Death Claim - Gbic.co.in

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assured must have had all the effects, which resulted in the accident, and hence theyrejected the accident benefit.A perusal of the PMR confirms that the life assured was intoxicated at the time ofaccident. The pertinent policy condition reads as- “The Corporation shall not be liableto pay the additional sum referred in (a) or (b) above if the disability or death of theLife Assured shall be caused by intentional self-injury, attempted suicide, insanity orimmorality or when the life assured is under the influence of intoxicating liquor, drug ornarcotic.” The Forum did not wish to interfere with the policy conditions.The complaint was dismissed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.02.2646Smt. A.JyothiVsLife Insurance Corporation of IndiaAward Dated : 30.03.2007Sri M.Anandan submitted a proposal for life insurance on 09.07.2003 toGummidipoondi Branch, Chennai Division II of LIC of India. The Insurer issued him aNew Janaraksha policy for Rs.50,000/-. Sri M.Anandan died on 20.01.2004.Smt.A.Jyothi, his wife and nominee under the policy, submitted her claim papers to theInsurer. The Insurer repudiated her claim on the grounds that the life assured hadwithheld material information regarding his health at the time of effecting insurance.In the hearing the complainant stated that her husband late Shri. M. Anandan was acoolie and an illiterate. Her husband was hale and healthy before his death. On beingquestioned about her husband’s hospitalization at M/s. Stanley Govt. Hospital in theyear 1982 and the reports of M/s Pavithra hospital during the year 2000, she repliedthat he was admitted in the above said hospitals for headache. She stated that he washaving fever with shivering on the date of his death and he had experienced sweatingwith breathlessness. She contended that he died only due to heart attack and it wassudden and an unexpected one. The Insurer stated that as per the medical recordsavailable it was evident that the deceased life assured had been hospitalized in theyear 1982 for 60 days and he was diagnosed to have Tuberculosis, Jaundice, Anaemiaand giddiness. The deceased life assured was also hospitalized during the year 1991,1992, 1993 and 1999 with complaints of headache. As per the Stanley Govt. HospitalReport, the deceased life assured was diagnosed to have sinusitis and SecondaryDepression during the year 1999. But the deceased life assured had failed to mentionthe same in the proposal form signed during the year 2003. The Insurer also statedthat had that been disclosed they would not have extended the deceased life assuredwith this policy or they would have arranged for detail medical examination. Hence,they have repudiated the claim due to suppression of material facts in the proposalform.Keeping in mind the economic and educational background of the life assured it wouldhave been possible that the details of illness (in the absence of specific questions) hadskipped the life assured’s mind. However as pre-proposal illness was present anamount equal to Rs.10,000/- was allowed.The complaint was partly allowed.Delhi Ombudsman CentreCase No. : LI/DL-III/74/05-06Smt.Shakuntala
VsLife Insurance Corporation of IndiaAward Dated : 25.10.2006Smt. Shankuntala lodged a complaint with this Forum on 25.04.2005 that her husbandlate Shri Jai Bhawan Sharma died on 29.12.2003. His death claim has been repudiatedby LIC of India. She lives in village and is not an educated lady. She has no source ofincome. She has requested this Forum to refund whatever money her husband had paidtowards premium against policy No.330345506 so that she could look after herself withthe money in case the claim is not paid.LIC of India, vide their letter dated 09.05.2005, informed this Forum that the deceasedlife assured took policy on 31.03.1998 for sum of Rs.25000/- at half yearly premium ofRs.973/- with Smt.Shakuntla as the nominee. The life assured, Shri Jai BhagwanSharma, died on 29.12.2003 and intimation was received by them on 13.02.2004. Thenominee under the policy was issued the necessary forms and the same weredeposited by her. The claim was repudiated on 27.07.2004 on grounds of concealmentof material facts regarding his health at the time of revival of the policy. As per theirinvestigation into the claim, they have indisputable evidence to prove that life assuredwas suffering from Pulmonary Tuberculosis and Bronchial Asthma prior to date ofrevival. The deceased did not disclose these facts in his Declaration of GoodHealth(DGH) for the revival of policy. It is evident that these material facts weredeliberately concealed to revive the policy insurance fraudulently. They have conveyedthe repudiation of the claim on 27.07.2004 to Smt. Shakuntala.At the time of hearing, Smt. Shakuntala contested that her husband was not sufferingfrom any disease and he died in the hospital because of chest pain. She pleaded tothis Forum that her claim maybe paid by LIC of India. LIC of India, at the time ofhearing, contested that late Shri Jai Bhagwan Sharma had concealed material factsthat he was suffering from Pulmonary Tuberculosis and Bronchial Asthma at the time ofrevival of the policy and they have rightly repudiated the claim.On enquiry by this Forum whether any medical examination was done at the time oftaking the policy or revival of the policy, the representative of LIC of India onexamination of the file revealed that medical was done on both the occasions – at thetime of taking the policy as well as at the time of revival. On examination of theQuestion No.9 of Medical Examiner’s Confidential Report – Are there any symptoms orsigns suggesting abnormality or disease of the Respiratory system? TheDoctor(Sqn.Ldr.)S.K.Garg mentioned NO in both the reports.In view of the medical examination done at the time of taking the insurance policy aswell as at the time of revival, there being no adverse medical comments, therefore, Iam not in agreement with the observations made by LIC of India, vide their letter dated09.05.2005, addressed to this Forum that late Shri Jai Bhagwan Sharma was sufferingfrom Pulmonary Tuberculosis and Bronchial Asthma prior to the date of revival.I, therefore, pass the Award that Smt.Shakuntala be paid death claim and otherbenefits accrued under policy No.330345506 along with 8% interest from 01.03.2004till the date of payment is made after deducting the amount towards the loan, if any,taken under the policy by the deceased.The Award shall be implemented within 30 days of receipt of the same. The complianceof the Award shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No. : LI/JD-410
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Repudiation of Claim for Payor’s
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Award Dated : 27-11-2006Repudiation
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The Complainant’s husband held a
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sniped at Utmost Good Faith that fo
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In view of the above, the decision
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concealment of material facts regar
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The complaint was registered and ne
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he had never suffered from any ailm
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from Chronic Hepatitis c Cirrhosis.
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same till death claim arises. The R
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adhikar ewam Rin pustika ” for Ag
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10 days from date of commencement a
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grounds of suppression of material
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the claim for the reason “Suppres
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It is observed from the Medical cer
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It has also not been verified by th
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disbursement of salary as reported
Page 39 and 40:
There was no dispute that the DD fo
Page 41 and 42: proposal the contract remains uncon
Page 43 and 44: the claim stating that her son bein
Page 45 and 46: states that no common poison was fo
Page 47 and 48: the Insurer on the ground that the
Page 49 and 50: On perusing the documents it is obs
Page 51 and 52: application for insurance on 22.12.
Page 53 and 54: preferred a claim with the Insurer.
Page 55 and 56: the time of taking the policies. In
Page 57 and 58: in January 2000. The policy was rev
Page 59 and 60: Subsequently he was referred to Tir
Page 61 and 62: All the spells of medical leave hav
Page 63 and 64: In the hearing, the complainant sta
Page 65 and 66: KTVR Group Hospital due to “Hepat
Page 67 and 68: Chennai Ombudsman CentreCase No. :
Page 69 and 70: He was also on leave during 11.04.2
Page 71 and 72: Life Insurance Corporation of India
Page 73 and 74: Chennai Ombudsman CentreCase No. :
Page 75 and 76: found in the body. It was further r
Page 77 and 78: family doctor. He admitted that his
Page 79 and 80: Smt.S.Shanthi obtained a life insur
Page 81 and 82: act. She stated that as per the sta
Page 83 and 84: evival was almost like a fresh cont
Page 85 and 86: contended that the deceased life as
Page 87 and 88: Sri J. Hussain Mohammed submitted a
Page 89 and 90: and his wife was sitting after her
Page 91: In the hearing the complainant stat
Page 95 and 96: Jodhpur on 11.11.2002 and was disch
Page 97 and 98: He had concealed the material fact
Page 99 and 100: They further needed claim forms No.
Page 101 and 102: on life of her husband Late Shri. R
Page 103 and 104: Delhi Ombudsman CentreCase No. : LI
Page 105 and 106: The representative from Life Insura
Page 107 and 108: 3 months and 14 days of taking poli
Page 109 and 110: 09.06.2003 and the proposal was sub
Page 111 and 112: Leukemia. Bone Marrow Report dated
Page 113 and 114: Thus, he withheld facts and was gui
Page 115 and 116: questions provided in item no.11 of
Page 117 and 118: the claims excepting the present on
Page 119 and 120: The submission of LIC is that the p
Page 121 and 122: LIC that other two policies of Sum
Page 123 and 124: Branch Office of LICI. It is stated
Page 125 and 126: We have considered the photocopies
Page 127 and 128: On the circumstances aforesaid, it
Page 129 and 130: Life Insurance Corporation of India
Page 131 and 132: nos.722662607 for Rs.50000/- and 72
Page 133 and 134: information. The insurer also suspe
Page 135 and 136: The claim was rejected by LIC stati
Page 137 and 138: Facts of the Case: (Late) G.Appa Ra
Page 139 and 140: Head Notes: Life assured availed a
Page 141 and 142: in English, which suggest that he i
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LIC about usage of herbal medicines
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age proof. She requested for settle
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the owner of the opposite vehicle i
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action was found to be based on pro
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certificate issued by one Dr.H.R.De
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suffering from disease prior to rev
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establish that the LA failed to dis
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The complaint under Rule 12(1)(b) r
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not be blamed entirely. But, the mi
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Life Insurance Corporation of India
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hypertensive before the inception o
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Ltd and expired on 30.09.04. Theref
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Kotak Mohindra Old Mutual Life Insu
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We may mention that the insurance c
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evidence to prove that the DLA was
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The insurance company in their self
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time of taking the policy and that
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the required papers and hence there
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their own guidelines can consider t
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the contract was not complete and e
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and, therefore, she interpreted tha
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cheque No.258433 dt.20.2.2007. Prob
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We were unable to modify the order
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certificates submitted by the claim
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Smt. Phoolpatti had lodged a compla
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dispute the will but contended that
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Jaiswal who in their report confirm
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treated the person but since the si
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31.03.05/11.04.05 issued under the
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Shri Sarvjit Gupta had lodged a com
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complainant awarded payment of full
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with him during the period 02.03.04
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Award dated 31.02.2007Smt. Shakunta
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asis of which proposal was complete
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Consultation/Treatment as proof of
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Smt Shantona Kanaiya Ghosh had take
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ody with altered behavior for few m
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Mumbai Ombudsman CentreCase No. : L
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Diabetes Mellitus since 20 years an
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Jhatingrao Gaikwad to pursue the ca
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into consideration, it would be rea
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Mumbai Ombudsman CentreCase No. : L
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