STATE CONSUMER DISPUTES REDRESSAL COMMISSION KERALA REVISION PETITION NO. SC/32/RP/14/2025 (Against the Order dated 1st November 2024 in Appeal DC/555/CC/505/2024 of the District Consumer Disputes Redressal Commission Ernakulam)

ORIENTAL INSURANCE COMPANY LIMITED PRESENT ADDRESS - METRO PALACE, XAVIER ARAKKAL ROAD ERNAKULAM,KERALA.

.......Petitioner(s)

Versus C D JOY PRESENT ADDRESS - KARUKAPILLY, KOMBANAD P.O., KOMBANAD, ERNAKULAMERNAKULAM,KERALA.

.......Respondent(s)

BEFORE:

HON'BLE MR. JUSTICE SRI.B.SUDHEENDRA KUMAR , PRESIDENT FOR THE PETITIONER:

NEMO FOR THE RESPONDENT:

NEMO DATED: 10/06/2025

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM REVISION PETTITION No. 14/2025 ORDER DATED: 10.06.2025 (Against the order in I.A.No.1146/2024 in C.C.No.505/2024 on the files of DCDRC, Ernakulam)

PRESENT:

HON’BLE JUSTICE SRI. B. SUDHEENDRA : PRESIDENT KUMAR SRI. AJITH KUMAR D. : JUDICIAL MEMBER REVISION PETITIONER/1^stOPPOSITE PARTY:

Oriental Insurance Co. Ltd., Regional Office, Metro Palace, Xavier Arakkal Road, Opposite Town Railway Station, Ernakulam North, Kacheripady, Ernakulam (by Adv. Saji Issac K.J.)

Vs.

RESPONDENTS/COMPLAINANT/OPPOSITE PARTIES 2 and 3:

1. C.D. Joy, S/o David, Karukapilly, Kombanad P.O., Ernakulam (By Adv. Narayan R., Amicus Curiae)

nd

2. Vidal Health Insurance, TPA Services, Door No.40/3232, 2 Floor, SL Plaza, Palarivattom, Kochi – 682 025

3. M/s MEDISEP Kerala, Vandanam, Uppalam Road, Statute, Thiruvananthapuram – 695 001

O R D E R

HON’BLE JUSTICE SRI. B.SUDHEENDRAKUMAR : PRESIDENT st The revision petitioner is the 1 opposite party in C.C.No.505/2024 on the files of the Consumer Disputes Redressal Commission, Ernakulam (‘the District Commission’ for short).

2. The complainant is a retired Head Master aged 78 years. He was a beneficiary of Medisep Scheme introduced by the opposite parties in collaboration st with the 1 opposite party. On 07.01.2024 at 11a.m., the complainant was taken to a nearby hospital in connection with a severe chest pain. During the initial treatment, the complainant’s heart stopped functioning for a while. Due to emergency, the complainant was referred to Rajagiri Hospital. The complainant was treated there as inpatient. The complainant had to spend an amount of Rs.2,16,000/-(Rupees Two Lakh Sixteen Thousand only) in connection with the treatment. The complainant st submitted a claim before the 1 opposite party which was rejected by them. In the said circumstances, the complainant filed the above complaint.

st

3. During the pendency of the said complaint, the 1 opposite party filed I.A.No.1146/2024 before the District Commission praying for hearing the maintainability of the complaint as a preliminary issue. It was alleged that since the Government of Kerala had implemented Medisep Grievance Redressal mechanism, the complainant ought to have approached the authorities under the said mechanism, before resorting to file a consumer complaint and since the complainant did not resort to approach the authorities envisaged under the scheme, the consumer complaint was not maintainable. In the said circumstances, the District Commission ought to have found that the complaint was not maintainable.

4. The District Commission, after hearing both sides and considering the relevant inputs, found that the complaint was maintainable in view of Section 100 of the Consumer Protection Act, 2019. Aggrieved by the said order, this revision petition has been filed.

5. Since there had been no representation for the respondents, we have st appointed Advocate Narayan R. as the amicus curiae to argue the case for the 1 respondent/complainant.

6. Heard the learned counsel for the revision petitioner and the learned amicus curiae. Perused the records.

7. The learned counsel for the revision petitioner has submitted that in view of the inhouse mechanism envisaged under the Medisep Scheme as per G.O.(P)No.76/2022/Fin. Dated 27.06.2022, the consumer complaint is not maintainable before resorting to t