Case No. 332/11/003/NL/07/2008-09
Smt. Meena Agarwal
Vs.
National Insurance Company Ltd
Order Dated: 22.01.2009
Facts & Submissions: This petition was against repudiation of accidental death claim under Group Janata Personal Accident (JPA) policy issued to Golden Multi Services Club (GMSCL) of G.T.F.S by the National Insurance Company Ltd. (NICL) on the ground of suppression of material fact in the proposal form.
The petitioner Smt. Meena Agarwal stated that Hon’ble Ombudsman advised the National Insurance Company Ltd. to reconsider her claim, but the concerned Divisional Office of the said insurer reiterated their earlier decision of repudiation on the ground of “Misrepresentation of Material Facts”. She further stated that her husband while taking the JPA policy declared his monthly income as Rs.8,500/-. Her husband was engaged in personal business and had no fixed income. He used to give variable amounts in different months according to his ability to meet the minimum requirement of the family and she never enquired about his monthly income. After the death of her husband she lodged a claim against the captioned policy. At the time of inspection she was dark about the monthly income of her late husband. Being nervous she declared her husband’s income as Rs. 5,000/- because in that month her husband has given 5,000/- for monthly expenditure. Because of her ignorance the claim was rejected. In view of above she requested the insurance company to review the repudiation decision and arrange for payment of the said claim but of no avail.
The insurance company did not provide a self-contained note.
DECISION: Since there was no proof for substantiating the income of the insured, Hon’ble Ombudsman was unable to agree with the arguments of the complainant. However, non-mentioning of the correct income did not vitiate the contract of insurance. Therefore, he directed the insurance company to pay an amount of Rs.2.50 lakhs (Rupees Two lakhs fifty thousand) as ex-gratia payment to meet the ends of justice.
