Group Accident Insurance Scheme under PMMSY: Permanent Partial Disability — Gujarat

What is the Group Accident Insurance Scheme's permanent partial disability benefit?

The Group Accident Insurance Scheme (GAIS) is the insurance sub-component of the Pradhan Mantri Matsya Sampada Yojana (PMMSY), the centrally sponsored fisheries programme of the Department of Fisheries, Ministry of Fisheries, Animal Husbandry and Dairying. In Gujarat the scheme is administered on the ground by the Commissioner of Fisheries, who reports to the Agriculture, Farmers Welfare and Co-operation Department, Government of Gujarat. The Commissioner's site lists it in Gujarati as માછીમાર જૂથ અકસ્માત વિમા યોજના, the fishermen's group accident insurance scheme.

This guide covers one specific slab of that policy: permanent partial disability, which pays Rs 2,50,000.

According to the National Fisheries Development Board (NFDB), which is the nodal agency for GAIS, the policy carries three slabs:

Gujarat matters disproportionately here. The state has the longest coastline in India and, as the Commissioner of Fisheries records, ranks first in fishing on India's west coast. A very large working population is exposed to winch and trawl injuries, net and rope accidents, engine-room burns and road accidents while moving catch, precisely the injuries that end in the loss of a hand, a foot or an eye rather than in death.

Key features

• Cover of Rs 2,50,000 for permanent partial disability from an accident.
• Zero premium for the fisher: the total premium of Rs 72.44 per fisher per year is shared 60:40 between the Centre and Gujarat.
• Eligible age band is 18 to 70 years.
• Insurer is Oriental Insurance Company Limited (OICL); the intermediary is Providence India Insurance Broking Pvt Ltd.
• Cover starts from the date the premium is paid to the insurance company for that policy year, not from the date a fisher's name is written down.

Who is covered for permanent partial disability?

You are covered if:

• You are a fisher, fisherwoman, fish worker, fish farmer or any other person directly involved in fishing and fisheries-related allied activities in Gujarat.
• You are aged between 18 and 70 years.
• Your name is on the state fisheries department's GAIS enrolment list for the running policy year, and the premium for that year has been paid.
• Your injury was caused by an accident of a covered type and has left a permanent partial impairment.

You are not eligible, and cannot claim, if:

• You are under 18 or over 70 years old.
• You were not enrolled for the policy year in which the accident happened. Enrolment does not roll over automatically; a fisher covered last year is not covered this year unless the name is carried into the current list.
• The injury arose from suicide or an attempt at suicide, or from a self-inflicted injury.
• The injury is traceable to a pre-existing physical or mental defect or infection rather than to the accident.
• You were under the influence of intoxicating liquor or drugs at the time.
• The accident happened while committing a breach of law with criminal intent.
• The claim falls under the pregnancy exclusion clause.
• The impairment is temporary. A fracture that heals, or a hand that recovers function, is not a permanent partial disability, though the hospitalisation slab of Rs 25,000 may still apply.

How much does the permanent partial disability benefit pay?

GAIS pays a flat Rs 2,50,000 for permanent partial disability. There is no graded percentage table published in the NFDB brochure — the practical question in every claim is which of the two disability slabs applies.

Permanent total disability, paid at Rs 5,00,000, is the loss of both hands, both feet, both eyes, or one hand and one foot, or an impairment that permanently and totally prevents the fisher from following any occupation. Permanent partial disability, paid at Rs 2,50,000, covers the loss of a single limb or a single eye and comparable permanent impairments.

The distinction turns almost entirely on the wording of the medical certificate. A certificate that says a fisher "cannot use his right hand" is a partial claim. A certificate that says the fisher "is permanently and totally incapacitated from any occupation" supports the higher slab. Fishers and their families in Gujarat routinely lose Rs 2,50,000 to a loosely worded certificate, so it is worth reading the certificate before leaving the hospital.

Which accidents are covered?

The NFDB brochure lists the covered events explicitly:

• Accidents in the sea, on the road or on the railway
• Drowning or going missing in water bodies
• Accidents due to fire or handling of poisonous substances
• Stroke of lightning or electric shock
• Accidents while working with machinery
• Murder
• Falls from height
• Riots
• Snake bite, scorpion bite, animal bite or rabies, or any injury by an animal resulting in death or the loss of a limb
• Any other accident

Note that the cover is a personal accident policy on the enrolled fisher, not a sea-only cover. A road accident on the way to the landing centre is covered on the same terms as a winch injury on a trawler.

How to apply for a permanent partial disability claim

1. Confirm your enrolment first. Visit the district Superintendent of Fisheries office and check that your name, age, Aadhaar number and nominee details are on the GAIS enrolment list for the current policy year, and that the premium has been remitted.
2. Report the accident to the police immediately. Get an FIR registered and the spot panchnama recorded. Without these the accidental cause cannot be established and the claim is closed on that ground alone.
3. Intimate the claim within 90 days. Send the claim intimation to the NFDB Insurance Cell by post, by e-mail to support@pmmsygais.com, on the toll-free number 1800-425-1660, or through the GAIS IT platform. You can also hand it to the district fisheries office, which must forward it to the Insurance Cell within 7 working days.
4. Obtain a disability certificate from a competent medical authority. Make sure it names the body part lost or permanently impaired and uses the word permanent.
5. Assemble the document set, claim intimation form, signed claim form, certified FIR, certified panchnama, disability certificate, hospital medical report or discharge summary, fishing licence or cooperative society membership certificate, address proof, NEFT bank account form signed by your bank, and the discharge voucher with a Re 1 revenue stamp.
6. Submit the originals to the district fisheries office within 180 days of the accident. The office verifies the records, uploads them through the MIS, and sends the originals with a covering letter to the NFDB Insurance Cell within 7 working days.
7. Track the file and respond to queries. Oriental Insurance settles the claim within 15 working days of receiving all relevant documents, so almost all delay beyond that point is an unanswered document query.

How to check the status of a claim

1. Call the NFDB GAIS toll-free number 1800-425-1660 with the claim intimation reference.
2. E-mail support@pmmsygais.com, which is the Insurance Cell's published address for claim queries.
3. Follow up in person at the district Superintendent of Fisheries office, quoting the inward number given when the documents were submitted, and ask specifically whether the file has left the district office for the Insurance Cell.
4. Escalate to the Commissioner of Fisheries, Gandhinagar, through cof.gujarat.gov.in, if the district office cannot say where the file is.

The Insurance Cell at NFDB was set up precisely to coordinate between state fisheries departments and the insurer, so it is the correct escalation point rather than the insurance company's branch counter.

Why permanent partial disability claims fail

• The fisher was not enrolled for the policy year of the accident. This is the largest single cause of rejection and it is entirely preventable.
• No FIR or panchnama, so the injury cannot be shown to be accidental.
• Certificate does not say "permanent". A certificate describing a temporary incapacity does not support a disability slab at all.
• Intimation filed after 90 days or documents filed after 180 days.
• Bank details mismatch. The NEFT form must be signed by the bank official and the account must be in the injured fisher's own name.
• Intoxication recorded in the medical report. Where the hospital record notes alcohol, the insurer applies the exclusion.
• Name or age mismatch between the fisheries register, the Aadhaar card and the hospital record.

The practical fix for most of these happens long before any accident: check once a year, at the start of the policy cycle, that your name and age are correct on the fisheries register, and keep a copy of the enrolment acknowledgement at home.

Where to raise a grievance

• NFDB GAIS toll-free: 1800-425-1660
• NFDB Insurance Cell e-mail: support@pmmsygais.com
• District Superintendent of Fisheries office in your district, listed under District Office Contact Details on cof.gujarat.gov.in
• Commissioner of Fisheries, Gandhinagar, the state nodal office for PMMSY in Gujarat

Enrolment and claims under GAIS are free at every stage. No agent has any role in getting a fisher enrolled or a claim settled, and no fee is payable to anyone.