Death Claim - Gbic.co.in

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Shri Sriram Meena had not taken any sick leave except for 5 days and other leaveswere taken for domestic work. As such it can be presumed that he has been consumingAlcohol for the last 30 years and I do not consider it material for LIC of India torepudiate the claim since he has been performing his duties.I, therefore, pass the Award that Smt. Koshalya Devi be paid the sum assured alongwith other accrued benefits under the policy together with 8% interest from 01.02.2002till the time payment is made.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/BK-419Smt.BismillaVsLife Insurance Corporation of IndiaAward Dated : 30.11.06Smt. Bismilla had lodged a complaint with this Forum 08.03.2005 that her son late ShriSamsuddin had taken a life insurance policy on 28.06.2001 for Rs.25000/- and the lifeassured has expired on 30.04.2004. She had completed all the formalities and wasadvised by LIC of India on 15.02.2005 that her claim has been repudiated. The reasonsfor repudiation were not valid. She has requested the Forum to settle the claim.LIC of India, vide their letter dated 17.01.2006 informed the Forum that during theirinvestigation, it was revealed that the life assured was handicapped at the time ofproposal. He was not in a position to move. The deceased life assured had applied forHandicap Pension from BDO, Panchayat Samittee, Nohar in the year 1999 which hasbeen confirmed by a letter from the Panchayat Samittee dated 09.11.2004. Thedeceased life assured had suppressed material information regarding his health andLIC of India had repudiated the claim on the grounds of concealment of material fact.This Forum has written a letter to LIC of India to get a confirmation from the StateGovernment whether the deceased life assured, Shri Samsuddin, was getting anypension from the State Government and any disability certificate was enclosed with theapplication with the State Government.At the time of hearing, the representative of Smt. Bismilla disclosed that late ShriSamsuddin was not getting any pension from the State Government. However, familypension was being given by the employer of his father.LIC of India, at the time of hearing, contested that the life assured had suppressedmaterial information regarding his health since he was a handicapped for the last 2years before the date of proposal and was not in a position to move. He had notdisclosed this material information in the proposal form submitted with the LIC of India.He had also applied for pension with the State Government. On enquiry by this Forumthat since LIC had received the Agent’s Confidential Report whether it was not the dutyof the agent to disclose that late Shri Samsuddin was handicapped which he has notdisclosed under Column III of his report . What action LIC of India had taken againstthe agent ? The representative of LIC of India informed the Forum that they had nottaken any action against the agent. Further, on enquiry from the representative of LICof India whether any disability certificate was obtained, the representative had noknowledge of the same.On examination of the papers submitted, it was observed that the life assured, ShriSamsuddin, was a handicap person as per the enquiry conducted by the LIC of India.
He had concealed the material fact that he was handicap. However, the agent in hisConfidential Report has not mentioned any disability of the life assured which showsthat the concealment of material fact by the life assured was not material since in theconfidential report, the agent has not given the true and fair picture of the life assuredto the Corporation.I am not in agreement with the decision of Life Insurance Corporation of India inrepudiating the claim of Smt. Bismilla. Since it is the duty of the agent to give true andfair picture of the life assured so as the risk could be under written properly. Further,LIC of India has not taken any action against the agent. LIC of India has also not triedto verify whether he got any pension from the State Government given to handicappedpersons nor they have been able to produce any disability certificate of Shri Samsuddinconfirming the degree of disability.I, therefore, pass the Award that Smt. Bismilla be paid the sum assured along with theother benefits accrued under the policy by LIC of India.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/BK-10/05-06Shri Rupa RamVsLife Insurance Corporation of IndiaAward Dated : 30.11.06The complaint was heard on 15.11.2006. The complainant, Shri Rupa Ram, wasabsent. He was also absent on the earlier date on 21.08.2006. LIC of India wasrepresented by Shri K.C.Sharma, Manager(Claims).Shri Rupa Ram had lodged a complaint with this Forum on 21.03.2005 that his mother,Smt. Mohni Devi, had taken LIC Policy No.501317047 for Rs.50,000/- from theirSujangarh Branch. After her death, he filed a claim with the LIC of India. LIC of Indiaon 29.10.2004 repudiated the claim on the grounds that Smt. Mohni Devi was sufferingfrom Dysphagia before taking the policy. The truth is that his mother was not sufferingfrom any disease. She was medically examined before the proposal was accepted byLIC of India. LIC of India has accepted her proposal only after her medical examinationthen how can the Corporation come up with the excuse that she was not keeping goodhealth. Their contention that she was not keeping good health is not true and baseless.He has requested the Forum to pay the claim.LIC of India, vide their letter dated 28.11.2005, informed the Forum that they hadrepudiated the claim on 29.10.2004 due to concealment of material fact. The policyholder was suffering from Dysphagia before taking proposal.At the time of hearing, the Forum raised a question that since medical was conductedin the case of Smt. Mohni Devi, how the doctor could not detect the disease ofDysphagia since she had difficulty in swallowing which should have come out ondiscussions with the life assured about her medial history. Even the agent has notmentioned about the disease in his report. Both the doctor and the agent have beennegligent at the time of proposal being made to LIC of India.On examination of the papers submitted by LIC of India, it is observed that as per thedischarge certificate of Acharya Tulsi Cancer Hospital where Smt. Mohni Devi wasadmitted, it is mentioned that she was suffering from Dysphagia for the last two years.She had expired on 19.02.2004 and she had taken the insurance policy on 14.08.2003.
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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
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There was no dispute that the DD fo
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proposal the contract remains uncon
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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 and 92: In the hearing the complainant stat
Page 93 and 94: VsLife Insurance Corporation of Ind
Page 95: Jodhpur on 11.11.2002 and was disch
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
Page 143 and 144: LIC about usage of herbal medicines
Page 145 and 146: 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
Page 217 and 218:
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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