GAISGUJ2

Group Accident Insurance Scheme under PMMSY: Permanent Partial Disability Gujarat

The scheme aims to provide financial assistance to fishermen/fishermen's families in case of death or injury. Through this scheme, insurance coverage for Permanent Partial Disability is provided to eligible fishers.

State Cash

States / UT: Gujarat

Nodal department: Agriculture, Farmers Welfare and Cooperation Department

Scheme for: Family

Scheme profile

DBT (direct benefit transfer): No

Categories: Agriculture,Rural & Environment, Banking,Financial Services and Insurance

Sub-categories: Insurance

Target beneficiaries: Industries

Tags: Fishermen, Disability, Insaurance, Injury, Partial Disability

Details

The scheme "Group Accident Insurance Scheme under PMMSY" with a component "Permanent Partial Disability" is introduced by the Agriculture, Farmers Welfare and Co-operation Department, Government of Gujarat. Insurance of Fishers is one of the sub-components of the PMMSY, and it provides insurance coverage to fishers, which includes fishermen, fish workers, fish farmers, and other individuals directly involved in fishing and related activities. The sub scheme offers coverage for permanent partial disability (PPD). The National Fisheries Development Board (NFDB) and M/s Oriental Insurance Company Limited (OICL) implement the scheme. The premium cost is shared between the Central and State Governments, with no contribution from the beneficiary. The implementing agency of the scheme is the Commissioner of Fisheries.

Objective of scheme:

  • To financially assist the fisherman/fisherman's family in case of death/injury.

Benefits

  • Sr. No. Name of Component Standard of assistance 1. Permanent Partial Disability₹2,50,000/- Mode of Disbursement:
  • The claim amount is deposited directly into the claimant& 39;s, nominee& 39;s, or legal heir& 39;s savings account via Direct Bank Transfer (DBT). Expected Time of Disbursement:
  • The insurance company will settle the claim within 15 working days of receiving the complete claim documentation. If a claim is not settled within this period, the insurance company will pay a simple interest of 10% on the admissible claim amount from the date of document submission until the payment date

**Sr. No.Name of ComponentStandard of assistance**1. Permanent Partial Disability₹2,50,000/-

Mode of Disbursement:

  • The claim amount is deposited directly into the claimant's, nominee's, or legal heir's savings account via Direct Bank Transfer (DBT).

Expected Time of Disbursement:

  • The insurance company will settle the claim within 15 working days of receiving the complete claim documentation. If a claim is not settled within this period, the insurance company will pay a simple interest of 10% on the admissible claim amount from the date of document submission until the payment date.

Eligibility

  1. The applicant must be a fisher, which includes fishermen, fish workers, fish farmers, and any other person directly involved in fishing or fisheries-related activities.
  2. The applicant must be between 18 and 70 years old.
  3. The insured person should not have been 71 years of age on the date of the accident.
  4. The applicant must be approved by the State/Union Territory (UT) fisheries department.
  5. At the time of a claim, the claimant or insured fisher must be verified and certified by an "Appropriate Authority".
  6. The applicant should have registered himself in the concerned district office.

Exclusions

The scheme does not cover claims for death, injury, or disablement resulting from:

  • Suicide or attempted suicide.
  • Self-inflicted injury.
  • Pregnancy, childbirth, or related consequences.
  • Pre-existing physical or mental defects or infections.
  • Influence of intoxicating liquor or drugs.
  • Venereal diseases or insanity.
  • Engaging in aviation or ballooning, except as a passenger on a licensed aircraft.
  • Committing a breach of law with criminal intent.
  • Ionizing radiation or radioactive contamination from nuclear fuel or waste.
  • Nuclear weapons material.
  • Service in the armed forces.
  • Murder by an immediate beneficiary or nominee.
  • War, invasion, civil war, rebellion, or other hostilities.
  • Natural death.
  • Funeral or ambulance charges (except for accidental hospitalisation claims).
  • Weekly compensation or child education funds.

Application Process

Offline

  1. Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
  2. The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
  • Letter to the Insurance Company/NFDB Insurance Cell/Intermediary.
  • Email to support@pmmsygais.com.
  • Through the IT & ITES platforms provided by the intermediary.
  • Via the NFDB Toll-Free Number (1800-425-1660).
  • To the "Appropriate Authorities".

Note: All claim documents must be submitted within 180 days of the accident.


Clarifications

Additional points from the scheme information published on myScheme (not legal advice).

What is the Permanent Partial Disability (PPD) benefit under the Group Accident Insurance Scheme (GAIS)?
The PPD benefit provides financial assistance to a fisher who suffers a partial disability as a result of an accident. <br>
What is the definition of Permanent Partial Disability according to the scheme?
PPD is a partial disability that is permanent in nature and results from an accident. The level of disability is determined by a doctor and a government hospital specialist. <br>
Are there specific injuries covered under PPD?
Yes, the policy specifies various injuries and their corresponding compensation as a percentage of the sum insured, for example, loss of a thumb or an index finger. <br>
Who is eligible for the PPD benefit?
Any fisher between the ages of 18 and 70, who is registered under the scheme, is eligible for this benefit. The insured person must not have completed 71 years of age on the date of the accident. <br>
How is the claim for PPD initiated?
An intimation about the disability must be sent to the insurance company within 90 days of the accident. <br>
What documents are required to claim the PPD benefit?
Key documents include the Intimation Form, Claim Form, a cancelled cheque or bank passbook copy, Certification by an Appropriate Authority, and a government-issued ID. You will also need accident-specific documents like a First Information Report (FIR). <br>
What additional documents are required for a PPD claim?
You will need the original detailed discharge summary, the treating doctor&#39;s certificate, a copy of the FIR or Medico Legal Certificate (MLC), and a disability certificate with a photograph from a government hospital specialist. <br>
Who determines the percentage of disability for a PPD claim?
The disability is assessed and certified by a government hospital specialist. <br>
How long do I have to submit all the claim documents?
All claim documents must be submitted within 180 days of the accident. <br>
Is there a timeframe for the insurance company to settle a PPD claim?
Yes, the insurance company will settle the claim within 15 working days of receiving all complete documentation. <br>

References

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