Death Claim - Gbic.co.in

Daughter’s marriage and to ensure that the Leave is granted by his Employer, hesubmitted false certificate of sickness. In corroboration of her pleading, she submittedcopy of an invitation letter purportedly printed in May 2001. Documents andsubmissions perused. It is observed that there are evidences like COT to establish thatthe DLA was under treatment for acute Pulmonary disease and Chest Pain prior to May2001. However, in the Proposal Form, all queries related to health and treatment wasanswered by the DLA in negative. Held that where Hospital Certificate and Doctor’sCertificate confirmed the disease and subsequent Leave obtained by the DLA,reversing the repudiation merely relaying on an invitation letter, is not justified.Repudiation uphled.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0361Mrs. Savita D. SutharVsLife Insurance Corporation of IndiaAward Dated 07.09.2005Complainant’s husband held a LIC Policy commenced from October 1998. He died inJune 1999. Respondent repudiated the Claim on the ground that the DLA understatedhis Age in the Proposal Form. The actual date of birth of the DLA was July 1943. But,in the Proposal Form, he mentioned the DOB as July 1969. Representative of theComplainant submitted that the DOB of the DLA as per School Leaving Certificate was1943, but the Agent of the Respondent misdirected the DLA to commit this error.Documents and submissions perused. It is observed that the DLA was literate who hadpassed SSC in 1962 and according to School Leaving Certificate, his DOB has beenmentioned in it as 05.07.1043. Further observed that the Risk covered was underTable-91 and the maximum Age at entry for the said Plan is 50 years. Ground forrepudiation established and upheld the repudiation decision.Ahmedabad Ombudsman CentreCase No. 21 - 001 - 0213S. M. RathodVsLife Insurance Corporation of IndiaAward Dated 30.09.2005Death Claim under a Life Policy repudiated on the ground of deliberate mis-statementand withholdment of material facts. The Claim was repudiated after two years from thedate of Policy. So it attracted only later part of Section 45 of Insurance Act 1938wherein it is required to be proved that there was deliberate fraud in withholding theinformation. Here, in this case, the Respondent could not adduce any evidence insupport of their contention regarding DLA’s past treatment. The respondent haddepended only upon the case history noted in the treating hospital. Again, it was alsonot noted as to who had reported that history. So, it was held that indisputableevidence about DLA’s having consulted a medical man did not exist. The repudiationwas set aside. Respondent was directed to pay Rs. 29,000/-.Bhubaneswar Ombudsman CentreCase No. I. O. O. / BBSR / 21 - 144Smt. Pranati MishraVsLife Insurance Corporation of India