1.      The present Revision Petition, under Section 21 (b) of the Consumer Protection Act, 1986 (for short “the Act”) has been filed by the Petitioner against order dated 06.03.2014 of the Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal (for short “State Commission”) in First Appeal No. 711 of 2010 wherein the Appeal filed by the Petitioner was dismissed.

2.      The case of the Complainant is that he had obtained a Medi-claim Policy jointly with his wife Smt. Pushpa Baghrecha from Golden Multi Services Club Limited (i.e. Respondent No. 1) who was the authorized agent of Star Health and Allied Insurance Company Limited (i.e Respondent No. 2). He paid a premium of Rs. 7899 for the Policy bearing No. C/K.0l./900000/GMC/01/2007-08/00408 which covered an amount of Rs 2,00,000/- for his wife and an amount of Rs 1,00,000-/ for himself. The coverage period of the said Policy was from 15.06.2007 to 14.06.2008. The Complainant was made the nominee for the Policy of his wife. On 31.07.2007, the Complainant’s wife had a severe headache and was admitted in SIMS Hospital where she succumbed to her ailment on 29.08.2007. Rs.1,68,117 was incurred towards medical expenditure. The Complainant filed a claim under the aforesaid Medi-claim Policy with Respondent No. 1. Respondent No. 1 forwarded the papers to Respondent No. 2 who repudiated the claim, vide letter dated 09.02.2008, on the ground that the insured had contracted the disease within 60 days of commencement of the Policy and therefore, the claim was not maintainable. The Complainant, thereafter, filed a Complaint before the District Forum with the following prayer: -

“a)That the respondent no. 1, 2 and 4 may be directed to pay a sum of Rs. 1,68,117/- to the complainant towards compensation.

b) Interest @ 18% may be awarded as compensation from the date of filing of the complaint till realization.

c) Cost of the complaint may be awarded to the complainant against the respondent no. 1 and 2.”

3.      The case of the Complainant was contested by the Opposite Parties who denied the allegations made in the Complaint. It was stated that as per the exclusion clauses of the Complainant’s Medi-claim Policy, if the insured contracted a disease within 60 days of the commencement of the Policy, then his claim was beyond the coverage of the Policy. In the membership application form it was highlighted that in acceptance of Policy, the job of Data processing may take maximum 30 days time, during which period, the Insurance Company would not be liable for any claim. 

4.      The District Forum, after hearing the Counsel for both the Parties and perusing the record of the case, passed the following order: -

“Accordingly on the basis of the aforesaid entire discussion it is held that the complainant has failed to prove, the complaint under Section 12 Consumer Protection Act and it is dismissed with costs. Looking to the circumstances of the case parties to bear their own costs as incurred.”

5.      Aggrieved by the order of the District Forum, the Petitioner/Complainant filed an before the State Commission, which dismissed the Appeal as under: -

“In view of the aforesaid, we find no merit in the appeal. It is dismissed but with no order as to costs.”

6.      Aggrieved by the order of the State Commission, the Petitioner/Complainant preferred the present Revision Petition. Heard the Counsel for all the Parties and carefully perused the record. Brief facts of the case are that the Petitioner obtained a Medi-claim Policy bearing No. C/K.0l./900000/GMC/01/2007-08/00408  from Golden Multi Services Club Limited (i.e. Respondent No. 1) who was the authorized agent of Star Health and Allied Insurance Company Limited (i.e Respondent No. 2). The Policy covered the Complainant’s wife for an amount of Rs.2,00,000/- and the Complainant for an amount of Rs. 1,00,000/- and the period of coverage of the Policy was from 15.06.2007 to 14.06.2008. On 31.07.2007, the Complainant’s wife had a severe headache and on 31.07.2007 was admitted in SIMS Hospital where she was treated till 29.08.2007. On 29.08.2007, the Complainant’s wife died as a result of her ailment. The claim of the Complainant, amounting to Rs. 1,68,117/-, under the aforesaid Medi-claim Policy was repudiated by Respondent No. 2, vide letter dated 09.02.2008, on the ground that the insured had contracted the disease within 60 days of commencement of the Policy and therefore, it was not maintainable.

7.     The Learned Counsel for the Petitioner contended that as per the exclusion clause, the Policy was to commence from the date of receipt of premium by Respondent No. 2 from Respondent No. 1. He relied on Section 64VB Clause (4) of the Insurance Act, 1938 to state that Respondent No. 1 was mandated by law to deposit the premium with Respondent No. 2 within 24 hours of its collection. According to the Petitioner’s Counsel the premium should be deemed to have been received by Respondent No. 2 on 30.05.2007 and the commencement of the Policy was from 30.05.2007. He, therefore, argued that the Petitioner’s wife was hospitalised on 31.07.2007, i.e. more than 60 days from the commencement of the Policy, and as such his claim did not fall under the exclusion clause. The Learned Counsel for Respondent No. 2 argued that the Membership Application Form collected by Respondent No. 1 contains ‘Special Conditions’ as per which the processing period of the Application Form was a maximum of 30 days and during such processing period no liability shall attach with the Insurance Company or its agent. It was further contended that the policy commenced from 15.06.2007 and the claim of the insured fell under the exclusion clause of the Policy and was not maintainable.

8.   In Deokar Exports Private Limited v New India Assurance Company Limited (2008) 14 SCC 598 the Hon’ble Supreme Court of India has explained the meaning of Section 64-VB of the Insurance Act, 1938 as follows:

“Two things emerge from the said section. The first is that the insurer cannot assume risk unless and until premium is received or guaranteed or deposited. The second is that a policy issued can assume the risk from a retrospective date provided such date is not earlier than the date on which premium had been paid in cash or by cheque to the insurer.”

Section 64-VB of the Insurance Act, 1938 therefore merely states that an Insurer will not assume risk before the premium is received by it. The Petitioner states that as per Section 64-VB, the agent of the insurer shall deposit the premium with the Insurer within 24 hours. The Section mandates that the agent of the insurer shall deposit the premium with the Insurer within 24 hours of its collection. In case the agent does not deposit the premium within 24 hours, then appropriate action under Insurance Act, 1938 may be taken against him, however, there is nothing in Section 64-VB which states that the premium will be deemed to be deposited within 24 hours of remittance by the insured. Deeming the Insurer’s risk to commence before it even received the premium would, therefore, be contrary to Section 64-VB. It was further held in Deokar Exports Private Limited v New India Assurance Company Limited that “In a contract of insurance, rights and obligations are strictly governed by the policy of insurance. No exception or relaxation can be made on the ground of equity.” It is therefore, settled law that once the Insured has accepted the period of coverage, he cannot object to it at a belated stage. If the Insured had an objection to the coverage period, then the same should have been raised at the time when the Policy was issued. In the present case, the Insurance Policy states that the cover commences from 15.06.2007. The insured was hospitalised on 31.07.2007, i.e. within 60 days from the commencement of the Policy and therefore Petitioner’s claim was covered by the exclusion clause of the Insurance Policy.

9.    Jurisdiction of this Commission under Section 21 (b) is very limited. This Commission is not required to re-appreciate and reassess the evidences and reach to its own conclusion. The Court can intervene only when the petitioner succeeds in showing that the Fora below has wrongly exercised its jurisdiction or there is a miscarriage of justice. It was so held by the Hon’ble Supreme Court in the case of Mrs. Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd. (2011) 11 SCC 269  has held as under: -

“13.        Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21 (b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums.  The decision of the National Commission rests not on the basis of some legal  principle  that  was  ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts.  This is not the manner in which revisional powers should be invoked.  In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21 (b) of the Act has been transgressed.  It was not a case where such a view could have been taken by setting aside the concurrent findings of two fora.”

10.       Same principle has been reiterated by Hon’ble Supreme Court in the case of Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H & R Johnson (India) Ltd. and Ors. (2016 8 SCC 286 wherein Hon’ble Supreme Court has held as under:-

“23. The  National Commission has to exercise the jurisdiction vested in it only if the State Commission or the District Forum has failed to exercise their jurisdiction or exercised when the same was not vested in their or exceeded their jurisdiction by acting illegally or with material irregularity. In the instant case, the National Commission has certainly exceeded its jurisdiction by setting aside the concurrent finding of fact recorded in the order passed by the State Commission which is based upon valid and cogent reasons.”