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Can I claim Permanent Partial disability benefit


15-Mar-2025 (In Insurance Law)
I got partial ACl and PCL tear in my right knee and nerve compression/osteo-airthritis in my right hand ever since my fall on road on 15th october 2024. Doctors say ligaments wont heal and not worth operating so I need to live with supports. My employer has been paying me full so far. Have a corporate group personal accidental coverage. Company HR refused my PPD claim and offering 10k settlement. What can/should I do? till now working remote but most cos now asking for wfo.
Answers (1)

Answer #1
560 votes
In your case, since you have sustained permanent partial disability (PPD) due to an accident and are covered under a corporate group personal accident insurance, the insurer is legally bound to assess and compensate you based on the extent of disability as certified by a registered medical practitioner, not arbitrarily. Here’s what you can do: 1. Obtain a Disability Certificate: Get a detailed medical certificate from a government or empanelled doctor specifying the percentage and nature of permanent partial disability, as this will form the basis of your PPD claim. 2. Review the Policy Document: Go through the terms of the group accident policy—particularly the PPD compensation table, which typically assigns percentage-based compensation amounts depending on the affected body part and severity. 3. File a Formal Claim in Writing: Submit a written claim request to the insurance provider through your employer, enclosing the disability certificate, medical reports, and accident details. Insist on a written explanation for any denial. 4. Escalate the Matter: If the HR or insurer still refuses to honour the claim fairly, you can file a complaint before the Insurance Ombudsman under IRDA guidelines. The Ombudsman can order compensation based on policy terms. 5. Alternative Legal Route: As a last resort, you can also file a civil suit for compensation in the appropriate court based on policy coverage and the injury suffered. Since you are working remotely but may be asked to return to office soon, and your condition restricts mobility, you may also seek protection under the Rights of Persons with Disabilities Act, 2016, for reasonable workplace accommodation.
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