Oriental Insurance Company, which was the opposite party before the District Forum, has filed this Revision Petition against the judgment and order dated 13.09.2006 passed by the State Consumer Disputes Redressal Commission, Punjab in Appeal No.848 of 2006 by which the State Commission upheld the order of the District Forum -2- with the modification that the amount of compensation would be Rs.80,000/- instead of Rs.90,000/-. Respondent took the mediclaim policy from the petitioner in the year 1999for the first time. This policy was renewed every subsequent year. Policy in question was valid upto 24.09.2003. Complainant/respondent was treated for the disease ‘Lumber Canal Stenosis with Spondylothesis’. Respondent was admitted in the G. B. Pant Hospital, New Delhi on 17.09.2003 and was operated upon on 22.09.2003 during the validity of the policy. The claim for Rs.90,000/- was lodged with the petitioner. Petitioner repudiated the claim vide its letter dated 22.02.2004 which led to the filing of the complaint before the District Forum. District Forum allowed the complaint in the following terms: “For the foregoing reasons and discussion, we accept the complaint and direct the opposite parties to make the payment of Rs.90,000/- as medical claim with interest at the rate of 9% since 22.9.2003 i.e. the date of the operation and we also direct the respondents/opposite parties to give the complainant compensation of Rs.10,000/- for mental agony & harassment & Rs.1000/- as cost of the petition.” -3- Aggrieved against the order passed by the District Forum, petitioner filed the appeal before the State Commission which has been dismissed. The only ground on which the claim of the respondent/complainant was repudiated was that the respondent had pre-existing disease at the time when the policy was taken. The State Commission relying upon the Exclusion Clause 4.3 of the policy which read as under: 4.1. Such diseases which have been in existence at the time of proposing this insurance. Pre-existing means any injury, which existed prior to the effective date of this insurance. Pre-existing condition also means any sickness or its symptoms which existed prior to the insured person had knowledge that the symptoms were relating to the sickness. Complication arising from pre-existing disease will be considered part of the pre-existing condition. 4.2. …………………… 4.3. During the first year of operation of insurance cover, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Monorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre-existing at the time of proposal, they will not be covered even during the subsequent period of renewal too.” came to the conclusion that the Clause 4.3 indicated that pre-existing disease has to be taken when the policy was taken for the first time and not for the subsequent period. The State Commission recorded the following reasons for coming to this conclusion: “Reading of Clause 4.3 will give an indication to the conclusion we have noticed above, i.e., the pre-existing disease has to be when the first policy was taken, which may have been continuing later on and not that it should have been pre-existing at the time when the last policy is taken. Clause 4.3 further indicates that particular diseases mentioned therein will not be covered in the first year if these were pre-existing at the time the insurance policy is taken as also would not be covered even during the subsequent period of renewal. This will indicate that if there is any disease other than those mentioned in Clause 4.3, that would not come in the way of the claimant if the disease was not pre-existing at the time the first policy was taken but may be there when the renewal of the policy is made. In the present case, the disease is not the one mentioned in Clause 4.3. We had an occasion to consider a similar point in Appeal No.759 of 2000 (New India Assurance Co. Ltd. v. Surjit Singh Kalra) decided on 27.4.2006. Consequently, we do not find anything wrong in the approach of the District Forum on this aspect.” The State Commission further held that the insurance company was entitled to deduct Rs.10,000/- in view of Excess Clause -5- mentioned in the policy. Respondent has accepted the order of the State Commission. We find ourselves in agreement with the view taken by the State Commission. Clause 4.3 of the Exclusion Clause clearly indicates that the pre-existing disease has to be when the policy was taken for the first time and not for the subsequent period. The word ‘Pre-existing’ of Exclusion Clause 4.3 clearly points out that it is applicable during the first year of the operation of the insurance cover and not for the subsequent period. For the reasons stated above, we do not find any merit in this revision petition. Dismissed. No costs. | 
