Death Claim - Gbic.co.in

Smt.Priyanka MewadaVsLife Insurance Corporation of IndiaAward Dated : 31.10.2006Smt. Priyanka Mewada lodged a complaint with this Forum on 21.02.2005 wherein shestated that her husband late Shri Ghanshyam Mewada had died one and a half yearsback. She is a widow and has been going to the office of LIC of India at Pali andJodhpur. She has also written five letters to the Delhi Office but her claim has not beensettled by LIC of India. What will happen to an ordinary man under thesecircumstances. She further stated that she would be grateful if the claim amount is paidto her within 15 days from the receipt of this letter.LIC of India, vide their letter dated 18.02.2004 addressed to Smt. Priyanka Mewadathat her husband had not paid the premium which was due on 10.10.2000 as a result ofwhich the policy lapsed. The lapsed policy was revived by him on 30.04.2002 on thebasis of Declaration of Good Health submitted by him. He had declared in hisdeclaration thatQUESTIONANSWER2. Since the date of your proposal for theabove mentioned policy:a) Have you ever suffered from any illness/diseaserequiring treatment for a week or more ? NOb) Did you ever undergo ECG,X-ray,Screening,Blood,urine or stool examination ?NO4. Are you at present in sound health ? YESLIC of India has mentioned that they have sufficient proof that late Shri GhanshyamMewada was suffering from Chronic Cirrhosis of Liver which was not declared by him atthe time of revival of the policy, a fact which he had concealed while declaring hishealth in DGH Form. LIC of India has repudiated the claim and has forfeited thepremium paid by late Shri Ghanshyam Mewada.LIC of India, vide their letter dated 23.03.2005, informed this Forum that the claimunder policy NO.100605463 was not payable because as per BHT of Goyal Hospital,Jodhpur dated 28.11.2002, that he was a known case of Cirrhosis of Liver. The policywas revived on 30.04.2002. He was sick before the revival of the policy. On the basisof BHT, an opinion was taken from DMR who in his report stated that late ShriGhanshyam Mewada was a chronic alcoholic who was continuously drinking for the last5 years as a result of which he was a case of Chronic Cirrhosis of Liver. DMR alsostated that he was a patient of Portal Hypertension. As such, the illness was before therevival of the policy.At the time of hearing on 27.02.2006, this Forum has enquired from the representativeof LIC of India whether they had conducted any enquiry from the employer of late ShriGhanshyam Mewada ? Whether he had taken any leave ? Further they should find outwhether he was admitted in any hospital in Pali prior to the revival of the policy .LIC of India, vide their letter dated 20.07.2006 informed the Forum that no record wasbeing maintained for leave taken by late Shri Ghanshyam Mewada by his employer.They further enquired from local Banger Hospital’s surgical ward, who has informedthat Shri Mewada was not admitted from 1998 to 2004.On examination of the various papers submitted by LIC of India, it is observed that lateShri Ghanshyam Mewada was first admitted in Goyal Hospital and Research Centre,