Death Claim - Gbic.co.in

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