AHMEDABAD - Gbic.co.in

Order No.BPL/LI 09-10/ 86Case No. TATA-235-23/11-09/MumShri Vishal Shivhare ……………..….…….……..ComplainantTATA AIG Life Insurance Co………………….. .………..…RespondentBrief Background - MiscellaneousShri Vishal Shivhare, resident of Ashtha Distt. Sehore (M.P.) lodged the complaint that hisfather Late Shri Prem Narayan Shivhare was covered under Health Insurance Policy No. U-086822901 for SA of Rs. 3.65 lakhs, he died on 06.01.2009. Claimed preferred by thecomplainant for Rs. 3.65 lakhs, but respondent paid him only Rs. 2933.28 towards fundvalue on the ground that death benefit was not opted.Aggrieved from the action of the respondent the complainant lodged the complaint on04.11.2009 to the respondent.The Respondent represented by M/s Sapna Korde, Manager(Operation), Bhopal presentedherself and submitted that the policy is issued as per the proposal form completed andsigned by the DLA. In the proposal form he has opted for hospitalization benefit andsurgical benefit @ 500/- and 10,000/- respectively and he has not opted the death benefit,hence the claim is rightly paid to the complaint as per the terms & conditions of the policymentioned in the document under the para no. 3 (a) Death Benefit. The complaint may bedismissed.FINDINGS & CONCLUSIONS:-There is no doubt that the DLA was covered under the above insurance scheme for dailyhospital benefit and surgical benefit @ 500/- and 10,000/- respectively. The proposal formfilled in by the DLA on 29.11.2008 does not reveal that the he has opted for death benefit.The policy condition 03(a) states that “If the covered member dies while the policy is in forceand before the maturity date, we will pay to the Nominee the Total Fund Value of the policyat the applicable Unit Price as specified in the section cut-off Daily Hospital Benefit (asdefined in the section “Daily Hospital Benefit”) of the covered member subject to thepercentage applicable to the procedure/surgeries in Table of Surgical Procedures/Surgeries.”In view of the above, it is found that respondent’s action to refund the fund value Rs.2933.28 is justified requires no intervention.The complaint is dismissed without any relief.Dated at BHOPAL, on 12 th of JANUARY 2010.