Death Claim - Gbic.co.in

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583626738 28.03.2001 Rs. 629/- No deduction afterintial two premiums.583627597 28.05.2001 Rs. 272/- One terminal gap &nine intermittentgaps.Unfortunately the life assured died on 10.12.2002. The Insurer rejected the claim onthe ground interalia that the policies were in lapsed condition as on date of death ofthe assured. Being aggrieved the complainant moved this forum for redressal.COMPLAINED that under Salary Savings Scheme the employer is responsible fortimely deduction of premiums.COUNTERED by LIC that the reasons for non deduction were obtained from theemployer & as the salary earned by the assured after statutory deduction during therelevant months (gaps period) was in-sufficient to recover the premiums they could notdeduct the same & as such the policies lapsed before death of the assured.OBSERVED that under SSS mode employer has been assigned the role of collectingpremium and remitting the same to the Insurer. As far employee as such is concenedthe employer will be the agent of the insurer (DESU vs. Basanti Devi & Others 1999NJC (SC) 593). If the salary earned by the assured was insufficient, it was incumbentupon the employer to inform the assured to make arrangement for direct payment. TheInsurer has also failed to inform the assured in this regard & as such no blame can belaid at his door.HELD that this is a fit case for ex-gratia consideration. The insurer is directed to payex-gratia award of Rs. 20000/- against each of the policies.Bhubaneswar Ombudsman CentreCase No. I. O. O. / BBSR / 24 - 288Shri Gesala Dhana RajuVsSBI Life Insurance Co. Ltd.Award Dated 18.05.2005Happened that deceased assured G. Surya Rao had obtained a SBI Life SuperSurakasha plan for housing loan borrowers of SBI Group from SBI Life Insurance Co.Ltd. for an assured sum equal to payment of one time premium of Rs. 33287/- videPolicy No. 83001000203. As ill luck would have it, the Assured died on 15.03.2003. On31.03.2003 the Complainant as legal heir lodged the claim. The insurer repudiated theclaim without assigning any reason and SBI, Attabira asked the Complainant to pay Rs.342081/- towards outstanding loan amount. Being aggrieved Complainant moved thisforum for redressal.COMPLAINED that as per terms & conditions of the policy the Insurer has to pay theoutstanding loan amount including interest. SBI, Attabira should take up with SBI Lifefor liquidation of the outstanding loan & interest amounting to Rs. 342081/-.Countered by the Insurer that they have settled the claim pendentilite & paid Rs.241081/- including principal & interest as stood on the date of death to SBI, Attabira &are taking steps to settle the balance amount Rs. 101013.06 accrued after death of theAssured.OBSERVED that condition No. 5 of the scheme provides for payment of outstandingloan amount including interest as per the original EMI schedule in the event of death of
the Assured housing loan borrower due to any cause. The insurer is therefore bound torepay the amount as per EMI schedule.HELD that the outstanding loan including interest accrued till date of payment as perEMI schedule should be repaid by the insurer within 15 days from date of receipt ofconsent letter from the complainant.Bhubaneswar Ombudsman CentreCase No. I. O. O. / BBSR / 22 - 110Shri Bipin Bihari SahuVsLife Insurance Corporation of IndiaAward Dated 23.05.2005Happened that Shri Bipin Bihari Sahu had obtained a policy under T & T 14-20 bearingNo. 580061957 from LIC of India, Berhampur Branch - I on 04.02.87 for an assuredsum of Rs. 25000/- under Mly mode of payment, subsequently converted to Yly mode.Duplicate policy was issued to him as the original was stated to be lost. On28.03.2003, when he visited Berhampur Branch - I to tender his premium due on04.02.2003, the same was not accepted by the Branch on the ground that the Policyhas been surrendered and value paid. As he had neither applied for surrender valuenor received the payment he lodged FIR alleging fraudulent surrender of the policy atBerhampur Town Police Station vide case no. 69 dtd. 16.05.2003. Being aggrieved fornon acceptance of premium he moved this forum for redressal.COMPLAINED that there is no reason for the Insurer to mail the S. V. Cheque not inthe address furnished by him and reflected in the policy bond, but in the C/o. VikrantBar & restaurant address, whose owner had been charge sheeted by the police forcommmitting the fraud in question.COUNTERED by LIC that pursuant to the surrender application dtd. 02.08.2002surrender was effected on 17.12.2002, after completion of all formalities for loss ofduplicate policy bond and S. V. Cheque was mailed in the address given by him in S.V. application.OBSERVED that the agent did not make over original policy bond on the ground that itwas lost for which a duplicate bond was issued to the assured on application. Secondlythe address given in the surrender application is different from the address given in thepolicy bond when the assured had not informed any change of address. Thirdly theperson applying for surrender value produced the original policy with a statement thatduplicate was lost. Fourthly advertisement for loss of policy was made in a hush - hushmanner in a Telugu Daily inviting objections for issuance of duplicate policy bondthough the duplicate bond was issued long before. Fifthly the insurer failed to comparethe admitted signatures of the assured with his disputed signatures in the surrenderedpapers as it looks different and distinct to the bare eye.HELD that the fraud was committed in connivance with the agent and some of theofficials of the Insurer. The Insurer in therefore directed to reinstate the policyaccepting all arrear premiums due from Feb’o3 waiving interest.Bhubaneswar Ombudsman CentreCase No. I. O. O. / BBSR / 22 - 164Ch. Braja Kishore DashVsLife Insurance Corporation of IndiaAward Dated 07.07.2005
Page 1 and 2: Death ClaimAhmedabad Ombudsman Cent
Page 3 and 4: Ahmedabad Ombudsman CentreCase No.
Page 5 and 6: proposal. Respondent submitted a ce
Page 7 and 8: 08.01.04. The recorded cause of dea
Page 9: Award Dated 05.05.2005Happened that
Page 13 and 14: COUNTERED by LIC that claim in resp
Page 15 and 16: Case No. LIC / 450 / Jalandhar / Ga
Page 17 and 18: Vs.Life Insurance Corporation of In
Page 19 and 20: the revival null and void. The Insu
Page 21 and 22: as reported in AIR 1981 MP 69 (DB)
Page 23 and 24: grant insurance to female lives wit
Page 25 and 26: there was suppression of informatio
Page 27 and 28: stated in the certificate in reply
Page 29 and 30: Smt. G. Saroja, lodged a complaint
Page 31 and 32: From the evidences submitted it was
Page 33 and 34: taken treatment for the same thus m
Page 35 and 36: On 24.06.2005, a personal hearing o
Page 37 and 38: A hearing of both the Insurer and t
Page 39 and 40: incumbent upon the Insurer to prove
Page 41 and 42: particulars in the proposal form co
Page 43 and 44: proposal treatment and the surgery
Page 45 and 46: Award Dated 14.09.2005Mr. M. G. Mug
Page 47 and 48: Chennai Ombudsman CentreCase No. IO
Page 49 and 50: policy. The Insurer argued that the
Page 51 and 52: post-mortem report his age at that
Page 53 and 54: Hon’ble Insurance Ombudsman today
Page 55 and 56: As the life assured was reported to
Page 57 and 58: to have been under treatment for tu
Page 59 and 60: It was also alleged by the LIC that
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died on 03.01.2004. The cause of de
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Life Insurance Corporation of India
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Although the complainant disputed t
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assured to be guilty of deliberate
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The life assured was also medically
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for the reasons as aforesaid, the r
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FACTS OF THE CASEOne Shri T. Nagara
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In the above facts, I am of the vie
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One Shri Devraj, S/o Shri T. Bosagi
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death was reported to be gangrene r
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Vs.Life Insurance Corporation of In
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ombudsman asked the insurer to re-o
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Zonal Review Committee as well as t
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However, the claimant was advised t
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There is conclusive evidence throug
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On analysis of the facts as present
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The policy was issued on the basis
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second week of November, 2001 durin
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The entire records have been scruti
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On an analysis it is observed that
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cough and fever and on 06.01.2003 f
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From the investigation Report it is
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22.12.95 at Bombay hospital. Howeve
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unfortunately expired on 18.12.2003
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Shukla approached the Office of the
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Award Dated 26.09.2005Shri Ramesh H
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The relevant records submitted to t
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Death Claim - Gbic.co.in

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