 5 years. TheDeceased Life Assured was taking treatment in Government Rajaji Hospital, Madurai13 years back. The same was revealed by the life assured himself as per the Doctor’sstatement. As per Claim Inquiry Report the life assured was suffering from the diseasefor the last 5 years. When questioned about the reporting of the Doctor after thestatement made by the complainant that the doctor was probably displeased with themand hence made such statements, the representatives of the Insurer said that theynever forced the claimant to get the forms from that doctor. On their own will they hadobtained the claims forms B and B1 filled by Dr.KamaludeenA perusal of the documents revealed that the deceased life assured faulted in notrevealing the pre-proposal illness when he took insurance. At the same time theInsurer has rejected the claim purely on the data available in Claim forms B B1 withoutgetting any material or documentary evidences. To reject a claim the Insurer shouldhave definite and clinching evidences. Hence the repudiation of the complainant’sclaim by the Insurer in its entirety was not justified and to be fair and equitable to boththe parties, an amount equal to Rs.30,000/- was allowed to the complainant.The complaint is partly allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.03.2616Sri.P.SakthikumarVsLife Insurance Corporation of IndiaAward Dated 29.03.2007Smt.S.Muthulakshmi had obtained a life insurance policy from Pollachi Branch II of LICof India on 15 th March 1999. The policy numbered 762066308 for a sum assured ofRs.50,000/- was issued under the Insurer’s Money Back Plan with accident cover.Smt.S.Muthulakshmi died on 27.09.2005. Sri P.Sakthikumar, her husband and thenominee under the policy, submitted the claim papers to the Insurer. The Insurer paidthe basic sum assured with bonus of Rs.70,700/- on 18.01.2006 but rejected theaccident benefit on the grounds that as per policy condition 10(6)(iv) the accidentbenefit is not payable since travelling in a motorcycle by 3 persons is against the law.