Death Claim - Gbic.co.in

In the hearing the complainant stated he agent simply took signature on the proposalform and they were not aware that details regarding the health condition had to bedisclosed in the proposal form. The agent had taken the proposal and chequesometime in November 2002 itself and the policy was completed only in January 2003.she however had no proof to substantiate this claim. She said that her son had firstcomplained of stomach pain in December 2002. Her son underwent some tests, scansetc., and it was confirmed that he had kidney stones. She said that her son did notavail any treatment before submitting the signed proposal form to the agent. The agentwas responsible for the delayed submission of the proposal form.The Insurer stated that they repudiated the claim on the ground that the assured hadfailed to disclose the details of his pre-proposal treatment for renal calculus. He hadundergone surgery on 15.01.2003. The ultrasound of abdomen taken at Vignesh Scanson 12.12.2002 confirmed that the assured had renal calculi in the upper calyx of rightkidney and middle calyx of left kidney. The assured had undergone tests at Bhabha X-Ray Institute on 16.12.2002 according to which there was evidence of bilateral renalcalculi and right distal urethral calculus with partial obstruction in the right collectingsystem by the distal urethral calculus. . Had he disclosed that he had renal stones theywould have called for special reports along with Kidney questionnaire. Accordingly theywould have underwritten and the decision would be either to postpone or to decline.The Insurer argued that the life assured was a diploma holder and not an uneducatedperson to just sign without reading the contents of the proposal form.It was therefore evident that the life assured was not in good health at the time ofproposing for insurance. The life assured by suppressing the material informationregarding his health had deprived the Insurer a chance of correctly assessing the risk.The complaint was dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.02.2648Smt.V.SaralaVsLife Insurance Corporation of IndiaAward Dated : 30.03.2007Shri V.Suresh Babu had submitted a life insurance proposal dated 30.03.2005. Thepolicy numbered 717640218 with date of commencement as 28.03.2005 from CityBranch 12 of LIC of India, Chennai Division II for a sum assured of Rs.30,000/- wasissued under Table 91- New Janaraksha with accident cover. Shri V.Suresh Babu diedon 13.05.2005 in a road accident. Smt.V.Sarala, his mother and the nominee under thepolicy, submitted the claim papers to the Insurer. The Insurer paid the basic sumassured with bonus of Rs.30,561/- but rejected the accident benefit on the grounds thatthe deceased life assured had been under the influence of alcohol at the time ofaccident.A perusal of records established that the LA had been under the influence of alcohol atthe time of the accident. The complainant’s argument that he was not driving thevehicle is not a valid reason to pay the accident benefit as the benefit is forfeited ifintoxicated. The insurer reproduced relevant portion of the medico-legal manual. Asper the manual if the blood alcohol concentration was between 100 to 300 mg% theperson would have some mental confusion, emotional instability, loss of criticaljudgement, impaired memory, sleepiness, slowed reaction time, loss of muscularcoordination, staggering gait, marked mental confusion, exaggeration of emotions,dizziness, decreased pain response, disorientation and thickened speech. The life