Death Claim - Gbic.co.in

Vs.Life Insurance Corporation of IndiaAward Dated 21.07.2005Shri M. Geoffrey Winster complained to this forum about repudiation of claim under thepolicy of his wife for suppression of material information relating to her health Thepolicy commenced on 28.01.2002 and the assured died on 06.03.2003, due toDisseminated Ovarian Malignancy.Though a personal hearing was arranged on 14.07.2005, the complainant was notpresent. The insurer argued that there was suppression of information about theassured being asthmatic since childood. She had availed medical leave for 60 days andtaken treatment in 3 different hospitals during pre-proposal period. All the documentaryevidences produced by the insurer revealved only post proposal treatment for‘Disseminated Ovarian Malignancy with Liver Secondaries’ at Bilroth Hospital, CancerInstitute and M R Hospitals though there was a mention of the assured being aknowncase of Bronchilal Asthama since childhood and not under treatment recoded byBillroth Hospital and cancer institute. According to employer’s certificate the leaveavailed by the assured was for ‘viral fever and not for Asthma’ thus the insurer failed toprove that the assured was suffering from Bronchial Asthma and was treated for thesame and that led to material suppression.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.01.2143 / 2005 - 06Smt. C. RevathiVs.Life Insurance Corporation of IndiaAward Dated 22.07.2005Smt. C. Revathy, W/o Late V. Chengalvarayan, complained to this forum that the deathclaim under the policy on the life of her husband, was repudiated by the Insurer on theplea that the life assured had made deliberate misstatements and withheld materialinformation regarding her correct state of health at the time of effecting insurance.The life assured had taken a Bima Kiran policy for Rs. 100000/- for 25 yearscommencing from 28.03.2001. The policy which was lapsed due to non-payment ofpremiums from 9/2002 was revived on 26.12.2003 on the strength of the PersonalStatement of Health dated 25.12.2003. The assured died on 18.01.2004 due toMetabolic Encephalopathy. When the complainant approached the insurer forsettlement of the claim the same was rejected on the grounds that the life assured hadmade deliberate misstatement about his health and withheld material infromation.A personal hearing was arranged on 14.07.2005. The complainant informed that herhusband was working with a contractor as a welder. They lived together for four years.They have four children. One year prior to his death her husband had fever andbecame normal after taking treatment from Goverment Hospital. Afterwards he waskeeping good health till his death. She denied that her husband had fever six monthsbefore his death and that he was administered anti TB Drugs The representative of theinsurer contended that the life assured had fever on and off for six months and revivedthe policy five days before admission to the Government Hospital for treatment offever. The insurer also informed that the anti TB drugs taken by the life assured led todeterioration in liver and kidney functioning ultimately leading to death due toMetabolic Encephalopathy.