Life Insurance Corpn. of India, the petitioner herein, was the opposite party before the District Forum.

          Present Revision Petition has been filed against the order passed by the State Commission of Maharashtra in F.A. No.1443/2008.  State Commission, by the impugned order, has dismissed the appeal thereby affirming the order passed by the District Forum.

          Son of the complainant/respondent had taken a LIC policy No.942697473 with effect from 28.12.2003 for a sum of Rs.1 lakh.  As per the terms and conditions of the policy, the life assured was also covered for certain critical illness by paying certain amount towards critical illness rider.  The life assured died on 10.12.2006 due to kidney failure.  Respondent, being the nominee, filed a claim before the petitioner.

          The basic claim on the life assured was paid by the petitioner to the respondent.  However, the claim towards critical illness for treatment of kidney ailment was repudiated on the ground that on the date of diagnosis, i.e., on 9.8.2006, when the critical illness regarding kidney was discovered, the policy was lying in a lapsed condition and was not revived within the grace period.  Moreover, as per policy document, no claim was payable in case of critical illness within 6 months of the revival of the policy.

          Being aggrieved, respondent filed a complaint before the District Forum.  Petitioner entered appearance and justified the repudiation on the ground that in case of discovery of critical illness the petitioner was not liable to pay any compensation within 6 months of the revival of the policy.  Petitioner/opposite party filed its written statement contending that the policy was revived on 14.8.2006 and as per clause 2(A) of the policy read with sub-clause (4), petitioner was not liable to compensate the respondent about the critical illness as the same was diagnosed within 6 months of the revival of the policy.

          District Forum, after taking into consideration the pleadings as well as the evidence led by the parties, allowed the complaint and directed the petitioner to pay Rs.1 lakh towards the critical illness along with costs of Rs.3,000/-. 

          Being aggrieved, petitioner filed appeal before the State Commission which has been dismissed by the impugned order.  State Commission in its order has observed that since the policy had been renewed with penalty, the policy would relate both to the date of issuance of policy and the petitioner would be liable to pay the same.

          We have heard the counsel for the parties and with their consent we are disposing of the Revision Petition at the admission stage.

          Clause 2(A) stipulates that benefit of the policy in case of critical illness would not be available for the first 6 months of the revival of the policy.  The same reads as under :

                                    “2.          CONDITIONS AND RESTRICTIONS

(A) WAITING PERIOD :  A waiting period of 6 months will apply from the date of commencement of risk or revival of the policy to the first diagnosis of the Critical Illness under consideration.  This would mean that the benefit of the policy Schedule is not applicable if any of the contingencies mentioned in Condition 2 (B) occurs (i) at any time or after the date on which the risk under the Policy has commenced but before the expiry of six months reckoned from that date or (ii) before the expiry of six months from the date of Revival.……………”

          One of the critical illness of which insurance cover was taken was kidney failure, which would squarely fall within the meaning of critical illness.  As stated above, the petitioner has already been paid the basic amount of Rs.1 lakh towards the life assured.  As per clause 2(A) reproduced above, waiting period of 6 months was to be applied from the date of revival of the policy to the first diagnosis of the critical illness under consideration.  In the present case, critical illness was diagnosed on 9.8.2006 and the policy was revived on 14.8.2006.  Life assured died on 10.12.2006, which falls within 6 months of the date of revival of the policy as well as the first diagnosis of the critical illness.  Fora below have not appreciated the various clauses of the policy.  Policy is a contractual obligation and the parties are governed by the terms and conditions of the policy.  As per the terms and conditions of the policy, respondent was not entitled to be compensated for the critical illness as the life assured died within 6 months of the revival and the first diagnosis of the critical illness.

          For the reasons stated above, this Revision Petition is accepted.  Orders passed by the fora below are set aside and the complaint is ordered to be dismissed with no order as to costs. 

Petitioner, in compliance of the order passed by this Commission on 6.11.2009 had deposited 50% of the awarded amount along with interest accrued thereon before the District Forum.  Petitioner would be at liberty to withdraw the same.  District Forum is directed to release the said amount in favour of the petitioner.

Revision Petition stands disposed of in above terms.