Death Claim - Gbic.co.in

701 261 446. Her husband had taken a policy with commencement date 21.09.2000 fora sum assured of Rs. 50,000/- for a term of 15 years. He died on 15.11.2002 due toPulmonary Edema, Rheumatic Mitral Stenosis and Pulmonary Hypertension. TheInsurer had repudiated the claim on the ground that the assured had not disclosed thecorrect state of health at the time of proposing for insurance and as such the policywas null and void.A hearing of both the Insurer and the complainant was held on 20.09.2005. Thecomplainant deposed that her husband had never suffered from any illness, had nottaken any medicines or treatment and had not been hospitalised. Her husband was adriver on a private lorry, went to Tirunelveli on his driving duties, where he complainedof chest pain and got admitted to Tirunelveli Govt. Hospital. He died in the hospital.Since his earlier health history did not indicate anything adverse, they had a suspicionabout his sudden death and caused a post-mortem conducted. Quoting that there wasno basis for the hospital recording that her husband had the problem of chest pain for12 years, she mentioned that her husband was only 32 when he died. The Insurerinformed tht the case sheets of Tirunelveli Medical College hospital confirmed that theassured was a known patient of Rheumatic Mitral Stenonis and was taking treatment atregular intervals. But he agreed that they did not have any particulars of the pasttreatment. The Ombudsman obsreved that the insurer cannot repudiate a claim basedon only claim forms B and B1 without any supporting evidence of the past treatment.The available evidence could only hit at some symptoms, which could have beenpresent during the pre-proposal period.The Insurer could not justifiably prove that they had indisputable evidence to establishthat the assured was ill and was treated before proposing and hence their contention ofmaterial suppression in the proposal could not stand the test of scrutiny.The complaint was allowed.Chennai Ombudsman CentreCase No. IO (CHN) / 21.01.2261 / 2005 - 06Smt. M. YasodhaVs.Life Insurance Corporation of IndiaAward Dated 30.09.2005A complaint was preferred by Smt. M. Yashodha, W/o Late A. Mani, agaist the ChennaiDivision I of LIC of India, regarding the denial of death claim on her husband’s policyno. 712 969 467. Her husband had taken a policy with commencement date 11.08.2003for a sum assured of Rs. 75,000/-. He died on 23.04.2004 due to Angio Sarcoma andMultiple Organ Failure. The Insurer had repudiated the claim on the ground that theassured had not disclosed details of his previous policy for a sum assured of Rs.85,000/- given in 03/2002 and the disclosure of which would have necessitated callingfor special medical reports for assessment of risk under the proposal. The complainantpleaded for consideration of her claim sympthetically.A hearing of both the Insurer and the compainant was held on 20.09.2005. Thecomplainant deposed that her husband was working as Driver in BSNL and was veryregular in attending to his duties. He had not suffered from any ailment at any time andhad not availed any leave. She agreed that he used to drink regularly and used to partwith ony paltry sum for household expenditure. He never told her that he had diabetes.During terminal illness he complained of chest pain and was admitted in NationalHospital, Chennai where he was treated for about 20 days and he died there. She saidthat she has received Rs. 85,000/- towards settlement of policy monies under the first