IMPORTANT POINT
When there is no irregularity in the orders passed by the lower fora, the same cannot be interfered with in the revisional jurisdiction.

V.K. Jain, Presiding Member—The petitioner obtained a mediclaim policy from respondent no.2 Oriental Insurance Company Ltd. through respondent no.1 Oriental Bank of Commerce, for the period from 04.02.2016 to 03.02.2017. The petitioner was admitted in Kaushalya Devi Hospital on 28.02.2016 and discharged on 26.02.2016. He lodged a claim for re-imbursement of the expenses incurred by him in his hospitalization. The claim however, was not paid by the respondent. Being aggrieved, the complainant/petitioner approached the concerned District Forum by way of a Consumer Complaint. The complaint was resisted by the respondent which inter-alia stated that in view of clause 4.2 of the policy, the ailments from which the complainant suffered, were not covered for 2-3 years from the commencement of the policy.

2. The District Forum having dismissed the complaint, the petitioner approached the concerned State Commission by way of an appeal. The said appeal also having been dismissed, he is before this Commission by way of this revision petition.

3. Clauses 4.1 and 4.2 of the insurance policy read as under:—

4.1 Pre-existing health condition or disease or ailment / injuries: Any ailment / disease / injuries / health condition which are pre-existing (treated/untreated, declared/not declared in the proposal form), when the cover incepts for the first time are excluded up to three Completed) years of this policy being in force continuously. For the purpose of applying this condition, the date of inception of this Mediclaim Policy taken from The Oriental Insurance Company shall be considered, provided the renewals have been continuous and without any break in period.

4.2 The expenses on treatment of following ailment / diseases / surgeries for the specified periods are not payable if contracted and / or manifested during the currency of the policy. If these diseases are pre-existing at the time of proposal the exclusion no 4.1 for pre-existing condition SHALL be applicable in such cases.

i.	Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.	1 year
ii.	Polycystic ovarian diseases	1 year
iii.	Surgery of hernia.	2 years
iv.	Surgery of hydrocele.	2 years
v.	Non infective Arthritis.	2 years
vi.	Undescendent Testes.	2 Years
vii.	Cataract.	2 Years
viii.	Surgery of benign prostatic hypertrophy.	2 Years
ix.	Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus.	2 Years
x.	Fissure / Fistula in anus.	2 Years
xi.	Piles.	2 Years
xii.	Sinusitis and related disorders.	2 Years
xiii.	Surgery of gallbladder and bile duct excluding malignancy.	2 Years
xiv.	Surgery of genito-urinary system excluding malignancy.	2 Years
xv.	Pilonidal Sinus.	2 Years
xvi.	Gout and Rheumatism.	2 Years
xvii.	Hypertension.	2 Years
xviii.	Diabetes.	2 Years
xix.	Calculus diseases.	2 Years
xx.	Surgery for prolapsed inter vertebral disk unless arising from accident.	2 Years
xxi.	Surgery of varicose veins and varicose ulcers.	2 Years
xxiii.	Age related osteoarthritis and Osteoporosis.	3 Years

If the continuity of the renewal is not maintained with the Company then subsequent cover shall be treated as fresh policy and clauses 4.1, 4.2, shall apply unless agreed by the Company and suitable endorsement passed on the policy. Similarly if the sum insured is enhanced subsequent to the inception of the policy, the exclusions 4.1, and 4.2 will apply afresh for the enhanced portion of the sum insured for the purpose of this section.

4. It woul