Medisep beneficiaries can approach consumer court without using internal grievance redressal mechanism: State consumer dispute redressal commission
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The state commission dismissed an appeal challenging the order of Ernakulam district consumer dispute redressal commission. The district commission previously ruled that the condition requiring complaints related to Medisep be resolved through a three-tier grievance redressal mechanism, based on the agreement between govt and insurance company before approaching the court, was a violation of consumer rights.
The Oriental Insurance Company filed an appeal against this.
In a complaint filed by C D Joy, 78, a retired headmaster from Karukappilli, Ernakulam, regarding the denial of an insurance claim under Medisep, the insurance company argued that one cannot directly approach the consumer court without going through the govt's internal grievance redressal mechanism. The state commission, with a bench comprising president Justice B Sudheendra Kumar and judicial member D Ajith Kumar, upheld the district commission's order rejecting the argument.
On Jan 7, 2024, Joy was taken to a nearby hospital due to severe chest pain. During the initial treatment, the complainant's heart stopped functioning for a while. Due to the emergency, the complainant was referred to a private hospital and was treated as an inpatient. The complainant spent an amount of Rs 2,16,000 on the treatment. The complainant submitted a claim to the insurance company, which was rejected.
The state commission, while hearing the case, appointed an amicus curiae who submitted that since no statutory body was constituted under any act to exclusively deal with matters relating to claims under the Medisep scheme, the complainant had every right to file the consumer complaint before the district commission without resorting to the in-house mechanism envisaged under the said scheme.
The commission also clarified in its order that, under Section 100 of the Consumer Protection Act, 2019, any consumer can approach the consumer courts pointing out deficiencies in service and unfair trade practices.
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