Death Claim - Gbic.co.in

suffered and the cause of death. All the available medical evidence, the Insurer reliedupon, thus, could only reveal that the assured was not in good health at the time ofrevival and was diagnosed for anaemia only in 2002. The Insurer could not prove thatthe assured was aware of his illness and the non-disclosure was a deliberate one.The Ombudsman observed that the policy had already run for 6 years and Section 45of the Insurance Act was operative. Also the Insurer could not conclusively provefraudulent material suppression by the assured. And hence, he awarded an ex-gratia ofRs. 15,000/- equivalent to 60 % of the sum assured.Thus the complaint was partially allowed in favour of the complainant.Chennai Ombudsman CentreCase No. IO (CHN) / 21.06.2046 / 2005 - 06Smt. K. KanagavalliVs.Life Insurance Corporation of IndiaAward Dated 06.08.2005Smt. Kanagavalli preferred a complaint against the decision of the Insurer to repudiateher claim under her husband’s policies, for non-disclosure of the details of his sufferingfrom Diabetes Mellitus while reviving the lapsed policies on 11.10.2003 and18.10.2003. The assured died on 21.01.2004.Both the Insurer and the complainant were called for a personal hearing on28.07.2005. The complainant said that her husband was suffering from D. M. only for ayear prior to death and was not in possession of any treatment prticulars. She deniedthat she herself had reported to the hospital authorities at the time of her husband’sterminal illness, that her husband was diabetic for 4 years. The Insurer argued that therepudiation decision was taken on the basis of Claim F. ‘BI’ certified by a doctor, whohad recorded the assured to be suffeirng from D. M. for 4 years as told by the wife atthe time of hospitalistion. The Insurer offered to refund the premium received after therevival, as a special case.The Ombudsmann observed that the policies had run for 12 and 14 years respectivelyand no investigation was conducted by the insurer, as to the details of the disease,diagnostic tests, exact treatment particulars etc., to prove the pre-revival illness andnon-disclosure of the same, except the solitary reference made by the doctor in ClaimF. ‘BI’, that was flatly denied by the complainant.The case was thus disposed off on merits in favour of the complainant.Chennai Ombudsman CentreCase No. IO (CHN) / 21.02.2018 / 2005 - 06Smt. J. SangeethaVs.Life Insurance Corporation of IndiaAward Dated 10.08.2005Smt. G. Dhanusu, had taken a policy for One Lakh and nominated her daughter Smt. J.Sangeetha to receive the death claim payment as and when it arises. She died on28.05.2004. The Insurer denied payments on the ground that the assured failed todisclose in her proposal for insurance dated 24.03.2003 the details of her RheumatoidArthritis, Hypothyrodism, the treatment availed for the same and also the lumpobserved in the breast and hence complaint preferred with this Forum.