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After eight years of devastating road accident in Hyderabad robbed him of sight in one eye, 49-year-old Chetan Tolia, a jewellery businessman from Ghatkopar, Mumbai, has finally won a long legal battle against his insurance provider. The District Consumer Disputes Redressal Commission, Mumbai Suburban Additional, has ordered The New India Assurance Company Limited to pay Tolia ₹16.5 lakh—the full compensation he was entitled to under his personal accident policy—along with 6% interest from 2017 and ₹35,000 for mental agony and litigation costs.
Tolia’s journey to justice was long and emotionally grueling. After the 2017 accident, he underwent multiple surgeries, including a failed corneal graft and treatment for a retinal detachment. Despite efforts, the vision in his left eye was declared permanently and irreversibly lost. According to the terms of his policy, he was eligible for 50% of the insured amount—₹16.5 lakh—for total loss of sight in one eye.
However, the insurer initially paid him just ₹4.5 lakh, citing a medical certificate from J J Hospital that reported a “30% disability.” New India Assurance interpreted this figure as indicative of partial vision loss, thus justifying a reduced payout. But medical experts later clarified that the 30% referred only to impairment in the affected eye, not to overall visual function. The same certificate also noted a “complete mobile retinal detachment,” describing the condition as “permanent, non-progressive and not likely to improve.”
Dr. M S Kamath, Secretary of the Consumer Guidance Society of India, criticized the insurer’s interpretation. “The policy talks about total loss of sight—not disability percentages. The insurer cherry-picked numbers and ignored the full medical context. This was a clear case of total and permanent loss of vision in one eye.”
For Tolia, the insurer’s denial was more than a financial blow—it was a dismissal of his suffering. “My eye is clouded, beyond recovery, and I’ve lived with this for eight years. Yet, they reduced my pain and trauma to a statistic,” he said.
Despite multiple appeals to the insurer’s grievance cell and the insurance ombudsman, Tolia found no resolution until the Consumer Commission ruled in his favor this April. The Commission concluded that New India Assurance had “wrongly interpreted the medical evidence” and failed to abide by the policy’s straightforward clause entitling him to full compensation for total sight loss in one eye.
Dr. Kamath emphasized that the J J Hospital certificate was never meant to assess overall disability. “Using it to justify a reduced claim was a misrepresentation,” he said.
Tolia’s case has sparked renewed debate about the conduct of insurance companies and the urgent need for reform in how claims—especially disability-related ones—are assessed and settled. “There’s a disturbing trend of insurers rejecting legitimate claims using ambiguous or outdated criteria,” said human rights activist Nilesh Panchal, who works in the healthcare sector.
Panchal stressed the need for intervention from the Insurance Regulatory and Development Authority of India (IRDAI). “We need strict enforcement, penalties for bad-faith denials, independent medical evaluations, and clear communication from insurers. Right now, the power imbalance heavily favors the companies.”
He also pointed out the lack of insurance literacy among middle- and lower-income groups, which leaves many unaware of their rights or unsure of how to challenge unfair decisions. “This isn’t just about compensation—it’s about restoring dignity and trust in the system,” Panchal said.
As Tolia finally receives the compensation he was promised, his story stands as a reminder of the systemic gaps in India’s insurance sector—and the resilience needed to overcome them.
