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Group Accident Insurance Scheme under PMMSY: Medical Treatment - Gujarat
Agriculture, Farmers Welfare and Cooperation Department
Last updated:
Overview
The scheme aims to provide financial assistance to fishermen/fishermen's families in case of death or injury. Through this scheme, insurance coverage for Medical Treatment is provided to eligible fishers.
Details
Description
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 Medical Treatment. 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.
Exclusions
• 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.
Benefits
• The claim amount is deposited directly into the claimant's, nominee's, or legal heir's savings account via Direct Bank Transfer (DBT).
• 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 Criteria
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.
7. <br>
Application Process
Step 1: Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Offline
Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Required Documents
• Intimation Form
• Claim Form
• Cancelled Cheque of claimant/insured/nominee/legal heir/s (or) copy of first page Bank Pass Book of claimant/insured/nominee/legal heir/s (or) copy of bank account statement of claimant/insured/nominee/legal heir/s duly attested by a gazetted officer along with self attestation
• Certification by the Appropriate Authority
• Any one of the IDs as mentioned, in the list of acceptable documents as proof of identity and proof of address from the general public in the country, by the Government of India. Any one of the acceptable IDs as proof of identity and address issued by the Government of India
• With respect to the requirement/s of claim documents or certificates, the law of the land in correlation to the customs and traditions of the geography shall prevail over the documents specified in this agreement.
• Road/Railway Accident: First Information Report (FIR) or Railway Protection Force (RPF) report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, Valid Driving License (if the insured was driving), and Death Certificate.
• Drowning: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, Death Certificate, and statements from two witnesses.
• Missing at Sea: A declaration by the family and a certificate from an Appropriate Authority.
• Fire: First Information Report (FIR)/Police Report, Post Mortem Report, and Death Certificate. If the body is completely charred, a declaration by a family member and a certificate from an Appropriate Authority are required.
• Poisonous Substances: First Information Report (FIR)/Police Report, Post Mortem Report, Viscera Report, Forensic Lab Report, and Death Certificate.
• Lightning/Electric Shock: First Information Report (FIR)/Police Report, Post Mortem Report, Inquest Panchnama, Spot Panchnama, and Death Certificate.
• Machinery: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, and Death Certificate.
• Murder: First Information Report (FIR), Spot Panchnama, Inquest Panchnama, Post Mortem Report, Death Certificate, and Final Police Report (if necessary).
• Falling from Heights/Naxalite Murder/Riots: First Information Report (FIR)/Police Report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, and Death Certificate.
• Animal-related Injury (e.g., snake bite, rabies): A certificate from a registered medical practitioner confirming the cause of death/disablement. If available, also include First Information Report (FIR)/Police Report, Inquest Panchnama, Post Mortem Report/Forensic Lab Report, Viscera Report (if not concluded from the Post Mortem Report), and Death Certificate.
• Accidental Hospitalisation: Original consolidated hospital bill with a breakup of each item, original payment receipt, corresponding prescriptions, treating doctor's certificate, copy of MLC, and original detailed discharge summary.
Frequently Asked Questions
Q: What is the Medical Treatment benefit under the Group Accident Insurance Scheme (GAIS)?
A: The Medical Treatment benefit provides financial assistance for the medical expenses of a fisher who is injured in an accident.
<br>
Q: What does the medical treatment benefit cover?
A: The benefit covers costs for medical treatment and hospitalisation resulting from an accident, including the cost of medicines, diagnostic tests, doctor's fees, and hospital charges.
<br>
Q: Who is eligible to claim the medical treatment benefit?
A: 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>
Q: How is a claim for medical treatment initiated?
A: The claim must be intimated to the insurance company within 90 days from the date of the accident.
<br>
Q: What documents are required to file a claim for medical treatment?
A: You will need the Intimation Form, Claim Form, a cancelled cheque or bank passbook copy, Certification by the Appropriate Authority, and a government-issued ID. Additionally, you will need accident-specific documents.
<br>
Q: What additional documents are specifically required for a medical treatment claim?
A: You must provide the original consolidated hospital bill with a breakup of each item, original payment receipts, corresponding prescriptions, the treating doctor's certificate, a copy of the Medico Legal Certificate (MLC), and the original detailed discharge summary.
<br>
Q: Do I need to submit the original hospital bills?
A: Yes, you are required to submit original consolidated hospital bills and payment receipts.
<br>
Q: How long do I have to submit all the claim documents?
A: All claim documents for medical treatment must be submitted within 180 days of the accident.
<br>
Q: Is there a timeframe for the insurance company to settle a medical treatment claim?
A: Yes, the insurance company will settle the claim within 15 working days of receiving all complete documentation.
<br>
Q: Are ambulance charges covered under this benefit?
A: No, ambulance charges are not covered under the accidental hospitalisation claim.
<br>
Q: Does the medical treatment benefit cover pre-existing diseases?
A: No, the policy does not cover expenses for pre-existing physical or mental defects or illnesses.
<br>
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 Medical Treatment. 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.
Exclusions
• 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.
Benefits
• The claim amount is deposited directly into the claimant's, nominee's, or legal heir's savings account via Direct Bank Transfer (DBT).
• 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 Criteria
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.
7. <br>
Application Process
Step 1: Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Offline
Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Required Documents
• Intimation Form
• Claim Form
• Cancelled Cheque of claimant/insured/nominee/legal heir/s (or) copy of first page Bank Pass Book of claimant/insured/nominee/legal heir/s (or) copy of bank account statement of claimant/insured/nominee/legal heir/s duly attested by a gazetted officer along with self attestation
• Certification by the Appropriate Authority
• Any one of the IDs as mentioned, in the list of acceptable documents as proof of identity and proof of address from the general public in the country, by the Government of India. Any one of the acceptable IDs as proof of identity and address issued by the Government of India
• With respect to the requirement/s of claim documents or certificates, the law of the land in correlation to the customs and traditions of the geography shall prevail over the documents specified in this agreement.
• Road/Railway Accident: First Information Report (FIR) or Railway Protection Force (RPF) report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, Valid Driving License (if the insured was driving), and Death Certificate.
• Drowning: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, Death Certificate, and statements from two witnesses.
• Missing at Sea: A declaration by the family and a certificate from an Appropriate Authority.
• Fire: First Information Report (FIR)/Police Report, Post Mortem Report, and Death Certificate. If the body is completely charred, a declaration by a family member and a certificate from an Appropriate Authority are required.
• Poisonous Substances: First Information Report (FIR)/Police Report, Post Mortem Report, Viscera Report, Forensic Lab Report, and Death Certificate.
• Lightning/Electric Shock: First Information Report (FIR)/Police Report, Post Mortem Report, Inquest Panchnama, Spot Panchnama, and Death Certificate.
• Machinery: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, and Death Certificate.
• Murder: First Information Report (FIR), Spot Panchnama, Inquest Panchnama, Post Mortem Report, Death Certificate, and Final Police Report (if necessary).
• Falling from Heights/Naxalite Murder/Riots: First Information Report (FIR)/Police Report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, and Death Certificate.
• Animal-related Injury (e.g., snake bite, rabies): A certificate from a registered medical practitioner confirming the cause of death/disablement. If available, also include First Information Report (FIR)/Police Report, Inquest Panchnama, Post Mortem Report/Forensic Lab Report, Viscera Report (if not concluded from the Post Mortem Report), and Death Certificate.
• Accidental Hospitalisation: Original consolidated hospital bill with a breakup of each item, original payment receipt, corresponding prescriptions, treating doctor's certificate, copy of MLC, and original detailed discharge summary.
Frequently Asked Questions
Q: What is the Medical Treatment benefit under the Group Accident Insurance Scheme (GAIS)?
A: The Medical Treatment benefit provides financial assistance for the medical expenses of a fisher who is injured in an accident.
<br>
Q: What does the medical treatment benefit cover?
A: The benefit covers costs for medical treatment and hospitalisation resulting from an accident, including the cost of medicines, diagnostic tests, doctor's fees, and hospital charges.
<br>
Q: Who is eligible to claim the medical treatment benefit?
A: 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>
Q: How is a claim for medical treatment initiated?
A: The claim must be intimated to the insurance company within 90 days from the date of the accident.
<br>
Q: What documents are required to file a claim for medical treatment?
A: You will need the Intimation Form, Claim Form, a cancelled cheque or bank passbook copy, Certification by the Appropriate Authority, and a government-issued ID. Additionally, you will need accident-specific documents.
<br>
Q: What additional documents are specifically required for a medical treatment claim?
A: You must provide the original consolidated hospital bill with a breakup of each item, original payment receipts, corresponding prescriptions, the treating doctor's certificate, a copy of the Medico Legal Certificate (MLC), and the original detailed discharge summary.
<br>
Q: Do I need to submit the original hospital bills?
A: Yes, you are required to submit original consolidated hospital bills and payment receipts.
<br>
Q: How long do I have to submit all the claim documents?
A: All claim documents for medical treatment must be submitted within 180 days of the accident.
<br>
Q: Is there a timeframe for the insurance company to settle a medical treatment claim?
A: Yes, the insurance company will settle the claim within 15 working days of receiving all complete documentation.
<br>
Q: Are ambulance charges covered under this benefit?
A: No, ambulance charges are not covered under the accidental hospitalisation claim.
<br>
Q: Does the medical treatment benefit cover pre-existing diseases?
A: No, the policy does not cover expenses for pre-existing physical or mental defects or illnesses.
<br>
Eligibility Criteria
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.
7
<br>
Benefits
The claim amount is deposited directly into the claimant's, nominee's, or legal heir's savings account via Direct Bank Transfer (DBT).
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.
Required Documents
| # | Document |
|---|---|
| 1 | Intimation Form |
| 2 | Claim Form |
| 3 | Cancelled Cheque of claimant/insured/nominee/legal heir/s (or) copy of first page Bank Pass Book of claimant/insured/nominee/legal heir/s (or) copy of bank account statement of claimant/insured/nominee/legal heir/s duly attested by a gazetted officer alon |
| 4 | Certification by the Appropriate Authority |
| 5 | Any one of the IDs as mentioned, in the list of acceptable documents as proof of identity and proof of address from the general public in the country, by the Government of India. Any one of the acceptable IDs as proof of identity and address issued by the |
| 6 | With respect to the requirement/s of claim documents or certificates, the law of the land in correlation to the customs and traditions of the geography shall prevail over the documents specified in this agreement. |
| 7 | Road/Railway Accident: First Information Report (FIR) or Railway Protection Force (RPF) report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, Valid Driving License (if the insured was driving), and Death Certificate. |
| 8 | Drowning: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, Death Certificate, and statements from two witnesses. |
| 9 | Missing at Sea: A declaration by the family and a certificate from an Appropriate Authority. |
| 10 | Fire: First Information Report (FIR)/Police Report, Post Mortem Report, and Death Certificate. If the body is completely charred, a declaration by a family member and a certificate from an Appropriate Authority are required. |
| 11 | Poisonous Substances: First Information Report (FIR)/Police Report, Post Mortem Report, Viscera Report, Forensic Lab Report, and Death Certificate. |
| 12 | Lightning/Electric Shock: First Information Report (FIR)/Police Report, Post Mortem Report, Inquest Panchnama, Spot Panchnama, and Death Certificate. |
| 13 | Machinery: First Information Report (FIR)/Police Report, Post Mortem Report, Spot Panchnama, Inquest Panchnama, and Death Certificate. |
| 14 | Murder: First Information Report (FIR), Spot Panchnama, Inquest Panchnama, Post Mortem Report, Death Certificate, and Final Police Report (if necessary). |
| 15 | Falling from Heights/Naxalite Murder/Riots: First Information Report (FIR)/Police Report, Spot Panchnama, Inquest Panchnama, Post Mortem Report, and Death Certificate. |
| 16 | Animal-related Injury (e.g., snake bite, rabies): A certificate from a registered medical practitioner confirming the cause of death/disablement. If available, also include First Information Report (FIR)/Police Report, Inquest Panchnama, Post Mortem Repor |
| 17 | Accidental Hospitalisation: Original consolidated hospital bill with a breakup of each item, original payment receipt, corresponding prescriptions, treating doctor's certificate, copy of MLC, and original detailed discharge summary. |
How to Apply
1
Fishers or their legal heirs must submit the required documents to the concerned district office for assistance. The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Offline Fishers or their legal heirs must submit the required documents to the concerned district office for assistance. The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
Frequently Asked Questions
The Medical Treatment benefit provides financial assistance for the medical expenses of a fisher who is injured in an accident. <br>
Sources and references
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