Death Claim - Gbic.co.in

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She was very much aware of the disease which she has not disclosed resulting inconcealment of material fact. Therefore, LIC of India has rightly repudiated the claim.I uphold the decision taken by Life Insurance Corporation of India repudiating the claimof Shri Rupa Ram under policy No.501317047.There is no further relief to be granted to the complainant.Complaint is disposed of finally.Delhi Ombudsman CentreCase No. : LI/UP-140/05-06Smt.KanaklataVsLife Insurance Corporation of IndiaAward Dated : 30.11.06The complaint was heard on 15.11.2006. The complainant, Smt. Kanaklata, waspresent. LIC of India was represented by Shri Prahlad Rai Tailer, AdministrativeOfficer.Smt. Kanaklata lodged a complaint with this Forum on 07.06.2005 that her latehusband Shri Prakash Chandra Sharma had taken two policies No.180378317 and181987198 from LIC of India, Dungerpur Branch. He expired on 06.04.1994. She hadcompleted all the formalities with regard to the payment of the claim against thepolicies. However, she shifted to Mumbai to look after the shop. She moved her familyalong with children to Mumbai after completing the formalities for payment of claim withLIC of India and on the verbal assurance of her relatives and the insurance agent tolook after her insurance claim but till date she has not received any amount against theabove mentioned two policies. She requested the Forum to get her claims approvedfrom LIC of India.LIC of India, vide their letter dated 16.08.2005 informed the Forum that the details ofthe policies are as under:-Policy No. 180378317 1819871981. Date of commencement : 28.03.1991 28.01.19932. Date of FPR : 31.03.1991 31.03.19933. Date of Revival : 23.04.1993 —-4. Sum Assured : 50000 500005. Mode : Hly Hly6. Instalment of premium : Rs.1410.80 Rs.1470.007. FUP : 28.03.1994 28.07.19948. Date of Death : 06.04.1994 06.04.19949. Cause of Death : Lungs Cancer10. Duration of Policy fromFPR/Revival : 11 months I year 5 days13 days11. Status of policy : In force death reportedLIC of India issued a series of letter resting with letters of death claim/18B dated29.07.1997 for submission of claim forms 3783,3784,3816 to the claimant Smt.Kanaklata Sharma. She did not comply the requirements hence the claim had not beensettled. The claimant has now submitted claim form 3783(R), 3785 dated 06.07.2005.
They further needed claim forms No.3784,3816 death certificate and policy bonds forconsidering the death claim. They have asked the claimant to submit the documentswithout further loss of time.The complainant, Smt. Kanaklata informed the Forum on 21.08.2006 that she had withgreat difficulty managed to get the duplicate certificates and necessary documentscompleted from the treating doctor.LIC of India informed the Forum vide their letter dated 06.01.2006 that they hadrepudiated the claim since late Shri Prakash Chandra Sharma was suffering from feverand pleural effusion of lungs and taken treatment for Adeno Carcinoma long withpleural effusion before the date of FPR 31.03.1993 under policy No.181987198 andfrom the date of revival 24.03.1993 under policy No.180378317. Smt. Kanaklata wasinformed accordingly.Since LIC of India could not produce the letters sent to Smt. Kanaklata, the case wasadjourned for next date for LIC of India to produce the letters sent to her.On 15.11.2006, the complaint was again heard and LIC of India produced the lettersdated 21.08.1998 by Registered post under Policy No.180987198 written to Smt.Kanaklata informing her that the claim stands repudiated since the details furnished inthe proposal form were incorrect as late Shri Prakash Chandra Sharma was alreadysuffering from fever and pleural effusion of lungs which he had concealed in theproposal form. Acccordingly, the claim stands repudiated for non-disclosure of materialfact. Further LIC of India had also informed Smt. Kankalata vide their letter dated21.08.1998, by Registered Post, repudiating the claim under policy No.181378317 thatthe declaration made in the proposal form by late Shri Prakash Chandra Sharma wasincorrect. Prior to revival of policy, Shri Sharma was suffering from fever and pleuraleffusion of lungs. He had concealed the material fact by submitting certificate of goodhealth. Accordingly, the claim was repudiated.Smt. Kanaklata Sharma deposed before the Forum that she has not received the letterssent by LIC of India and she had been contacting their Udaipur Office andsubsequently their Dungerpur and Sagwara Branch in this regard. She also submitted aletter to the Forum wherein she has mentioned that LIC of India officers were directedto settle the claims. This statement of Smt. Kanaklata Sharma is incorrect. The Forumonly advised LIC of India to produce the letters written to Smt. Kanaklata Sharma in theyear 1998 repudiating the claim and her letter is irrelevant and baseless. She pleadedthe Forum that she should be paid her claim by LIC of India.LIC of India informed the Forum that they had sent letters under both the policies byregistered post to Smt. Kanaklata Sharma on 21.08.1998 on the basis of medicalattendant certificate of Dr.J.C.Kothari wherein he has mentioned that late Shri PrakashChandra Sharma was suffering with the disease of fever and pleural effusion of lungsand taken treatment for Adeno Carcinoma in the hospital on 01.04.1993. PolicyNo.180378317 was revived on 23.04.1993 and the first premium receipt was31.03.1993. Late Shri Prakash Chandra Sharma was very well aware of the disease asa result of which he died on 06.04.1994. He had concealed the material fact in theproposal form submitted to the Corporation. LIC of India has rightly repudiated theclaim.On going through the papers and after hearing both the parties, it is observed that ShriPrakash Chandra Sharma died on 06.04.1994 and LIC of India had repudiated theclaim on 21.08.1998. As per the RPG Rules,1998, only complaints which are less thanone year old should be entertained and LIC of India having repudiated the claim in theyear 1998, the complaint was time barred. However, this Forum has examined the
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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
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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 and 96: Jodhpur on 11.11.2002 and was disch
Page 97: He had concealed the material fact
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
Page 147 and 148: 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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Death Claim - Gbic.co.in

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