The main legal point established in the judgment is that the insurer's liability for the loss suffered by the bank was limited by the terms and conditions of the policy, including the excess clause, and the complainant was entitled to reimbursement only to the extent specified in the policy.

As per Hon'bleShri V.K. Agarwal, President:-

1. This complaint under section 12 read with 17 of the Consumer Protection Act 1986, is filed by the appellant Jila Sahkari Kendriya Bank Maryadit, Bilaspur, (hereinafter called "Cooperative Bank" for short) for recovery and reimbursement of the loss to the tune of Rs. 6,94,805/- under the "Bankers' Indemnity Policy", (hereinafter called "Policy" for short) issued by the opposite party insurer, National Insurance Company Ltd. on account of loss caused to it due to fraud and embezzlement by one.

2. The relevant averments in the complainant stated in brief are that the complainant obtained from the opposite party the policy and paid premium for coverage of risk of item A to E to the extent of Rs. 10,00,000/-, additional insurance and coverage of risk under item A to the extent of Rs. 50,00,000/¬and for additional insurance and coverage of risk for item B to the extent of Rs. 15,00,000/-. It was further averred that one of the employees of the complainant bank, namely Santosh Kumar Dubey who was working as a cashier, committed fraud and embezzlement, resulting in total loss to the complainant bank to the tune of Rs. 9,62,365/-. However, later on, the said employee Santosh Kumar Dubey refunded Rs. 3, 10, 140/- to the complainant bank and thus net amount of loss of Rs. 6,52,225/- remained to be recovered. The complainant intimated the OP insurer about the loss caused to it as above. The OP insurer appointed a surveyor who assessed and reported that Rs. 1,09,100/- were payable towards the said loss under the terms and conditions of the policy. The complainant also averred that the police report was lodged and departmental enquiry was also initiated, against the delinquent employee Santosh Kumar Dubey. It was averred that since loss was caused as a result of fraud committed by the employee of the complainant bank, hence, it was entitled to recover the loss from the insurer, as per the terms of the policy. It was further averred that reimbursement of Rs. 1,09,100/- as assessed by the surveyor does not fulfill the obligation, of the OP insurer, under the said policy. It was prayed in the complaint that the OP insurer be directed to pay to the bank Rs. 6,94,805/- with interest & bonus etc. and compensation be also awarded on account of delay and financial loss caused to the complainant bank.

3. The complaint was resisted by the OP insurer. It was averred that the complainant was entitled to reimbursement only in terms of policy conditions. It was also averred that the surveyor assessed the reimbursable loss to the extent of Rs.1,09,100/- as per the terms and conditions of the policy. It was further averred that the complainant has failed to furnish documents including copies of accounts book of the various depositors, whose amount was alleged to be embezzled as also the final report by the police and the documents relating to the departmental enquiry of the delinquent employee Santosh Kumar Dubey. It was also averred that there was a delay in lodging the report with the police. It was further averred that the complainant bank was negligent in not properly controlling the transactions of the bank and in not following the procedure regarding the deposits. Hence, the complainant was not entitled to any compensation.

4. The submissions of the learned counsel were heard. The contention of learned counsel of the complainant was that the employee Santosh Kumar Dubey practiced fraud and misappropriated total amount of Rs. 9,62,365/-which was handed over to him for being credited in their accounts, by various depositors. It was further submitted that since the said employee later on refunded Rs. 3, I 0, 140/-, the balance of Rs. 6,52,225/- remained to be recovered. It was submitted that since, the bank was put to loss to the above extent on account of fraud and embezzlement by its employee, hence, the complainant was entitled to the reimbursement to that extent, under the policy. It was submitte