Citation : 2025 Latest Caselaw 1530 Ori
Judgement Date : 22 July, 2025
IN THE HIGH COURT OF ORISSA AT CUTTACK
W.P.(C) No.6956 of 2024
Sulochana Barik .... Petitioner
Mr. Satyabhusan Das, Advocate
-Versus-
The National Insurance .... Opposite Parties
Company, Cuttack and others
Mr. P.K. Mahali, Advocate for O.P. No.1
Mr. M.P. Singh, Advocate for O.P. No.5
CORAM:
JUSTICE R.K. PATTANAIK
DATE OF JUDGMENT:22.07.2025
1.
Instant writ petition is filed by the petitioner challenging the impugned order dated 18th October, 2023 passed in connection with Revision Petition No.2188 of 2019 as at Annexure-8 by learned National Consumer Disputes Redressal Commission, New Delhi and to modify the same with a direction to opposite party No.1 to pay her the differential amount in terms of the decision of learned State Consumer Disputes Redressal Commission, Odisha, Cuttack confirming the order of the learned District Consumer Disputes Redressal Forum, Bhadrak in consumer Complaint Case No.76 of 2011 on the grounds inter alia that such a decision with regard to the payment of an amount of Rs.2 lac
only with interest from the date of repudiation of claim till realization is not legally tenable, hence, therefore, the same is liable to be interfered with followed by a consequential direction issued in that regard.
2. Bereft of unnecessary details, the brief facts pleaded on record are that the petitioner's late husband during his lifetime, on being approached by opposite party No.6, had become an account holder of Sahara India Commercial Corporation Limited, namely, opposite party No.5 (shortly as, 'the Sahara India') through its Branch at Bhadrak under the Sahara Swarn Rajat Yojana Scheme and had deposited Rs.10,000/- each (four accounts), in total, Rs.40,000/- and it was on 9th August, 2005. The said scheme covered insurance benefits among other facilities and for the said purpose, opposite party No.5 was having a tie-up with opposite party No.1, namely, National Insurance Company Limited(in short, 'the Insurance Company'). With such pleading on record, it is claimed by the petitioner that her husband died in a vehicular accident on 7th June, 2010 and after the latter's death, she being the nominee claimed the insurance for an amount of Rs.8 lac through opposite party No.6 and in that connection, representations were submitted to opposite party No.2 on 16th June, 2010 and 11th July, 2010 informing about his death with a request for its early settlement. When the claim of the petitioner was not settled, she approached the learned Forum and filed the complaint, wherein, opposite party Nos.2 to 5 did not appear and were set ex parte, whereas, opposite party Nos.1 and 6 submitted their reply as
per Annexures-2 and 3 respectively. It is further pleaded that opposite party No.1 denied the liability on the ground of breach of one of the conditions of the insurance policy regarding delay in intimation demanding the claim to have been made within 30 days from the date of accident or within the extended period, since, such intimation was received by opposite party No.2 on 7th June, 2010 again on 11th July, 2010, the same having not been forwarded to opposite party No.1 till 24th July, 2010, a plea about the delayed intimation could not be said as beyond the stipulated period and hence, does not amount to any such breach of the policy conditions. Notwithstanding, such a plea of opposite party No.1, the learned Forum by order dated 18th April, 2012 (Annexure-4) disposed of complaint on contest and directed payment of full insurance claim for an amount of Rs.8 lac along with interest @ 9% per annum on and from 24th July, 2010 till realization of the same. Being aggrieved of the above decision, opposite party No.1 challenged it before the learned State Consumer Dispute Redressal Commission in First Appeal No.436 of 2012 and disposed of on 28th June, 2019, confirming the order of the learned Forum. The confirming order of learned State Commission as at Annexure-6 was challenged by opposite party No.1 before the learned National Commission by filing a revision (Annexure-7), however, the same was allowed in part by a judgment dated 18th October, 2023 i.e.Annexure-8 fixing the claim at Rs.2 lac instead of Rs.8 lac. The said decision at Annexure-8 is under challenge at the
behest of the petitioner, according to whom, the same is not in terms of the policy.
3. Heard Mr. Das, learned counsel for petitioner, Mr. Mahali, learned counsel for opposite party No.1 and Mr. Singh, learned counsel for opposite party No.5.
4. In fact, the petitioner filing the complaint before the learned Forum demanded an amount of Rs.8 lac payable to her towards insurance compensation accrued against the accounts along with interest besides Rs.50,000/- towards mental agony and harassment and Rs.10,000/- on other heads as made to reveal from a copy of the same at Annexure-1. Before the learned Forum, opposite party Nos.1 and 6 filed their written statements. According to opposite party No.6, the husband of the petitioner having been convinced, the accounts were opened and on 9th August, 2005, such deposit of Rs.40,000/- was made but on 7th June, 2010, he died and the complainant being the nominee and wife in order to receive the accidental benefit informed him on 16th June, 2010 with the required application along with the documents. It has been pleaded by opposite party No.6 that an amount of Rs.57,248/- was paid to the petitioner due to late information received regarding the death of her husband and cancellation of the accident claim. In so far as opposite party No.1 is concerned, the allegation of deficiency in service was opposed and objected to demanding dismissal of the complaint. It was pleaded by opposite party No.1 as per Annexure-2 that the accidental claim benefit was rightly
cancelled due to the late information regarding the death of the petitioner's husband being intimated denying any such service related deficiency by them, hence, the complaint deserves a dismissal but learned Forum directed opposite party No.1 to pay the full insurance claim to the petitioner amounting to Rs.8 lac accrued under the accounts opened through opposite party No.5 along with interest @ 9% per annum from the date of repudiation of such claim till realization within a stipulated period along with the compensation of Rs.20,000/- payable to her on account of deficiency of service but without any costs.
5. As earlier stated, opposite party No.1 preferred First Appeal No.436 of 2012 and it was disposed of vide Annexure-6 and confirmed the decision of learned Forum and declined to entertain the plea of delayed intimation, as a corollary, breach of a condition of the insurance policy and dismissed it with a finding that the Insurance Company is liable to pay the insured amount as there has been no fault on the part of the petitioner. Being unsuccessful in the appeal, opposite party No.1 approached the learned National Commission filing the revision and it led to the passing of the impugned judgment i.e. Annexure-8.
6. The contention of opposite party No.1 before the learned National Commission was confined to the following issues:
(i) Whether learned State Commission and District Forum failed to appreciate that there was no privity of contract
between the Insurance Company and the petitioner since the policy was taken by the Sahara India.
(ii) Whether opposite party No.1 was liable to pay the insured amount to the petitioner in view of the tripartite agreement and whether, learned State Commission erred in holding that the Sahara India was working as the Agent of the Insurance Company.
(iii) Whether condition No.18 of the scheme would apply to the case of the petitioner to which the Insurance Company was not a party, as such compensation provided therein, whether would apply and if the same is recoverable only from the Sahara India under the scheme.
7. Considering the facts pleaded on record, learned National Commission answered the key issue, such as, the quantum of compensation payable to the petitioner and whether, it should be Rs.8 lac or Rs.2 lac. Referring to terms of the Insurance Company and Clause-2A and Clause 18 of the Sahara India, it was concluded that the former shall prevail and not that of the latter and upon considering the conditions applicable, the petitioner is entitled to an insurance claim of Rs.2 lac and hence, accepted the argument advanced by opposite party No.1 but with an observation that there should have been greater clarity on the terms and conditions at the behest of the Insurance Company, while drafting the same, which has been accomplished specifically for such a tailor-made policy. The conclusion of learned National Commission at the end was that the petitioner is entitled to the amount of Rs.2 lac as sum
total of the deposits in the accounts taken together towards determination of the insurance claim and not separately and as a result, allowed the revision and directed such payment along with interest @ 10% per annum from the date of reputation of the claim till realization within eight weeks therefrom with a penalty interest @ 12% per annum for the default period besides a sum of Rs.50,000/- payable to the petitioner towards litigation cost.
8. Mr. Das, learned counsel for the petitioner would submit that learned National Commission could not have reduced the claim amount to Rs.2 lac and grossly erred in allowing the plea of opposite party No.1. The further submission is that opposite party No.1 never pleaded either before learned Forum or learned State Commission with any such plea vis-à- vis terms and conditions of the accidental claim except opposing it on the ground of delay in intimation regarding death of the petitioner's husband and therefore, it could not have been permitted to take a new plea in the revision. The contention is that despite the observation of the learned National Commission that there can be no different conditions of insurance contract and hence, opposite party No.1 ought to have had a better clarity while drafting the policy interfered with the decision of learned Forums below and therefore, the impugned judgment at Annexure-8 since based on surmises and conjectures, the same is liable to be set at naught.
9. Regarding the maintainability of the writ petition, Mr. Das, learned counsel for the petitioner cited an order of the Apex Court in Banarsi Devi Vrs. Pink City Heart and General Hospital & others in SLP (C) Nos.16987-16988 & 17008 of 2023 dated 11th September, 2023 contending that jurisdiction of a High Court is invocable assailing the decisions of the National Commission. No objection on the maintainability of the writ petition was raised by opposite party No.1, hence, the issue needs no discussion. This Court has however no hesitation to hold that the writ jurisdiction is maintainable challenging decisions of learned National Commission as law on the point is no more res integra.
10. Since the delayed intimation about the death of the petitioner's husband and plea of opposite party No.1 opposing the insurance claim did not find favour with learned Forums below and was not one of the grounds raised before the learned National Commission either, the Court is not inclined to deal with the same as it is not necessary.
11. The sole question involved is with respect to quantum of insurance claim. The terms and conditions of the policy under the scheme is claimed to be as per Clause-2A and the same as has been reproduced in the impugned order by learned National Commission is as to the following.
"Depositors under Silver Year Lakh Yojna, Sahara Swarn Yojna and Sahara Rajat Yojana under Housing Scheme-
Whether the deposits are in more than one scheme, the scheme under which the deposit is maximum would be considered. If the deposit amount is Rs.70,000/- and above, the Sum Insured will be Rs.5,00,000/- (Rs. Five Lac only) and if the deposit amount is up to Rs.69,999/- the Sum Insured will be Rs.2,00,000/- (Rs. Two Lac only)."
12. The demand of the petitioner is based on Clause 18 of the terms and conditions of the Sahara India and the same was also referred to by learned National Commission and it reads as under.
"(18) Accidental Death Benefit
In case of accidental death only, the nominee (s) of the deceased coupon holder shall be entitled for insurance compensation amount (as per terms and conditions applicable) as per following chart-
If accidental Insurance compensation
death occurs
amount
In Option (A) In Option
& (B) 8 *
(C)
After 1 year Rs.2,00,000/- Rs.50,000/-
& upto 2 yrs
After 2 years Rs.3,00,000/- Rs.1,00,000/-
& upto 3 yrs
After 3 years Rs.4,00,000/- Rs.1,50,000/-
& upto 4 yrs
After 4 years Rs.5,00,00/- Rs.2,00,000/-
& upto 10 yrs
* In Option (B), the above benefit shall be
applicable only after Rs.1,00,000/- advance amount is deposited in the company."
13. As regards the other plea that the ground with respect to applicability of the terms and conditions of the Insurance Company, Mr. Das, learned counsel for the petitioner placed reliance on a decision of the Apex Court in Sunil Kumar Maity Vrs. State Bank India & another in Civil Appeal No. 432 of 2022 decided on 21st January, 2022 and contends that it is impermissible to take for the first time before the learned National Commission. In the decision (supra), it has been held and observed that the revisional power is exercisable provided grave misappreciation or superficial appraisal of evidence has taken place having no jurisdiction to call for and refer to a suo moto report as it is distinct and different from appellate jurisdiction. In the case at hand, the impugned decision has been arrived at considering the policy conditions without applying the scheme and terms thereof, which, in the humble view of the Court, is not erroneous as any such decision shall have to be made with reference to the contract between the parties. Whether any such ground was raised and plea was advanced earlier is immaterial and therefore, the learned National Commission cannot be said to
have committed any wrong in dealing with the issue and the contention of opposite party No.1 in reaching at a conclusion.
14. There is no denial to the fact that the husband of the petitioner had four accounts opened under Sahara Swarn Rajat Yojana against Option (C) on deposit of Rs.10,000/- against each and in total, Rs.40,000/- made on 9th August, 2005. The husband of the petitioner died on 7th June, 2010 after four years from the date of commencement of the policy. The petitioner is the nominee and claimed the policy amount for Rs.8 lac in view of Clause 18 of such policy. The insurance claim was forwarded to opposite party No.1. Since each deposit of Rs.10,000/- for an insured sum of Rs.2 lac and as it was in relation to four numbers of accounts, the claim of the petitioner was for an amount of Rs.8 lac in view of the terms and conditions as per Clause 18 of the Sahara India. According to such policy, if accidental death occurs after four years and up to ten years in respect of compensation under Option (C), a sum of Rs.2 lac is payable. The said clause is claimed to be applicable to the case of the petitioner. Instead, learned National Commission held that the Sahara India is not the Insurance Company and hence, the terms and conditions of the policy issued by opposite party No.1 shall apply and according to Clause 2A of the Insurance Company, if the deposit amount is up to Rs.69,999/-, the sum insured would become Rs.2 lac, where deposits are made in more than one scheme, the scheme under which the deposit is maximum would be considered. The seminal question is,
whether, the insurance claim to be governed by the terms and conditions of opposite party No.1 or the Sahara India?
15. The question as formulated is that what is the quantum of compensation payable to the petitioner? The primary question is whether the Sahara India is an Insurance Intermediary or Insurance Company by itself? One may argue that any dispute over death insurance claim where Sahara India and the National Insurance Company are involved, the liability for payment would fall upon former being the entity providing the policy to its clients. It may also be claimed that the Sahara India has an agreement with the Insurance Company, it could be for reinsurance or other support. The Sahara India often sells policies directly to the consumers under different schemes, which include accidental death benefits. In the case at hand, the late husband of the petitioner had been issued with a policy coupon under a scheme. In such a situation, one could question, whether, the Sahara India can ever be held as an Insurance Intermediary. The Insurance Company's role is normally involved as a reinsurer or in a similar capacity, where it provides support to the Sahara India in managing the risks associated with the policies. But the fact remains, the consumers' claim is typically against the Sahara India as it has sold the policy and collected the premiums. As a necessary corollary, it may be concluded that the Sahara India is to settle the claim with the policyholders' nominees. Unfortunately, on account of a contract between the Sahara India and opposite party No.1, such a dispute has emerged involving the petitioner, who is
stuck in the middle. It may also be concluded that while the Insurance Company may have an agreement with the Sahara India, the primary liability for settling the policy claims rests with the latter, which is to bear the liability. In the instant case, though, such a ground was raised before the learned National Commission, the liability to settle the claim of the nominee has been saddled with opposite party No.1 but for a lesser amount in view of Clause 2A dealing with depositors under the scheme. The claim of the petitioner is based on Clause 18 of the policy of the Sahara India and since the account holder died after four years not before ten year timeline, such is the demand for death compensation of Rs.2 lac for each of the coupon and for an amount of Rs.8 lac.
16. One of the grounds opposing the claim by opposite party No.1 before the learned National Commission was that Clause 2 A of the policy conditions to apply and even if the petitioner may be entitled to an amount of Rs.8 lac under the scheme and Clause18 thereof, the same is recoverable from the Sahara India but ultimately, the claim is settled against the Insurance Company perhaps considering the Sahara India as an Insurance Intermediary and on the premise that opposite party No.1 is the insurer and hence, to settle the claim of the petitioner and thus, directed it to pay the death compensation. A question may be asked, whether, the Sahara India is really an Insurance Intermediary. As is understood in the ordinary parlance, the insurance intermediaries are the entities that facilitate sale and servicing of the insurance policies between the Insurance Company and customers and
they do not themselves underwrite the policies. The Insurance Companies are actually involved in issuance and management of policies taking on the risks of providing the coverage. As far as the Sahara India Life Insurance Company Limited is concerned, it has the license received from the Insurance Regulatory and Development Authority of India (IRDAI) to operate as a life insurer since 2004. While the Sahara India has interests in various sectors and utilizes intermediary for distribution, it has a direct involvement in the insurance market as a Life Insurance Company and not just as an intermediary. In fact, an insurance intermediary like a broker or agent acts as a go-between the Insurance Companies and consumers helping them find and purchase insurance policies, whereas, the Sahara India Life Insurance is the insurer itself selling own policies to the customers.
17. The petitioner's husband purchased the policy under a scheme of the Sahara India, which outlined the insurance amount and compensation payable against accidental death benefits. As per Clause 18 and terms and conditions stipulated therein, if death of the account holder occurs after four years but before ten years, insurance amount in case of Options A and B, the insurance amount would be Rs.5 lac, whereas, for Option C, the compensation stands at Rs.2 lac. The insurance claim of the petitioner is referred to Clause 18 under the Scheme but in view of the fact that the Sahara India has an agreement with opposite party No.1, Clause 2 A of the Insurance Company has been applied. Admittedly, there is no privity of contract between the petitioner and opposite party
No.1. On the other hand, the contract has been entered in between the Sahara India and the Insurance Company. In that case, who is to honour the claim when the contract is between the Insurance Company and Sahara India? As it was earlier discussed, the Sahara India cannot be said as an Insurance Intermediary as intermediaries serve as a bridge between the consumers and insurance companies seeking to sell the latter's policies. But, herein, it has to be held that the Sahara India has a contract with opposite party No.1 to cover the risks. If under the scheme, the death compensation is allowed as per Clause18 by the Sahara India and opposite party No.1 is to cover the risk, it shall have to be according to the scheme and in the humble view of the Court, the same cannot be as per Clause 2A of the Insurance Company's policy. What was the understanding between the Sahara India and the Insurance Company is in between them and any such risk covered by an agreement, must have to be as per the terms and conditions of Clause 18 concerning accidental death benefits payable to the customers. The Court is also of the view that had it been a case of the Sahara India being an Insurance Intermediary, things would have been different and in that case, the claim was to be dealt with on the terms and conditions of the policy of the Insurance Company. Such a contract between the Sahara India and the National Insurance Company if not properly understood would certainly lead to confusion or a chaotic situation and create a lot of hardship to the customers, many of whom do not really possess the basic knowledge and nuances of insurance policies obtained by
them. In view of contract between the Sahara India and the Insurance Company, it shall have to be understood so as to cover the potential death benefits. In other words, the agreement between them on death insurance is an outcome of business arrangement where one offers such insurance to its customers and the other provides the actual insurance coverage for that scheme. In the considered view of the Court, accidental death benefits shall have to be settled as per the scheme and in view of the insurance coverage with a contract, opposite party No.1 shall have to settle the claim. If there is any deficiency in service, obviously, the Sahara India and National Insurance Company are to be made liable. The conclusion is that in the case of the scheme, the nominee of a deceased investor would claim the insurance compensation from the Sahara India which would then settle the claim based on the terms of the scheme and the contract, it has with the Insurance Company. It is incomprehensible to oppose the claim applying the terms and conditions of Clause 2(A) of the Insurance Company in view of the contract between the Sahara India and the Insurance Company on death insurance. In fact, the Sahara India is a financial company that used the Insurance Company as its insurer to provide coverage for own policy holders with a promise selling the policies on death benefits but instead of directly managing the claims, it entered into a contract with the Insurance Company to handle the insurance aspect of the scheme. Having reached this far with the above discussions, the irresistible conclusion of the Court is that the Sahara India though acted like an
intermediary but essentially floated the scheme and issued the policies insuring the potential death benefits with a contract between it and the Insurance Company and such insurance coverage and payment of death compensation shall have to be under the scheme in question and obviously with reference to the terms and conditions of Clause18. For that matter, opposite party No.1 cannot be allowed to deny any such coverage for the scheme with independent terms and conditions like Clause 2A when the policy was sold according to the conditions and in terms of Clause 18 of the Scheme floated by the Sahara India. Any other conclusion would be like misguiding the investors making them believe that the death claim is based on the scheme totally ignorant about any such contract between the Sahara India and the Insurance Company. Such denial of compensation applying the policy of the Insurance Company could be alleged as a case of unfair business practice with the interest of the investors at stake. The further conclusion is that the contract between the Sahara India and the Insurance Company for death insurance is an agreement outsourcing the actual insurance coverage and such an arrangement cannot be detrimental to the interest of the depositors. The only view acceptable would be to treat the contract as an insurance coverage for the potential death threats and therefore, it shall have to be obliged by the Insurance Company Both the learned Forums below accepted the contention of the petitioner and in absence of any dispute over the policy in
question rightly therefore held and concluded that an amount of Rs.8 lac is payable to settle the insurance claim.
18. To add up, when an investor is motivated to make deposits under a scheme and as per the terms and conditions of the scheme, it allows financial assistance post-accidental death, such claim shall have to be settled accordingly in favour of the nominee. In fact, the death compensation with such monetary assistance is assured by the Sahara India pursuant to the scheme floated by it. When the petitioner fulfilled all the conditions in respect of the scheme and her husband had made the deposits and later died, no justiciable reason lies opposing the claim by the Insurance Company when it has agreed upon to cover the risk based upon a contract with the Sahara India having received premiums therefor. It was never an understanding between the depositors and the Sahara India on any such terms and conditions of the Insurance Company, rather, the deposits have been made looking at the scheme in place and death compensation allowed thereunder in favour of the nominees. The said aspect in the humble view of the Court has been lost sight of by learned National Commission. At no point of time, either the Sahara India or the Insurance Company ever questioned liability to be discharged on any such ground before learned Forums below and raised it before learned National Commission with a plea that the terms and conditions of Clause 2A of the Insurance Company would rather apply. No doubt such a question may be entertained at any stage and even before learned National Commission,
since the claim shall have to be settled on the basis of the scheme and contract between the parties. The account holder of the policy never had any contract with the Insurance Company he having purchased, made deposits as per the scheme of the Sahara India and when a question arose to settle the death compensation, it is totally unfair to oppose it applying the terms and conditions of the Insurance Company. Any such decision could well be alleged as unfair trade practice and defrauding the investors. In the present case, the husband of the petitioner died in 2010 and in the meantime, 15 years have gone by and still the claim is not fully settled as per the scheme. It is really disheartening to notice that the nominee is yet to be paid the death compensation in full taking an excuse and advantage of a contract between the Sahara India and the Insurance Company. The course of action adopted by the Sahara India in association with the Insurance Company has taken the toll leaving the petitioner being the nominee in great distress, that too, for such a long period of time and hence, according to Court, reasonable cost should be awarded to her as a solace and to mitigate the suffering to a certain extent.
19. Interestingly, a Division Bench of the learned National Commission in an identical case in National Insurance Company Limited Vrs. Smt. Shimla Sharma & others in Revision Petition No. 527 of 2012 disposed of on 15th April, 2013 held that the insured amount is to be paid on each of the investments made by the insured and not taking all the investments cumulatively as brought to the notice of the
Court by Mr. Das, learned counsel for the petitioner. In such view of the matter, the Single Bench of the National Commission should have followed it as a binding precedent to maintain the judicial discipline and propriety but has departed rather adopted a course denying the entitlement of the petitioner, which cannot be countenanced and hence, deserves to be interfered with in the interest of justice and accordingly, it is ordered.
20. In the result, the writ petition stands allowed. As a logical sequitur, the impugned order dated 18th October, 2023 passed in Revision Petition No.2188 of 2019 as at Annexure-8 by learned National Consumer Disputes Redressal Commission, New Delhi is hereby set aside confirming the decision of the learned State Commission with a direction to opposite party Nos. 1 and 5 to ensure payment of Rs. 8 (Eight) lac to the petitioner at the rate of interest fixed by learned Forum along with an amount of Rs. 20,000/- (Twenty Thousand) towards compensation on account of deficiency in service with a cost assessed at Rs.10,000/- (Ten Thousand) on the head of litigation and other expenses.
(R.K. Pattanaik) Judge TUDU/Balaram
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