DR SURESHA G (SR ENVIRONMENTAL CONSULTANT ) 08 June 2016

Lic claims

Dear Club members

Good day to all.

I have a, inquiry and request you to go through the case and give your valuable opinion.

I greatly appreciate if you could respond at the earliest. My sister’s husband I mean my brother in law. Late J.N. Mahantheshappa purchased a life insurance policy No 629540623 (RS. 2,00,000) in 2010. He was working as Assistant Engineer in minor irrigation department on daily basis and regularized in Feb 2015 and after exact 6 months he passes away.

Hewas regularly paying the LIC premium yearly until 2013 then the policy was lapsed due to nonpayment of premium. Then on 11-10-2013 he has declared good health and undergone the medical checkup as required by LIC through a LIC certified Doctor and paid the premium. Then the policy becomes regularized in 2013 and he paid the premium regularly until his death occurred on 18/08/2016.

Then my sister submitted all the documents to LIC for claiming the benefits of her husband’s policy.

After 5 months she received a reply from the LIC on 31.03.2016 which stated that her application for death claim has been rejected (the letter is attached for your reference).

In fact he was alcoholic since 2007 .But he never admitted to hospital or never injured or never undergone continuous, medical treatment for any of the ailments up to march 2016. He was regular to his duties and have good health.

LIC is giving non sense reasons, for rejecting the claims. When he submitted the DGH to (Declaration of good health) he declared the truth.

He never suffered from any illness / disease requiring a treatment for a weak or noise his answer was ‘NO’ it is true.
He has never undergone any operation/ accident / injury his answer was ‘NO’, it is true.
He never undergone ECG X-ray /blood test/ urine or stool examination. His answer is ‘NO’ which is true.

4 – He declared sound health as he was working 8 ½ hours daily and performed regular duties until May 2016.

Now our question is why LIC did not investigate all these details in 11.10.2013 while reinstating the policy. Of course he died because of liver cirrhosis.

Now LIC is trying to defend that his claims are not acceptable. Deceased J.N. Mahanthshappa has 4 dependents. 1st& 2nd daughters are studying in the engineering and the 3rd son is 11th standard.

Due to Karnataka state government’s new policy J.N.Mahanthashappa’s dependent’s will not get any Job on compassionate grounds nor pension nor the service benefits. His children’s future is in problem .They are starving now.

The investigation made by LIC is totally wrong and information on the treatment in 25/08/2012 is a OPD visit not admission.

Could you please advise me the further course of action.

Respectfully Yours

Dr. Suresha G.

Davanagere

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2 Replies

Kumar Doab (FIN) 08 June 2016

Before jumping to write to insurer you may shwo all docs on record to a very able counsel specializing in consumer matters and let your bale counsel draft and structure your representations.

You may if you want try without a counsel, by writing to Cahirman's office in LIC and Chairman IRDA, if you are expert in such matters.

G.L.N. Prasad (Retired employee.) 09 June 2016

There are umteen NCDRC decisions. I have also taken up a case of similar nature. A simple objection is not a permanent rejection.

Get entire leave records of your brother in law from employer under RTI. Then find out the total sick leave availed by him in his service year wise with copies of medical certificates.

If he has not availed sick leave or such sick leave on minor illness you have a strong case to fight.

There are certain other important matters to be seen. What is the nature of death ? Are those reasons attributable to Alcoholism ? Has he undergone a treatment for long with Anti biotics overdoses during that time as the affect of such long term use of high doses may act against liver and symptoms are same as alchol. There are several cases of Cirrosis even among non alcoholics and the reasons for cirrosis is not entirely due to alcoholism. Even such chronic alcoholics may not get cirrosis.

You need not at present go for consumer forum. First go to Ombudsman and within 2 years from date of receiving rejection, you can file consumer complaint.

The chances of getting the claim are 100%. But one has to focus and get the entire documents to establish against their findings.

When LIC has rejected such claim, I have helped her mother at the initial stage itself even without resorting to Ombudsman or Forum. The case I helped is payment on first premium and claim was rejected to a lecturer, and he has not taken even a single sick leave during that period, and he has not undergone any medical tests. The point I have stressed is his accident on a road in summer, on a high way, when melter coal tar burnt his skin and the hospital at Hyderabad administered high power antibiotics which might be the one reason for cirrosis. Fourtnately as he has not taken any leave that has helped him.