Permanent partial disablement under an insurance policy is determined by the percentage of impairment certified by a competent medical authority and is not restricted solely to cases involving amputation.

ORAL ORDER

1. By the present writ petition, the petitioner is challenging the order dated 29.12.2025 passed by the learned Insurance Ombudsman, Ahmedabad, whereby the complaint No.AHD-H-044-2526-2241 dated 29.12.2025 has been allowed and the respondent has been awarded permanent partial disablement claim as well as hospitalization cash benefit.

2. The learned counsel for the petitioner submits that in the present case, there was a fracture injury to the respondent and it could not be categorized as permanent partial disablement. He submits that the petitioner Insurance Company has repudiated the claim of the respondent in terms of the Insurance Policy. The learned counsel further submits that the respondent was treated for left foot crush injury and metatarsel fracture, which is not covered under the Insurance Policy. The diagnosis also is not covered under the benefits stated in Table B2. The learned counsel, therefore, submits that the petitioner Insurance Company is not liable to pay the claim amount as the treatment falls outside the scope of the policy coverage. The learned counsel further submits that even the medical certificate dated 07.03.2025 does not state any permanent disablement caused to the respondent. He, therefore, submits that the impugned order be set aside.

3. Heard the learned counsel for the petitioner, considered the submissions and perused the documents on record.

4. By the impugned order, the learned Insurance Ombudsman has considered the arguments raised by the petitioner herein. It has been held that the clause regarding permanent partial disablement– Table B2 clearly mentions that the permanent partial disabilities are to be compensated based on the percentage assessed by the competent medical authority. In the present case, the Government Hospital Doctor has assessed the complainant’s permanent disability at 13%, which is not disputed. It is further noted that the policy does not restrict permanent partial disablement only to cases involving amputation. As rightly observed by the learned Insurance Ombudsman, the decisive factor under the permanent partial disablement clause is permanent impairment duly certified by the Government Medical Authority. In the present case, the respondent has suffered permanent partial disablement to the extent of 13%. Accordingly, the learned Insurance Ombudsman has settled the claim of the respondent by awarding 13% of the capital sum insured under the permanent partial disablement benefit. Consequently, the respondent is also entitled to hospitalization cash benefit as awarded.

5. No infirmity can be attached to the impugned order. The impugned order is just and proper and in accordance with the Insurance policy taken by the respondent. The Special Civil Application is devoid of merits and is accordingly dismissed. No order as to costs.