Page 50 - Life Insurance Today January-June 2020

Ltd. about non-settlement of death claim under two poli- chased a policy bearing no.585004078 under Bal Vidya Plan
cies bearing numbers 16464208 and 15512190 purchased on from the Insurance Company in January 2003 with an un-
27.12.2013 and 17.10.2012 for a premium of Rs. 50,000/= derstanding that the survival benefit /Maturity benefit
and Rs. 25,000/= respectively in the name of her husband would be received on the stipulated dates at the defined
Late Shri Sanjeev Sareen. Her Husband died on 03.08.2015 rates.The policy document received from the Insurance
and she filed the claim on 24.08.2015. However, the Com- Company contained a detailed schedule of periodic survival
pany rejected the claim vide letter dated 20.01.2016 for non- benefit payments to be effected at the specified variable
disclosure of the fact that he was suffering from diabetes rates with the specific dates mentioned herein. He received
and hypertension prior to the purchase of the policy. the survival Benefits as per the terms and conditions of the
policy till December 2016.
Findings: - The Life Assured Lt. Shri Sanjeev Sareen suf-
fered from Diabetes and Heart Problems which is evident He did not receive the amount equal to basic sum assured
from the treatment papers submitted by the Company. due on 30.01.2017 as specified in the policy document. He
However, the same is denied by the claimants and hence, did not receive the survival benefit at the enhanced rate
they were given 15 days time to procure documentary of 4% of the sum assured w e f 31.01.2017 as per clause
evidence to disprove the treatment papers. (e) of the benefit schedule of the policy document. Instead
he continued to receive the same at the rate of 2% of the
The claimants could not submit any proof to substantiate their sum assured. He took up this matter with the Respondent
claim that the life assured was not suffering from diabetes and Insurance company and he was informed that policy bond
heart ailments and was not under treatment for the same. was prepared manually and there was clerical error due
to which lump sum survival benefit due date was inadvert-
The Company informed that policies bearing numbers ently mentioned as 30.01.2017. Instead of 01.01.2018. He
15512190 and 16464208 were purchased on 13.10.2012 was also informed to return the policy for necessary cor-
and 03.12.2013 for premium of Rs. 25,000/= and Rs. rection. He has requested the Forum to direct the Respon-
50,000/= and premium paying term 15 years and 10 years dent to settle the Survival Benefit amounts as per the policy
respectively. The policies were delivered on 22.10.2012 and document.
01.01.2014. The life assured was suffering from Diabetes
and Heart Ailment prior to the purchase of the policies and OBSERVATIONS OF THE FORUM:
was under treatment of Dr. Gagandeep Singh at Healing The Forum was informed by the Respondent that the date
Touch Super Specialty Hospital, Ambala and Dr. Rohit of taking the policy was 31.01.2003, date of commence-
Aggarwal at Aggarwal Health Care, Patiala. The death ment of policy ( due to dating back) was 01.01.2003, date
claim was repudiated as this material fact was not disclosed of birth of child is 30.01.1999, completed age of the child
while purchasing the policies.
was 4 years and premium was calculated on age 3 years
due to dating back. The complainant got the benefit of
Decision: - In view of the documentary evidence submit-
lower premium of Rs. 9950/- due to dating back of the
ted by the Insurance Company and inability of complain- policy. The Respondent submitted to the Forum a copy of
ants to provide any evidence to disprove the same, the the plan salient features and informed that as per the plan
stand of the Insurance Company is vindicated and the com- salient features survival benefit would be paid in arrears
plaint is dismissed.
on the policy anniversary only, 2 years after commence-
ment of policy or after completion of the specified age of 5
Survival Benefit years of the named child. The survival benefit would be paid
Mr. Shakti Prasad Mohanty monthly @ 1% of the sum assured (S.A.) which would in-
crease to 2% of the S.A. on completion of 10 years of age
V/S and 4% of the S.A. on completion of 18 years of age. In
LIC of India, Bhubaneswar DO addition to this, a lump sum survival benefit equal to basic
S.A. would be payable on the policy anniversary at which
Complaint Ref. No. MUM-L-029-1718-0244 the named child completes the age of 18 years. The policy
document is silent about the above mentioned conditions
FACTS OF THE CASE: viz. age specified benefits payable in arrears on the policy
The complainant, Mr. Shakti Prasad Mohanty had pur- anniversary only.

50 January - June 2020 Life Insurance Today