A serious accident can stop an employee from working for weeks, or for good. Disability benefits are therefore one of the most important parts of a Group Personal Accident (GPA) policy. The amount paid isn’t a fixed figure, though. Instead, it depends on the type and severity of the disability, the policy’s benefit schedule, and its conditions.
This guide explains the disabilities covered under Group Personal Accident insurance, how insurers calculate each benefit, and what HR teams should check in their own policy. In addition, the percentages quoted come from two published insurer policy wordings, which we name alongside each figure. However, they only illustrate how such schedules work; they are not a universal standard.
GPA policies generally recognise three disability categories:
- Permanent Total Disability (PTD) – permanent, total loss of specified functions, such as sight in both eyes, or of all capacity to work.
- Permanent Partial Disability (PPD) – permanent loss of part of the body, such as a finger, paid as a percentage of the sum insured.
- Temporary Total Disability (TTD) – temporary inability to work after an accident, usually paid weekly.
Still, definitions, percentages, and limits vary by policy.
What Types of Disabilities Are Covered Under Group Personal Accident Insurance?
A GPA policy can pay for three kinds of accidental disability – PTD, PPD and TTD – but only as the policy defines them and only if the schedule includes them. Also, an accidental bodily injury triggers these benefits, not an illness.
Disabilities covered by Group Personal Accident policies – comparison:
| Disability category | Meaning | Nature of disability | Typical benefit structure | Key condition to check |
|---|---|---|---|---|
| PTD | Total, irrecoverable loss of specified functions, or permanent inability to do any work | Permanent and total | Lump sum, often 100% of the sum insured for listed losses (as in both wordings reviewed) | The exact list of losses, and the “any employment or occupation” test |
| PPD | Permanent loss, or loss of use, of part of the body | Permanent but partial | Lump sum: a scheduled percentage of the sum insured | The percentage table, and how the insurer assesses unlisted injuries |
| TTD | Temporary total inability to work | Temporary and total | Weekly payment for a limited number of weeks | Weekly amount, maximum weeks, any waiting period |
However, not every GPA policy includes all three. Some cover death and PTD only, so check the schedule.
What Is Permanent Total Disability (PTD)?
PTD is a permanent and total disability that the policy specifically recognises, such as the loss of both eyes or both hands, or a disability that permanently prevents the insured person from working at all. It therefore differs from PPD, which affects only part of the body, and from TTD, which is temporary.
Still, a medical diagnosis isn’t the same as a payable PTD claim. A doctor may describe a serious impairment, but the insurer pays only if the loss matches the policy’s definition. In particular, both wordings reviewed use two tests:
- Specified losses – for example, “total and irrecoverable” loss of sight in both eyes, or physical separation of two hands or two feet. Both pay 100% of the sum insured for these. They pay 50% for the loss of one eye, or of one hand or foot (ICICI Lombard Section 2.2; Royal Sundaram D.2(a)-(b)).
- Total inability to work – an injury that permanently and totally disables the person from “engaging in any employment or occupation” (ICICI Lombard Section 2.2). This is a strict test: being unable to return to your own job may not be enough.
The 12-month condition. Specifically, both wordings require the specified loss to result from the injury within twelve months of the accident. This is different, though, from saying a disability must “last 365 days”.
Other policies may define PTD differently, for example by reference to the person’s own occupation. Therefore, check your wording.
Hypothetical PTD Calculation
Assumptions: sum insured ₹20,00,000. The loss is sight in both eyes, which is 100% under the ICICI Lombard wording.
Therefore, ₹20,00,000 × 100% = ₹20,00,000. If the loss were one hand only (50% under the same wording), the benefit would be ₹10,00,000.
What Is Permanent Partial Disability (PPD)?
PPD is the permanent loss, or loss of use, of part of the body – a finger, a toe, or hearing in one ear, for example – paid as a percentage of the sum insured according to the policy’s schedule. Unlike PTD, the person can usually still work, perhaps in a different capacity.
Generally, insurers calculate PPD by applying the scheduled percentage for the specific loss to the sum insured. The percentage depends on the body part and on how much of it the person loses; for instance, one phalanx (finger bone) versus the whole finger.
For injuries not in the table, both wordings say a doctor assesses the percentage – “as assessed by the Doctor” (ICICI Lombard) or by the company’s panel doctor (Royal Sundaram). So don’t assume a percentage from the name of the injury.
The figures below come from two published policy wordings. However, they are specific to those policies, are not an industry standard, and don’t replace your own policy schedule.
Illustrative PPD Compensation-Percentage Table
| Injury or loss specified in the policy | Insurer and policy/document name | Stated compensation percentage | Relevant policy wording or section | Verification source |
|---|---|---|---|---|
| All toes | ICICI Lombard – Group Personal Accident (UIN ICIPAGP03004V040203) | 20% | Part II, Section 2.3 | ICICI Lombard wording |
| Great toe – both phalanges | ICICI Lombard – Group Personal Accident | 5% | Part II, Section 2.3 | As above |
| Hearing – both ears | ICICI Lombard – Group Personal Accident | 75% | Part II, Section 2.3 | As above |
| Hearing – one ear | ICICI Lombard – Group Personal Accident | 30% | Part II, Section 2.3 | As above |
| Four fingers and thumb of one hand | ICICI Lombard – Group Personal Accident | 40% | Part II, Section 2.3 | As above |
| Thumb – both phalanges | ICICI Lombard – Group Personal Accident | 25% | Part II, Section 2.3 | As above |
| Thumb – one phalanx | ICICI Lombard – Group Personal Accident | 10% | Part II, Section 2.3 | As above |
| Index finger – three / two / one phalanges | ICICI Lombard – Group Personal Accident | 10% / 8% / 4% | Part II, Section 2.3 | As above |
| Little finger – three / two / one phalanges | ICICI Lombard – Group Personal Accident | 4% / 3% / 2% | Part II, Section 2.3 | As above |
| Any other permanent partial disablement | ICICI Lombard – Group Personal Accident | As assessed by the doctor | Part II, Section 2.3 (xii) | As above |
| Hearing – both ears / one ear | Royal Sundaram – Group Personal Accident Policy (APA002) | 75% / 30% | Section D.2(d) | Royal Sundaram wording |
| Four fingers and thumb / four fingers | Royal Sundaram – Group Personal Accident Policy (APA002) | 40% / 35% | Section D.2(d) | As above |
| All toes | Royal Sundaram – Group Personal Accident Policy (APA002) | 20% | Section D.2(d) | As above |
In both wordings, the loss of one eye isn’t in the PPD table. Instead, the permanent disablement section pays it at 50% – a reminder that insurers group benefits differently.
Hypothetical PPD Calculation
Assumptions: sum insured ₹10,00,000. The loss is two phalanges of the index finger, which is 8% under the ICICI Lombard wording.
Therefore, ₹10,00,000 × 8% = ₹80,000.
Under the same wording, after a PPD payment, the insurer reduces that person’s sum insured by the amount paid (Part III, clause 9(iv)(b)). So, in this example, ₹9,20,000 would remain for future claims in the policy period.
What Is Temporary Total Disability (TTD)?
TTD is a temporary disability that leaves the insured person totally unable to work for a period, after which the person should recover. It differs from PTD and PPD because the person loses nothing permanently.
However, being off work doesn’t automatically mean a TTD claim. Specifically, both wordings reviewed require total inability to engage in any employment or occupation, as a direct result of the accidental injury. As a result, an employee who can do light or alternative work may not qualify.
However, policies set the weekly amount differently:
- Royal Sundaram (APA002, D.2(e)): 1% of the capital sum insured per week, not exceeding ₹3,000 per week across all policies, for up to 104 weeks. Total payments cannot exceed the sum insured.
- ICICI Lombard (Section 2.4): a weekly amount “as stated… in the Schedule”, for up to 104 weeks or as stated in Part I. Total payments cannot exceed the sum insured.
Neither wording states a waiting period. Nevertheless, some policies do have a waiting period or a minimum disability period before payment starts. Also, TTD doesn’t necessarily track salary, so it may not replace the employee’s full pay.
How TTD Weekly Benefits Work
- First, the accident happens and causes an injury.
- Medical documentation – then the employee gets a doctor’s certificate stating the period of total disability.
- The insurer assesses whether the injury meets the policy’s TTD definition.
- The insurer applies any waiting or qualifying period in the policy.
- The insurer then calculates the weekly benefit using the policy’s formula and any cap.
- Finally, payment continues only for certified weeks of total disability, up to the maximum period and the overall limit.
Overall, four things work together:
- The weekly benefit amount – what the insurer pays for each eligible week.
- The eligible weeks – the certified weeks of total disability.
- The maximum – the cap on the number of weeks, or the total payable.
- The waiting period – weeks at the start that the insurer doesn’t pay, where the policy has one.
Hypothetical TTD Calculation
Assumptions: the Royal Sundaram formula (1% of the sum insured per week, capped at ₹3,000); sum insured ₹5,00,000; 10 certified weeks of total disability; no waiting period.
- First, 1% × ₹5,00,000 = ₹5,000 per week, so the ₹3,000 cap applies.
- Therefore, ₹3,000 × 10 weeks = ₹30,000.
Variation (hypothetical – not from either wording): if a policy had a one-week waiting period, 9 weeks would be payable: ₹27,000.
If the employee is away for 14 weeks but certified as totally disabled for only 10, only 10 weeks qualify.
PTD vs PPD vs TTD – Key Differences
| Factor | PTD | PPD | TTD |
|---|---|---|---|
| Duration | Permanent | Permanent | Temporary |
| Permanence | Irrecoverable | Irrecoverable | Recovery expected |
| Nature of impairment | Total loss of specified functions, or of all capacity to work | Partial loss of a body part or function | Total but temporary inability to work |
| Common benefit calculation method | Percentage of SI (100% or 50% for listed losses in the wordings reviewed) | Scheduled percentage of SI | Weekly amount (a percentage of SI or a stated sum) |
| Potential payment structure | Lump sum | Lump sum | Weekly instalments |
| Main evidence or eligibility issue | Loss matches the definition; certified as permanent | Body part and degree of loss | Certified period of total disability |
| Important policy limitation | 12-month condition; “any occupation” test (wordings reviewed) | Unlisted injuries assessed by a doctor; SI may reduce after payment | Weekly cap; maximum weeks; aggregate limit |
How Disability Compensation Limits Work Under GPA Insurance
The sum insured is the reference point, but the amount payable depends on the benefit percentage, any caps, and the policy’s aggregate limit. In other words, a ₹10 lakh sum insured doesn’t mean the insurer pays ₹10 lakh for every disability.
- Percentage benefits. Insurers usually pay PTD and PPD as lump sums, calculated as a percentage of the sum insured.
- Weekly benefits. By contrast, TTD comes in weekly instalments, often with its own cap.
- Aggregate limit. In addition, both wordings cap total death and disability payments for a person in the policy period at the sum insured (ICICI Lombard Section 2.5; Royal Sundaram E.1(3)).
- Overlapping benefits. Moreover, Royal Sundaram states that compensation is not payable under more than one sub-clause for the same incident (E.1(1)). So, check how your policy treats combined injuries.
- Medical expenses are separate and payable only if the policy includes that extension. See medical expenses under GPA.
| Benefit or limit | What it means | What the HR buyer should verify |
|---|---|---|
| Sum insured | Base amount per employee | Flat, graded or salary-linked; adequacy |
| PTD benefit percentage or limit | Percentage paid for each listed total loss | The list of losses; the “any occupation” wording |
| PPD percentage schedule | Percentage for each partial loss | The full table; how the insurer assesses unlisted injuries |
| TTD weekly benefit | Weekly amount while totally disabled | Formula and cap in rupees |
| Waiting or qualifying period | Initial unpaid period, if any | Whether one exists, and its length |
| Maximum TTD payment period | Most weeks payable | Number of weeks (104 in both wordings reviewed) |
| Exclusions and eligibility conditions | Events or people not covered | The exclusion list; age and occupation limits |
Practical Examples of PTD, PPD, and TTD Claims
These are fictional scenarios to illustrate the mechanics. However, the insurer decides eligibility based on the policy wording, the evidence, and its assessment.
Example 1 – PTD (Arjun). For instance, a road accident leads to the loss of both feet. Under a policy that, like the wordings reviewed, pays 100% for the loss of two feet, and with an assumed sum insured of ₹15,00,000, the benefit would be ₹15,00,000. However, the loss must result within the policy’s 12-month window. Also, factors that could change the outcome include an exclusion (such as intoxication), disputed medical evidence, or a different definition in the policy.
Example 2 – PPD (Meena). Similarly, a factory accident causes loss of hearing in one ear. So, using the 30% shown in both wordings and an assumed sum insured of ₹8,00,000, the benefit would be ₹2,40,000. In addition, the insurer will need a specialist audiology report confirming that the loss is total and permanent. However, the insurer would assess a partial hearing loss differently.
Example 3 – TTD (Ravi). Lastly, a fall fractures Ravi’s wrist, and his doctor certifies him unfit for any work for 6 weeks. So, under a policy using the Royal Sundaram formula, with an assumed sum insured of ₹2,00,000, the weekly benefit is 1% = ₹2,000 (below the ₹3,000 cap). So, over 6 weeks, that is ₹12,000. If he could have done light duties, the claim might not qualify, and a waiting period would reduce the payable weeks.
What Documents Do Insurers Need for a Disability Claim?
Generally, insurers ask for some or all of the following. In any case, the insurer’s own checklist decides what you need.
- Completed claim form
- Accident details and an FIR (First Information Report) where the police handled the case
- Medical reports, treatment records and diagnostic reports, such as X-rays
- For PTD or PPD: a disability certificate stating the nature and degree of disability, from a competent or insurer-approved doctor
- For TTD: a certificate of the period of total disability, and a fitness certificate on recovery
- Employer confirmation of employment and, for TTD, leave records
- Identity and bank details
For the full process, also see SecureNow’s guide on how to file a GPA claim.
Common Mistakes to Avoid When Understanding GPA Disability Benefits
| Mistake | Why it matters | Recommended action |
|---|---|---|
| Assuming every injury qualifies | Only defined disabilities are paid | Check the definitions |
| Treating PTD, PPD and TTD as interchangeable | Different tests and payouts | Learn each definition |
| Assuming PPD percentages are universal | Schedules differ between insurers | Read your own schedule |
| Assuming TTD pays full salary | It may be capped or based on the sum insured | Check the formula and cap |
| Ignoring waiting or maximum periods | They reduce payable weeks | Confirm both in the wording |
| Confusing the sum insured with the payout | Payouts are percentages of it | Work through examples |
| Relying on summaries | Summaries omit conditions | Read the policy wording |
| Skipping exclusions and documents | Claims may be delayed or refused | Review GPA exclusions and the claim checklist |
How HR Teams Should Review GPA Disability Benefits
- Confirm the PTD, PPD, and TTD definitions, including the “any occupation” wording.
- Then check the PTD percentages and the list of losses.
- Review the full PPD schedule and how the insurer assesses unlisted injuries.
- Verify the TTD formula, weekly cap, maximum weeks, and any waiting period.
- In addition, check the aggregate limit and whether the sum insured reduces after a claim.
- Also review the exclusions.
- Similarly, confirm the claim documentation process.
- Then compare these terms across quotations on an equal basis.
- Ask the insurer or broker to clarify any unclear wording before purchase.
SecureNow’s guide to what a GPA policy covers explains the wider cover. Also, its list of GPA add-on covers includes extensions, such as mobility support, that some employers add for disabled employees.
Conclusion
Overall, disability benefits are where GPA policies differ most, and where assumptions are most costly. In short, knowing the definitions, the percentage schedule, the TTD formula and the overall limits tells HR teams and employees what the policy will actually pay after an accident.
Before relying on your cover, read the policy wording and schedule. Also, ask your insurer or a qualified insurance adviser to explain anything unclear. To review or compare cover for your workforce, explore Group Personal Accident insurance with SecureNow.
This article is general information. Also, percentages quoted are from the named policy wordings and apply only to those policies. Therefore, your benefits depend on your own policy schedule and wording. Insurance is the subject matter of solicitation.
Frequently Asked Questions
Q) What disabilities are covered under Group Personal Accident insurance?
A) Generally, GPA policies cover three types of accidental disability: Permanent Total Disability (PTD), Permanent Partial Disability (PPD), and Temporary Total Disability (TTD). However, which ones apply, and how the policy defines them, depends on its schedule and wording.
Q) What is the difference between PTD and PPD?
A) PTD is a total, permanent loss of specified functions, or of the ability to do any work. In contrast, PPD is the permanent loss of part of the body or its function, such as a finger, paid at a smaller scheduled percentage of the sum insured.
Q) What is the difference between permanent and temporary disability?
A) A permanent disability is irrecoverable, so the insurer pays it as a lump sum. By contrast, a temporary disability should end with recovery, and the insurer usually pays it weekly while the person is totally unable to work.
Q) How do insurers calculate PPD compensation under GPA insurance?
A) Specifically, the insurer applies the percentage in the policy’s PPD schedule for the specific loss to the sum insured. For example, under one published wording, 8% applies to two phalanges of the index finger: 8% of ₹10 lakh is ₹80,000.
Q) Is the PPD compensation percentage the same for every insurer?
A) No. Schedules can differ in their percentages, in the injuries they list, and in how the insurer assesses unlisted injuries. So, always use the percentages in your own policy schedule.
Q) How does a TTD weekly benefit work?
A) Generally, the insurer pays a weekly amount for each certified week of total disability, calculated by the policy’s formula, up to any weekly cap and a maximum number of weeks. For example, one published wording pays 1% of the sum insured per week, up to ₹3,000, for up to 104 weeks.
Q) Does TTD always cover an employee’s lost salary?
A) No. In fact, TTD may be based on the sum insured or a fixed amount, may have a weekly cap, and usually requires total inability to do any work. As a result, it may pay less than the employee’s salary.
Q) Is a disability benefit automatically payable after an accident?
A) No. First, the disability must meet the policy’s definition. In addition, the policy must cover the accident, no exclusion may apply, and the required medical and other documents must support the claim.
Q) What documents do insurers need for a GPA disability claim?
A) Typically, the claim form, accident details or an FIR, medical and diagnostic records, a disability certificate (PTD or PPD) or a certificate of the period of disability (TTD), employer confirmation, and identity and bank details. Still, the insurer’s own list prevails.
Q) Where can an HR buyer check the applicable disability limits?
A) In the policy schedule and the policy wording – specifically the benefit table, the PPD schedule, the TTD clause, and the aggregate-limit clause. Also, the insurer or broker can explain any unclear term.
