Death Claim - Gbic.co.in

and his wife was sitting after her brother. It was dark being night and after nearly 2Kms. of drive he had tried to avoid a Coimbatore to Pollachi state transport bus comingin the opposite direction. His bike fell in to a ditch and his wife lost balance and felldown. She suffered from injuries and immediately they rushed her to hospital whereshe died. S.Muruganandam, complainant under policy no. 761107384, agreed to all theabove details. He only added that their cell phone had started ringing and his sisterwas trying to attend the call.The insurer stated that since the accident was caused due to breach of law they hadrejected the claim for Double Accident Benefit under policy condition 10(b). He readout the policy condition 10(b). He said that on the basis of FIR and PIR they hadconcluded that it was breach of law since 3 persons had travelled in the bike, whereasonly 2 persons were allowed to travelIn this instance even though the life assured was only a pillion rider she was travellingas one of the three passengers on a motor cycle (which is permitted to carry only 2passengers as per the Motor Vehicle Act) which tantamount to breach of law. Thereforeit is evident that the accident had been due to a breach of law and the Insurer wascorrect, according to the conditions of their policy, in rejecting to pay the accidentbenefit.The complaint was dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.06.2641Sri.S.ArivoliVsLife Insurance Corporation of IndiaAward Dated : 30.03.2007Smt.K.Mala had obtained a policy from Mannargudi Branch of LIC of India aftersubmitting a proposal on 30.03.2005. The Insurer issued her a policy for one lakhunder their Endowment Plan. Smt.K.Mala had to pay a quarterly premium of Rs.776/-for 34 years. Smt.K.Mala died on 10.11.2005 due to Respiratory failure. Sri S.Arivoli,her husband and nominee under the policy, preferred the death claim with the Insurer.The Insurer repudiated his claim on the ground that the life assured had withheldmaterial information regarding her health at the time of effecting insurance with them.In the hearing the complainant stated that he was working as a Chemistry Professor inGovernment Arts College, Mannargudi. He was married at the age of 28. His wife was22 years old at that time. They waited for one year and since she did not conceive,they started consulting doctors and started treatment for infertility. A Gyneacologist,had advised abdomen scan. From the scan it was found that his wife had small cystsand it was not considered as a problem. The complainant was very clear that his wifewas well and had been consulting doctors for her infertility before proposing forinsurance. After the proposal only the ovarian cancer, removal and treatment hadcommenced. According to the insurer the life assured had been on treatment since1997 which was not disclosed at the time of proposing for life insurance.In this instance the life assured had been on treatment for infertility and also had cystsin her ovary and had symptoms of severe stomach pain for one year which was beforeproposing for insurance. However none of these relevant details were mentioned in theproposal for insurance. This led the Insurer to wrongly issue her the policy undernormal rates.