Mumbai News: Man Wins ₹16.5 Lakh Insurance Payout After 8-Year Legal Fight Over Vision Loss
Mumbai News: Man Wins ₹16.5 Lakh Insurance Payout After 8-Year Legal Fight Over Vision Loss
In a landmark victory for policyholders, a 49-year-old jewellery trader from Ghatkopar, Mumbai, has secured a ₹16.5 lakh insurance payout after an eight-year legal battle following the loss of vision in one eye due to a road accident as reported by Hindustan Times. The ruling, delivered by the District Consumer Disputes Redressal Commission (Mumbai Suburban Additional), highlights critical flaws in insurance claim processing and emphasizes the need for greater transparency and consumer protection in the sector.
Chetan Tolia suffered a traumatic eye injury in a 2017 road accident in Hyderabad, resulting in complete and irreversible blindness in his left eye. Despite this, The New India Assurance Company Limited initially paid him only ₹4.5 lakh—substantially less than the 50% compensation promised under his personal accident policy for total vision loss in one eye.
The insurer based its decision on a disability certificate from J J Hospital, which mentioned “30% disability.” However, this figure referred specifically to the affected eye and not to overall bodily impairment. The same certificate confirmed a “complete mobile retinal detachment” and described the condition as “permanent, non-progressive and not likely to improve.”
Medical experts and consumer advocates criticized the insurance company’s interpretation of the certificate. “There was a clear misunderstanding or deliberate misrepresentation of what the disability percentage meant,” said Dr. M S Kamath, Secretary of the Consumer Guidance Society of India. “Insurance policies typically define loss based on functionality, not percentages. When an eye is completely non-functional, that is total vision loss, and the compensation should reflect that.”
Tolia recounted the emotional and financial toll of the prolonged dispute. “They treated me like a statistic, not a human being,” he said. “Despite all the medical reports and proof, I had to fight every step of the way to be heard.”
The consumer commission ruled that the insurer had “misinterpreted the medical certificate” and ignored the clear terms of the policy. It directed the company to pay the full ₹16.5 lakh sum along with 6% annual interest from 2017, and ₹35,000 for mental distress and litigation expenses.
Health rights advocates are now calling for systemic reforms. “Insurers must be held accountable for unfair claim rejections,” said Nilesh Panchal, a human rights advocate in the healthcare space. “The Insurance Regulatory and Development Authority of India (IRDAI) should mandate standardized disability evaluations and enforce transparent communication with policyholders.”
Panchal also highlighted the lack of awareness among the general public about insurance procedures. “Many people, especially in middle- and lower-income groups, don’t understand policy terms or how to challenge claim denials. We need a more empathetic and accountable system.”
