Heard the learned counsel for the parties and perused the material on record.  Controversy before us relates to the applicability of the mediclaim policy issued by the petitioner in the years 1994 and 1997.

          Briefly stated, the facts relating to the complaint filed before the District Forum by the respondent/complainant were that the respondent/complainant had insured with the petitioner company under Mediclaim (Hospitalization and Domiciliary Hospitalization Benefit) Policy with effect from 14.9.1994.  This policy was renewed from time to time on payment of premium.  It was the case of the complainant that the policy issued in 1997 revealed that the coverage of insured under ‘categorization method’ was withdrawn and instead the policy of payment of maximum sum assured was introduced.  Accordingly, the complainant was also insured under the said scheme and premium was assessed on the same basis.  It was his case that he was insured on the basis of maximum sum assured.  Subsequently he had incurred a sum of Rs.18,000/- and Rs.1,93,030/- respectively for the hospitalization for the periods, viz., 15.7.2002 to 15.7.2002 and then again 22.7.2002 to 27.7.2002 with Escorts Heart Institute and underwent coronary angioplasty.  But when the claim was preferred with the petitioner company, the claim was settled only to the extent of Rs.99,600/- retaining the balance amount of Rs.1,21,371/-.  In these circumstances, alleging deficiency in service on the part of the petitioner, a complaint was filed before the District Forum, who, after hearing the parties, allowed the complaint and directed the petitioner to pay Rs.1,21,371/- to the complainant along with interest at the rate of 12% per annum from the date of filing of claim till its realization.  The complainant was also awarded compensation of Rs.5,000/- for mental agony and Rs.1,000/- as costs.

          Aggrieved by this order, an appeal was filed before the State Commission, who, after hearing the parties, dismissed the appeal.  Hence, this Revision Petition before us.

          We heard the learned counsel for both the parties at length and also perused the material on record.  The basic controversy revolves around the applicability of terms of the policy at the relevant time.

First policy was issued in 1994, second policy was issued in 1997 and third policy was issued in 2004 relating to the periods September 1994 to September 1995, September 1997 to September 1998 and September 2001 to September 2002.

          A perusal of these policies will show that in the policy of 1994, there were certain limits in mediclaim, whereas in the policy issued in 1997, there were no such limits item-wise.  Overall insured amount was Rs.3 lakh. 

At this stage, we would like to state that Clause 5.9(A), on which the petitioner wishes to rely, will have no relevance in the instant case, for the simple reason that as per material brought on record by the petitioner, the policy relating to the period 14.9.2001 to 30.9.2002, in which the Clause 5.9(A) appear, was issued only on 21.7.2004 meaning thereby that any change in the policy terms like Clause 5.9(A) was not in the knowledge of the insured, as the policy was issued after almost 2 years from the expiry period of the policy in question. 

In such a situation, we are left with two policies, namely, 1994 and 1997.  Once the petitioner had issued the policy in 1997 fixing overall limit of Rs.3 lakh in which there was no limit, as was the case in 1994, and since the petitioner charged higher premium in 1997 as compared with the policy of 1994, hence, in our view, the contract will be governed by the policy issued in 1997.  As rightly held by both the lower fora in the policy of 1997, there are no limits prescribed and the policy was to be governed by the overall limit of the amount for which insurance covers were obtained. 

          In the aforementioned circumstances, we find no infirmity in the order passed by both the lower fora in view of which we find no merit in this Revision Petition.  Dismissed with costs of Rs.10,000/- to be paid by the petitioner to the respondent/complainant within a period of 6 weeks from today.