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Agent's Role In Insurance Claim Is Limited To Forwarding Claim To Insurer: NCDRC
Ayushi Rani
29 Jun 2024 6:45 PM IST
The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra, held that an agent's liability in the insurance claim process is confined to the facilitation and forwarding of claims to the insurer. Once this role is fulfilled, they cannot be held liable for any deficiencies or delays in the claim settlement process, which are the insurer's responsibility. Brief...
The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra, held that an agent's liability in the insurance claim process is confined to the facilitation and forwarding of claims to the insurer. Once this role is fulfilled, they cannot be held liable for any deficiencies or delays in the claim settlement process, which are the insurer's responsibility.
Brief Facts of the Case
The complainant's deceased husband had purchased a Janata Personal Accident Insurance Policy from National Insurance Ltd/insurer through GFTS Multi Services/agent with an assured sum of Rs. 1 lakh for 15 years. The deceased died from an accidental fall during a festival. The complainant reported the death and submitted a claim to the insurer, but the claim was not settled. Consequently, she filed a complaint before the District Forum seeking compensation, interest, and litigation costs. The District Forum allowed the complaint and directed the insurer and the agent to pay the complainant the sum assured against her deceased husband's insurance policy of Rs.1,00,000 and Rs. 500 toward cost and interest @ 6%. Being dissatisfied with the order, the agent appealed to the state commission of Odisha, which dismissed the complaint. Consequently, the agent filed a revision petition before the National Commission.
Contentions of the Opposite Party
The insurer denied receiving any communication or documents from the agent, attributing the claim's delay to the agent's non-cooperation, and argued against the relief sought due to missing documentation. The agent argued that its role was limited to facilitating the insurance and submitting documents. Thus, it should not be held liable.
Observations by the National Commission
The National Commission observed that the primary issue was whether there was a service deficiency on the agent's part in handling the complainant's claim. It was established that the agent's role was limited to forwarding the claim to the insurer, which it did promptly. There was no evidence of delay by the agent in processing the claim, so it could not be held liable for any deficiency in service.
Consequently, the National Commission allowed the revision petition and dismissed the order by the State Commission. The insurer was directed to follow the state commission's order since it did not contest the order before the National Commission.
Case Title: GTFS Multi Services Ltd. Vs. Smt. Pravati Behera
Case Number: R.P. No. 4/2021
