1.   This appeal has been filed under section 51(1) of The Consumer Protection Act, 2019 in challenge to the Order dated 11.08.2020 of the State Commission in complaint no. 137 of 2016.

2.   We have heard the learned counsel for the appellant (the ‘complainant’) and the learned counsel for the respondents (the ‘insurance co.’) and have perused the record including inter alia the State Commission’s impugned Order dated 11.08.2020 and the memorandum of appeal.

3.   The matter relates to repudiation of an insurance claim on the death of the insured.

The complaint was earlier dismissed by the State Commission vide its Order dated 26.02.2018. However, in appeal no. 437 of 2018, this Commission, vide its Order dated 14.12.2018, directed the State Commission to decide the complaint afresh in the light of its Order  (“The State Commission shall decide the complaint afresh in the light of this order within a period of six months from the date on which the parties appear before it.”) This Commission also made certain observations, as contained in para 5 of its said Order, for the State Commission to consider while deciding the case afresh.

The State Commission has now passed the impugned Order, in which it has required the complainant to present his case to the insurance co.’s claims review committee and directed the said committee to pass appropriate order thereon within three months (“- - - the complainant may present his case along with documents before Review  Committee mentioned in repudiation letter dated 29.3.2016 and Review Committee should pass appropriate order in accordance with law after proper enquiry and opportunity of evidence and hearing to complaint. - - - The Review Committee shall pass order as provided above positively within 3 months from the date on which representation is submitted by complainant before Review Committee.”).

4.   Learned counsel for the complainant submits that the complaint contains allegations of ‘deficiency in service’ on the part of the insurance co. The State Commission was expected to examine the matter and decide the case on merit with clear findings of deficiency or otherwise. It had also to follow the observations made by this Commission as contained in para 5 of its Order dated 14.12.2018 in appeal no. 437 of 2018 vide which the case was earlier remanded back for decision afresh. The letter dated 29.03.2016 of the insurance co. vide which the claim was repudiated had also intimated that if the decision was not agreeable the complainant may write to its claims review committee. The complainant had accordingly addressed the review committee but as communicated vide the insurance co.’s letter dated 30.05.2016 the committee had upheld the earlier decision and had decided that his request cannot be acceded to. Submission is that the State Commission has neither followed this Commission’s observations contained in para 5 of its Order dated 14.12.201 nor returned its findings on deficiency or otherwise on the part of the insurance co. as it was required to do in the normal course, but has required the complainant to again approach the same review committee which had even earlier rejected his case.

Learned counsel for the insurance co. submits that the insurance co.’s claims review committee will be dutybound to examine the matter again in the light of the directions contained in the State Commission’s Order. Submission is that even though it had earlier rejected the case the review committee will take a decision afresh now that the State Commission has ordered so.

5.   The insurance co. earlier repudiated the claim vide its letter dated 29.03.2016. As per its advice the complainant represented to its claims review committee. As informed vide the insurance co.’s letter dated 30.05.2016 the committee upheld the earlier decision and decided that the request could not be accepted. The complainant then approached the State Commission. The complaint made before the State Commission contained allegations of ‘deficiency in service’ on the part of the insurance co.  This Commission vide its Order dated 14.12.2018 in appeal no. 437 of 2018 requested the State Commission to decide the complaint afresh and also made certain observations as contained in para 5 of its said Order for the State Commission to consider. While adjudicating afresh on merit as per the law, the State Commission was required to give clear findings of deficiency or otherwise in the normal course. However, the State Commission has rather required the complainant to approach the same claims review committee, a forum which had already been explored and exhausted, and which had even earlier rejected his case.

Though we agree with the learned counsel for the insurance co. that the review committee shall be dutybound to examine the matter afresh in compliance of the State Commission’s Order passed subsequently but it appears wholly inappropriate that the same committee which had earlier rejected the case may re-examine it when the requirement per se is for the forum itself to take evidence, appraise the matter and arrive at its own findings of deficiency or otherwise. It bears significance that the complainant being totally dissatisfied with the insurance co.’s internal functioning had made his complaint before the forum and the forum in the normal wont was required to adjudicate on merit apropos its deficiency or otherwise.

6.   As such we are of the clear opinion that the State Commission should decide the case on merit and should not require the matter to be referred for decision to any committee or authority within the insurance co.

7.   Sequel to the above discussion, the Order dated 11.08.2020 of the State Commission impugned herein is set aside and the case is remanded back to the State Commission with the request that it may not require the matter to be referred to any committee or authority within the insurance co. but may decide the matter on merit as per the law inter alia keeping in consideration the observations made by this Commission in para 5 of its Order dated 14.12.2018 in appeal no. 437 of 2018 and may return categorical findings of deficiency or otherwise on the part of the insurance co.

8.   The parties are directed to appear before the State Commission on 11.01.2023.  

Looking at the disconcerting history of the case, the State Commission is requested to make an endeavour to decide the case within three months of this date.

9.   The Registry is requested to send a copy each of this Order to the parties in the appeal and to their learned counsel as well as to the State Commission immediately. It is also requested to forthwith communicate this Order to the State Commission by the fastest mode available. The stenographer is requested to upload this Order on the website of this Commission immediately.