Facts which lead the consumer to take recourse to this commission is, complainant being the younger brother of the deceased Ajit Biswas who effected a postal life insurance policy before the post office under the signature of Assist. Divisional Manager of Circle Kolkata, The present complainant is a nominee of the certificate (P.L.I.) when the deceased left legal heirs like parents and another brother and one sister who were made party to this petition. The policy maker Ajit Biswas died on 18/04/2009 following a sudden heart attack. Now being nominee of the policy maker this complainant with all of his documents  i.e. death certificate, policy bond, original premium receipt, P.M. report, ration card, death claim form, approached before the department that is to the chief post master general W.B. Circle Kalkata through Superintend of Post Office Malda Division on 12/10/2009 for the certificate-assured-money. But OP no.1 to 3 as department not paid any heed to this claim of money as contracted by the deceased as per terms of policy. Thereafter on 23/04/2013 this complainant sent a legal notice to the department but they were dragging the mater by hook or crook. He again sent another notice of lawyer on 03/06/2015 but no payment was arranged. On the contrary department sent a letter dated 19/06/2015 behind the settlement of the claim of the parties but that letter also with no effect. Accordingly finding no other alternative this petition arose against them (OP) behind the P.L.I. No. WB142084-CS sum assured as Rs.2,00,000/-. The complaint is within the statuary period in filing this case from the cause of action i.e. 03/06/2015 (when demand notice lastly issued). Now the complainant claims the sum assured as Rs.2,00,000/- and compensation for mental agony and harassment of Rs.15,000/- and litigation cost as Rs.10,000/-

Ops through Superintendent of Post Office responded this complaint on stating that the decease Ajit Biswas factually made the policy under policy No. WB-142084-CS but all the documents were sent to D.D.M.(P.L.I) Kalkata by office letter No.J/PLI/CORR-II/DEATH/CLAIM/MDA on 24/03/2015 which is under process. All the statement of the complainant were not true, as cause of  death is  pending for report of viscera and accordingly claim of complainant was not settled for want of viscera report.

In their written argument they have specifically said that till today the final opinion for cause of death of the deceased was not opined by the autopsy surgeon Dr. Nirmal Chandra Sarkar and cause of death kept pending for chemical examination report of viscera. So the claim of complainant was not settled by the Ops for want of viscera report. They further argued that P.S. Habibpur also indicated that final opinion for cause of death was reserved for viscera report. Ops further argued that P.W.-2 autopsy surgeon clearly said that the final opinion is reserved for want of chemical report of viscera. So complainant will not get any relief as he not submitted complaint with all of documents like chemical examination report of viscera of the decease. Accordingly there is no deficiency of service on the part of Ops.

In order to substantiate claim of the petition the complainant filed the documents like:-

1. All the corresponding letters dated 07/06/2013, 12/01/2010, 19/06/2015, 18/10/2011, 01/12/2011, 22/11/2011, 20/12/2011, 20/08/2013,

2. Policy certificate.

3. Death certificate of Ajit Biswas.

4. Final report of U.D. case.

5. P.M. report.

6. Final opinion.

7. Legal notice of advocate dated 23/04/2013, 03/06/2015.

          Apart from those, complainant examined himself in writing and adduced the evidence of the father in writing as a legal heir as P.W.-2 who was cross examined like as complainant.

           Company as Ops examined witness namely Arun Kumar Day who is P.R.I.P. of Malda Head Post Office who stated that claim of complainant was not settled for want of viscera report.

:Decision with reason:

Point to be decided:-

 1. Whether case is maintainable?

2. Whether any deficiency of service by the OP or there any unfair trade practice?

3. Whether this complainant is entitle to be allowed his claim?     Points are taken together.

          This commission carefully perused entire documents as filed by the parties and also perused the evidence behind the claim. From those, it is admitted position that the decease created the policy bearing No.WB-142084-CS to the department of P.L.I. Admitted position policy holder died. Further admitted that so long the deceased was alive yearly premium was given by him serially. There is also no denial that the deceased not died out of sudden heart attack. It is also admitted position complainant was the nominee of the certificate when parents and another brother and one sister were the legal heirs.

          Now on scrutiny of entire documents and cross examination of the witnesses it came in to manifestation to the commission that for not submitting the reason of death or viscera repost of the deceased under P.M. report these Ops became reluctant in disbursing the claim.

          This commission carefully gone through the entire policy paper of the deceased which marked as exbt. On perusal of the same we nowhere found that without final report of viscera, if the insured died or the body of the deceased was under gone in post-mortem examination, the claim of insurance would not be disbursed. The opinions which came before this commission as documents behind the death of the decease none of the document says that there any unnatural death took place either murder of the decease or suicide etc. So we the commission observes that it is the obligatory duty on the part of the post-mortem maker/examiner to pass final opinion after the examination of dead body, but they (doctors) remained kept it reserved, rather avoid it on saying that except report of viscera, the opinion or reason of death could not be passed.  If so, Why?  For the latches of the post-mortem holder regarding passing of final opinion, the insured or his legal heirs would suffer? When insured paid premium regularly so long alive. Factually it is the policy on the “life” as insured, but not any certificate/policy of the insured that the policy holder must be alive up to the maturity of the year of policy. We know as per terms of policy if incidentally any immature death caused to the insured before maturity of the policy, the insured amount will be disbursed to the legal heirs through the nominee as mentioned in the policy. There remains no clause under policy that on the event of death either homicide of suicide all the premium by the insured will be forfeited by the insurer. In the periphery of this dispute this commission find from the report of U.D. case that the case ended with F.R.T. (final report) that means no unnatural death caused. The medical officer who held P.M. (Post-mortem) cunningly shifted his duty of passing final opinion on the natural or unnatural death on the plea of not receiving any viscera report.We (commission) say,   what viscera will say? Whether that person or the deceased consume any unnatural substance himself or is made consumed any substance to him for which death caused. But that opinion is quite possible to pass by the pacific doctor on the spot of holding P.M. on examining viscera instantly either by himself or by any other expert doctor on the spot but that has not being done, on the contrary viscera kept reserved day after day for report and observation is passed by the P.M. examiner that final reason of death cannot be passed due to not receiving any viscera report. But this commission is saying / observing, why? for the fault of doctors these legal heirs of the policy holder would suffer day after day when old parent are alive, and probably they required this insured amount urgently in absence of their earning son. It is admitted position that from the earning of the deceased so long his was alive this deceased person Ajit Biswas gave his earning as premium to this company in the hope that either at the end of his maturity years he himself will get the assured amount or if death caused to him, his legal heirs would get it from the insurer and as per that hope he shared his earning with the insurer in the form of premium as per contract.

But we the commission finds, this insurer-company without obeying that contract day after day putting harassment and insecurity to the legal heirs and basically old parents on the plea of not getting viscera report or final reason of death. Here we the commission asking  whether there any contract between insured and insurer that if any unnatural death caused, none will get the money as heirs?   We think never such clause remain. If remained it was the duty of the OPs to show that but not the complainant. Naturally if no such clause remains in the certificate, why the company on the plea of viscera report day after day enjoying the earning of the decease given as premium to them.

Is it not any unfair trade practice?  Obviously. Why so many correspondence of letters required to be effected by the heirs of the insured when they had no blame/ fault of not paying premium so long decease was alive?  Fault of other (that is PM holder) could not be burden to the legal heirs of the decease.

Case obviously succeeds and the commission is holding that legal heirs of the deceased must not suffer for the lack of passing opinion by the P.M. holder on the cause of viscera report. We hold it was the duty of the insurer to prove that any violation of contract has been made as per contract paper like certificate of bearing No.WB124084-CS but nowhere in the orbit of proof either documentary of personal evidence it was proved by the officer that any fault was made by the complainant.

Accordingly we hold there is unfair trade practice on the part of the insurer in not disbursing the assured amounts till now to the nominee.

Hence           it is Ordered,

          that the complaint succeeds. Complainant as nominee on the certificate bearing No.WB-124084-CS on behalf of the legal heirs of decease insured is entitle to get Rs.2,00,000/- as matured amount and also entitle to get Rs.15,000/- for harassment and mental agony and Rs.10,000/- as litigation cost by the OP company No.1,2&3 jointly or severely. They are liable to pay the entire Rs.2,25,000/- within three month from the date of this order. In default complainant is at liberty to execute the order under section 71 and 72 of CP consumer act 2019.

Let a copy of judgment/final order be supplied to the parties free of cost.