Page 56 - Life Insurance Today July - December 2020

distt Udhamsingh Nagar as his father had died at Jaspur was quite healthy before he died on 02/01/2017. The
only. He also submitted cremation certificate issued from Insurance Company stated that the deceased life assured
Shamsan Jeerrnodhar Samiti dated 02/09/2016 in support was suffering from Diabetes, Hypertension, and Kidney
of his claim. The Insurance Co further stated that during related problems prior to the policy issuance, which was
investigation, it was found that the life assured Mr. Sunil not disclosed in the application dated 16/12/2013 and de-
had expired on 02/09/2016 which was also confirmed by the tails of the life assured on application form were found to
complainant. be false. As the insured was ill before taking insurance, the
claim was repudiated by the company on the ground of
However, the death certificate submitted by the claimant concealment of material facts regarding health by the de-
contained incorrect information with regard to place & ceased life assured.
time of death and the same was accordingly cancelled by
the issuing authority. The company further stated that they Since the insured had paid premiums without any break for
had rejected the said claim as per the clause 14 of the 4 years from inception and as per amendment act to the
policy bond which states that as Fraud, misrepresentation section 45 of the Insurance Act1938, a policy cannot be
and Forfeiture would be dealt in accordance with provi- questioned or claim repudiated after completion of 3 years,
sions of section 45 of insurance act 1938 as amended from even if some facts were suppressed or provided incorrectly,
time to time. The matter has been examined on the basis once the period of 3 years is over, the insurer cannot deny
of documents on record, submissions during the personal claims on ground of suppression of facts. The insurance
hearing and investigation report submitted by the Insur- company was directed to pay the death claim.
ance Company.
Case of
In support of repudiation of claim, the Insurance Company
have submitted Death certificate issued by the Govt of Sh. Rajeshwar Nath Gupta Singh
Uttar Pradesh dated 03/10/2016 stating the date of death v/s
as 02/09/2016 but the same has been cancelled by issuing LIC of India.
authority. On the other hand the claimant has produced a
death certificate dated 18/05/2017 issued by the govt. of
Uttarakhand stating the date of death as 02/09/2016, which This is a complaint filed by Shri Rajeshwar Nath Gupta
was not available with the Insurance Company. The Insur- against the decision of Life Insurance Corporation of India
ance Company was given a copy of death certificate issued relating to non-settlement of death claim of his sister’s
by the govt. of Uttarakhand dated 18/05/2017 for verifying pension policy. The claimant stated that his sister had pur-
its veracity. In response to that, the insurance company chased a Deferred Annuity policy from LIC of India on
have sent a mail dated 13/11/2017 “stating that they have 24.2.2005 which matured on 24.2.2011 and he was the
reviewed the case and are ready to settle the claim for sum nominee in her policy. His claim was rejected by Divisional
assured on death and applicable interest. Office Agra on the ground that his sister had not given the
name of spouse as nominee at the time of annuity.

Case of
The complainant stated that since his sister was unmarried,
Smt. Lalita hence, the question of spouse as nominee does not arise.
v/s It is possible that the time of maturity, wrong annuity op-
tion was ticked by his sister. His claim was genuine and
HDFC Life Insurance Company Ltd. should be paid by the Insurance Company in the shape of
annuity or sum assured. The Insurance Company submit-
The deceased had taken a HDFC Life Click 2 Protect Insur- ted that the policy matured on 24.2.2011 and annuity
ance Plan from HDFC. His death claim was rejected by the started @ 5949/- on yearly basis.
company on ground of non-disclosure of material facts
related to the health of insured at the time of proposal The total Notional cash option under the policy was Rs.
dated 16/12/2013. The complainant stated that her husband 66023/-. After receipt of five annuity installments, the as-

"Relationships almost always kill a beautiful friendship."

56 July - December 2020 Life Insurance Today