Death Claim - Gbic.co.in

denied that her husband ever suffered any heart ailment or treated at Balaji Hospital.She however, admitted that her husband had consulted Dr. Matheswaran at MayaHospital for stomach pain. The Insurer had produced before the Ombudsman thereports of Balaji Hospital of 1996, where the assured had been referred to as a case ofmild ARS and advised to go for TMT and Coronary Angio. However, no readings ofsuch reports were available. The Cardiac Report of Madras Scan Systems indicatedmild diastolic dysfunction. The Medical Attendant’s certificate and the HospitalTreatment certificate of Perambur Railway Hospital talked only about the terminalillness and did not refer to any past history of heart ailment.The Ombudsman opined that it was 7 long years after the initial treatment for heartailment in 1996 and there was no evidence to show that the assured continued tosuffer heart problems. Further the policy was in force for more than two years and Sec45 was in full operation and the onus of proving fraudulent material suppression waswith the Insurer, he said. He observed that, neither the paltry and inconclusiveevidence produced by the Insurer to show that the assured suffered continuously northe complainant’s contention could given full weightage. To ensure ‘equity and naturaljustice’ it was awarded that an amount equal to 50 % of the basic sum assured begiven to the complainant on ex-gratia basis.The complaint was partially allowed on ex-gratia basis.Chennai Ombudsman CentreCase No. IO (CHN) / 21.08.2201 / 2005 - 06Smt. B. TamilselviVs.Life Insurance Corporation of IndiaAward Dated 18.08.2005Shri S. Bharathi had taken the policy bearing no. 732295821 for Rs. 50,000/- atPondichery Branch, Vellore Division on 20.03.2000. He died on 01.07.2001 due toCerebral Infarction. Smt. B. Tamilselvi, wife and the nominee under the policyapproached the Insurer for payment of death claim. The Insurer denied the claim onthe ground that the assured had made incorrect statements and withheld materialinformation at the time of proposing for insurance and held the policy null and void.The complainant approached our Forum for redressal.A Personal hearing of both the parties was held on 12.08.2005. The complainantdeposed that her husband did not suffer from any ailment barring the occasionalheadache till his hospitalization in SRMC. Chennai in June, 2001. The details, that herhusband was an alcoholic, smoker and a known case of Cerebro Vascular Attack asrecorded in the hospital records were not given by her but could have been of herhusband’s colleagues. She further disputed that her husband was suffering fromEnteric fever and Infective Hepatitis, Hypertension or breathlessness before taking thepolicy. She added that the leave was availed by her husband only for houseconstruction and other family exigencies. The Insurer produced before this Forum, theleave applications of the assured with relevant medical certificates to establish the preproposalillness of the assured. They further argued that the acceptance of proposalwould have been deferred till complete cure in view of the Hepatitis suffered by theassured.The Ombudsman observed that the Insurer could not produce any clear cut evidence toprove that the assured suffered from the said ailments, and availed treatmentexcepting the medical certificates produced by the assured to their employer foravailing leave. At the same time, failure on the part of the assured to mention the leave