A 49-year-old man has finally received insurance compensation worth Rs. 16.5 lakhs. Eight years ago he became blind in one eye after a road accident. “My retina has completely detached, leaving my eye clouded and without vision,” he said. But the fight wasn’t just medical—it was against an insurance system that dismissed his pain and denied his rightful claim.

According to the experts, his case highlights the emotional and legal toll numerous policyholders deal with and underscores increasing calls for reform in how insurers assess disability and settle claims.

In 2017, Chetan Tolia, a jewelry businessman from Ghatkopar, suffered a road accident in Hyderabad, after which he went through numerous surgeries, which included a failed corneal graft and treatment for retinal detachment. The vision in his left eye was declared permanently lost. In his personal accident policy with The New India Assurance Company Limited, it said it was only partial vision loss, so they paid much less than what the policy promised.

Although, the 30% The amount was based only on the damage to one eye—not on overall vision loss. The similar certificate mentions a “complete mobile retinal detachment” and states the condition as “permanent, non-progressive, and not likely to improve.” Apart from this, the insurer addressed the percentage as a reflection of overall disability. They ignored the fact that no one checked how both eyes work together or how it affects daily life.

Dr. M. S. Kamath, secretary of the Consumer Guidance Society of India, said that the certificate from JJ Hospital was unclear—it didn’t mention whether the disability percentage was for one eye or overall eyesight. The insurance company used this number without understanding the full medical situation. He explained that a damaged eye with complete retinal detachment means total vision loss. The insurance policy talks about “loss of sight,” not percentages. So, the company misused the report to reject the full claim.

Tolia, the person affected, said the company ignored his pain and the seriousness of his condition. “My eye was beyond recovery. Still, they used one unclear number to deny me what I deserved,” he said.

Over the years, Tolia complained many times to the company’s grievance cell and even the insurance ombudsman, but he didn’t get justice. During this time, his health got worse, he lost more vision, and he felt mentally stressed because the system that was supposed to help him didn’t care.

Finally, in April 2025, the District Consumer Court in Mumbai ruled in Tolia’s favor. The court said the insurer had misunderstood the medical evidence. The policy clearly stated that if someone lost full sight in one eye, they should get 50% of the insured amount. The court ordered New India Assurance to pay Rs. 16.5 lakh with 6% interest from 2017, plus Rs. 35,000 for mental stress and legal costs.

The insurance company did not respond to questions from Hindustan Times.

Dr. Kamath also said the JJ certificate only measured the damage in one eye—it wasn’t meant to judge total disability. The insurer used it wrongly on purpose.

Tolia’s case has raised concerns about how private health insurance works in India. Dr Kamath said insurers often reject valid claims by misusing medical terms and outdated rules. He said there are no proper guidelines or neutral medical reviews, so insurance companies act as both judge and jury.

Human rights activist Nilesh Panchal said the insurance regulator (IRDAI) must take action. He called for strict rules, fines for unfair claim rejections, and clear communication from insurers. He said people recovering from serious health problems are especially at risk of being treated unfairly.

Panchal also said many people don’t fully understand their insurance policies, especially in lower- and middle-income groups. “There’s a big gap in power between insurance companies and the people making claims,” he said. “We need more than just rules—we need responsibility, clear medical guidelines, and compassion in the system.”