Consumer Complaint Maintainable Under MEDISEP Scheme in Absence of Statutory Grievance Forum: Kerala State Commission
Pranav B Prem
The Kerala State Consumer Disputes Redressal Commission recently ruled that complaints under the MEDISEP (Medical Insurance Scheme for State Employees and Pensioners) scheme are maintainable before Consumer Commissions, especially in the absence of any statutory authority established under law to exclusively deal with such grievances. The order was passed by a Bench comprising Justice B. Sudheendra Kumar (President) and Judicial Member Ajith Kumar D in Oriental Insurance Co. Ltd. v. C.D. Joy & Others.
The revision petition was filed by the Oriental Insurance Company Ltd. challenging an interlocutory order passed by the District Consumer Disputes Redressal Commission, Ernakulam in I.A. No.1146/2024 in Complaint No. 505/2024. The preliminary objection raised by the insurance company before the District Commission was regarding the maintainability of the complaint filed by a retired headmaster who was a beneficiary under the MEDISEP scheme.
As per the complaint, the respondent, a 78-year-old pensioner, suffered a serious medical emergency in January 2024 and was treated as an inpatient at Rajagiri Hospital, incurring medical expenses of ₹2,16,000. Despite being a beneficiary of the MEDISEP scheme, his claim for reimbursement submitted to Oriental Insurance was rejected. Consequently, he approached the District Commission seeking redress.
Before the District Commission, the insurer contended that the complaint was not maintainable as the complainant failed to first approach the in-house Medisep Grievance Redressal Mechanism implemented by the State Government. It was argued that the Consumer Commission lacked jurisdiction due to the existence of the alternative forum prescribed under G.O.(P) No.76/2022/Fin. dated 27.06.2022. The District Commission, however, found the complaint maintainable and decided to proceed under Section 100 of the Consumer Protection Act, 2019, prompting the insurer to approach the State Commission in revision.
During the revision hearing, the Commission noted that there was no representation for the complainant. Accordingly, Advocate Narayan R. was appointed as amicus curiae to assist the Bench. The counsel for the insurer reiterated the argument regarding the presence of an internal redressal mechanism under the scheme, which, according to them, should have been exhausted before filing a consumer complaint.
The amicus curiae submitted that although there was a grievance redressal procedure under the scheme, no statutory authority had been constituted under any enactment to exclusively deal with claims arising under the MEDISEP scheme. Hence, the consumer forums could still be approached directly, as the scheme's redressal mechanism was not a bar in law.
The Commission examined Section 100 of the Consumer Protection Act, 2019, which clearly provides that the provisions of the Act shall be in addition to and not in derogation of any other law. Citing this provision, the Commission observed that “the Consumer Commission is having jurisdiction to entertain a complaint relating to claims under the Medisep scheme, particularly when there is no statutory authority to exclusively deal with the matters relating to the claims under the Medisep scheme.”
The Commission also took note of the Supreme Court's ruling in Chairman, Thiruvalluvar Transport Corporation v. Consumer Protection Council (AIR 1995 SC 1384), distinguishing that case from the present one. In that case, the Court had ruled that when a specific statutory forum is provided under another enactment like the Motor Vehicles Act, then the jurisdiction of consumer forums stands excluded. However, in the present case, no such exclusive statutory forum exists.
Rejecting the insurer’s argument, the State Commission upheld the view of the District Commission and dismissed the revision petition. It directed the District Commission to proceed with the matter “in accordance with law,” further clarifying that “the District Commission shall consider all issues independently and untrammelled by any of the observations in the order passed by the District Commission.” Before concluding, the State Commission recorded its appreciation to Advocate Narayan R., the amicus curiae, for his valuable assistance in deciding the case.
Appearance
Counsels for the Revision Petitioner: Adv. Saji Isaac K.J.
Counsels for the respondent: Adv. Narayan R., Amicus Curiae
Cause Title: Oriental Insurance Co. Ltd. V. C.D. Joy
Case No: Revision Petition No. SC/32/RP/14/2025
Coram: Justice B. Sudheendra Kumar [President], Ajith Kumar D. [Judicial member]
