PER JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER Petitioner being aggrieved of concurrent findings of the Foras below resulting in dismissal of his claim has preferred this revision petition. 2. Briefly stated facts relevant for the disposal of the revision petition are that the petitioner is the power of attorney holder of Jaspreet Singh Bakshi. Jaspreet Singh Bakshi obtained medical insurance for self, his wife and his son Sahaj Singh from the opposite party. Insurance cover was valid from 21.7.2010 to 20.7.2011. Sahaj Bakshi developed signs of Dengue fever on 14.8.2010. He was rushed to Ashlok Hospital, Safdarjung Enclave, New Delhi. On confirmation of Dengue fever Sahaj Bakshi was taken to Chandigarh and was admitted in Fortis Hospital, Mohali on 15.8.2010. Cost of the treatment amounted to Rs.83,570/-. The Insurance claim filed by the insured was repudiated by the opposite party claiming that as per exclusion clause-2 of the insurance policy the insurance company was not liable to make payment under the policy if the insured person contracted any disease during the first 30 days from the date of commencement of the insurance policy. Being aggrieved by the repudiation the petitioner filed the consumer complaint before the District Consumer Forum-II, Chandigarh in his own name describing as the attorney of the insured Col. Jaspreet Singh Bakshi. Consumer complaint was contested by the opposite party. 3. The District Forum by Majority of 2 : 1 came to the conclusion that the opposite party was right in repudiating the claim in view of exclusion clause-2 of the insurance contract. Being aggrieved of the order of the District Forum the petitioner preferred an appeal before the State Consumer Disputes Redressal Commission, UT Chandigarh. The State Commission concurred with the Majority decision of the District Forum and dismissed the appeal. Relevant observation of the State Commission are reproduced thus: - he question for determination before us, is whether dengue is a disease or not. In our view dengue is a disease spread by mosquitoes bite, transmitting the virus to human body, which causes infection, owing to which the person suffers from high fever and gets ill/sick which in some cases may cause death. The dictionary meaning of the disease is an unhealthy condition of the body ( or part of it) or the mind; illness, sickness. It cannot be ruled out that a person suffering from dengue becomes unhealthy / sick and may even die. Therefore, we do not hesitate in holding that dengue is a disease. Since, in the present case, the insured namely Sahej Bakshi suffered from dengue, within 20 days of the commencement of policy, his claim was not covered under the medical insurance Policy, as per exclusion clause 2 thereof. Exclusion clause 2 clearly provides that the insured shall not be entitled to any amount spent by him for the treatment of disease contracted by him during the first 30 days from the date of commencement of Policy. The appellant, who himself placed on record, the terms and conditions of the Policy could not say that he was not aware of the exclusion clause. Therefore, the claim of the insured was rightly denied by the opposite party. If we see the case from another angle that dengue is not a disease as held by Lady Member of the District Forum, then, the insured Sahej Bakshi could not claim any amount under the Medical Insurance Policy because under the said policy he could only claim the expenses incurred by him, on his medical treatment for the disease, suffered by him. Therefore, the appeal is liable to be dismissed, as, the majority order passed by the District Forum, is perfectly legal, and valid, and the same does not suffer from any perversity. 4. The petitioner has contended that the State Commission has committed a grave error in failing to appreciate that at the time of issue of insurance policy the terms and conditions relied upon by the opposite party for repudiating the claim were not disclosed or explained to the insured. It is submitted that the aforesaid terms and conditions were conveyed to the insured later after the encashment of the cheque for the premium. The State Commission has failed to appreciate that the insurance contract came into force on accepting of the cheque amount and, therefore, the opposite party had no right to unilaterally introduce the terms and conditions which were not made known to the insured. It is also contended that the exclusion clause-2 specifying 30 days limit after which the liability of the insurance company to indemnify in respect of a disease contracted by the insured is unfair and illegal. 5. Learned counsel for the opposite party on the contrary has argued in support of the impugned order. He has contended that the Foras below have rightly appreciated and interpreted the insurance contract and there is no jurisdictional error or material illegality in the impugned order which may call for interference by this Commission in exercise of revisional powers. 6. Learned counsel for the OP on the contrary has argued in support of the impugned order. He has contended that the consumer complaint filed by the petitioner in his name is liable to be dismissed because there is no privity of contract between the petitioner and the OP. Secondly, it is contended that even on merits, the petitioner has no case. The foras below have rightly appreciated and interpreted the insurance contract. There is no jurisdictional error or material irregularity which may call for interference by this Commission in exercise of its revisional powers. 7. We have considered the rival contentions and perused the record. Admittedly, the insurance policy was obtained by Jaspreet Singh Bakshi for self, his wife and son Sahaj Singh. The petitioner is neither the insured nor the beneficiary under the insurance contract. Therefore, technically speaking he could not have maintained the consumer complaint in his name. However, on perusal it is clear that the consumer complaint was filed by the petitioner claiming himself to be the attorney for Jaspreet Singh Bakshi who purchased the medical insurance policy. From this, it is evident that for all intent and purposes, the complaint has been filed by Col. T.S.Bakshi in his capacity as attorney on behalf of the insured. Therefore, we do not find any reason to non suit the petitioner on the technical plea of maintainability raised by the respondent opposite party. 8. Coming to the merits of the case. On perusal of the impugned order, we find that both the foras below have rejected the claim of the petitioner under the insurance policy in view of Exclusion Clause (2) under the heading xclusionsin the terms and conditions of the insurance policy. 9. It is well settled that an insurance contract is a species of commercial transactions and while deciding the dispute between the insured and the insurer, the terms and conditions have to be construed strictly. Similar question came up before the Supreme Court in (2009) 5 SCC 599 titled as Vikram Greentech India Ltd. & Anr. Vs. New India Assurance Co. Ltd, wherein Honle Supreme Court observed thus: n insurance contract, is a species of commercial transactions and must be construed like any other contract to its own terms and by itself. In a contract of insurance, there is requirement of uberimma fides i.e. good faith on the part of the insured. Except that, in other respects, there is no difference between a contract of insurance and any other contract. The four essentials of a contract of insurance are, (i) the definition of the risk, (ii) the duration of the risk, (iii) the premium and (iv) the amount of insurance. Since upon issuance of insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the insurance policy, its terms have to be strictly construed to determine the extent of liability of the insurer. The endeavour of the court must always be to interpret the words in which the contract is expressed by the parties. The court while construing the terms of policy is not expected to venture into extra liberalism that may result in re-writing the contract or substituting the terms which were not intended by the parties. The insured cannot claim anything more than what is covered by the insurance policy. [General Assurance Society Ltd. Vs. Chandumull Jain and another, Oriental Insurance Co. Ltd. Vs. Sony Cheriyan and United India Insurance Co. Ltd. Vs. Harchand Rai Chandan Lal]. Document like proposal form is a commercial document and being an integral part of policy, reference to proposal form may not only be appropriate but rather essential. However, the surveyorsreport cannot be taken aid of nor can it furnish the basis for construction of a policy. Such outside aid for construction of insurance policy is impermissible. 10. Relevant Exclusion Clause (2) relied upon by the foras below reads thus: ny disease contracted by the insured person during the first 30 days from the commencement date of the policy. This exclusion shall not apply in case of the insured person having been covered under any health insurance policy (individual or Group Insurance policy) with any of the Indian Insurance Companies for a continuous period of preceding 12 months without a break. 11. On reading of the above, it is clear that if the insured contracts a disease within first 30 days of the commencement of insurance policy, the insurance company shall not be liable to indemnify the insured for expenses unless it is shown that the insured had a continuous health insurance policy with some Indian Insurance Company just prior to taking of insurance cover. In the instant case, there is nothing on the record to suggest that the insured Sahej Singh had a previous health insurance cover for a continuous period of 12 months. Therefore, in view of the law laid down by the Apex Court, the foras below were right in dismissing the claim of the petitioner under the insurance contract in view of the Exclusion Clause. 12. The petitioner has tried to wriggle out of the Exclusion Clause by taking a plea that he was not explained the terms and conditions of the contract and terms and conditions were supplied to him after the encashment of the cheque issued for payment of premium. The above submission of the petition is misconceived. On perusal of para 3 & 4 of the consumer complaint filed in the District Forum, we find that according to the petitioner, Jaspreet Singh Bakshi submitted proposal form for obtaining the medical insurance cover on 21.07.2010 alongwith cheque for payment of premium dated 21.07.2010. The insurance policy was issued on 26.07.2010 mentioning the period of coverage from 21.07.2010 to 20.07.2011. From this, it is evident that the insurance contract came into being only on 26.07.2010 when the policy document was issued. Even if the plea of the petitioner that insured was not explained the terms and conditions of the insurance policy is accepted for the sake of arguments, then also, the petitioner has no case because clause 10 of the insurance contract under the heading onditions ree Look Periodwas given to the petitioner with option to seek cancellation of policy if he was not agreeable to the terms and conditions of the insurance policy. Relevant clause 10 providing for ree Look Periodreads thus: Free Look Period of 15 days from the date of receipt of policy is available to the insured to review the terms and conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and in such an event the Company shall allow refund of premium after adjusting the pre-acceptance medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Free look cancellation is not applicable at the time of renewal of the policy. 13. On reading of the above, it is clear that if the insured was not agreeable to the terms and conditions, he had an option to seek cancellation of the policy with refund of his premium. The insured had not opted for cancellation of the policy. Therefore, now he cannot be allowed to claim that he is not bound by the Exclusion Clause because it was not explained to him when he remitted the cheque for payment of insurance premium. 14. In view of the discussion above, we do not find any jurisdictional error or material irregularity in the impugned order, which may call for interference by this Commission in exercise of revisional jurisdiction. Revision petition is accordingly dismissed. |