Mumbai: Shoba Kshirsagar, 55, a waste-picker in Pune, became the sole breadwinner overnight after her 35-year-old son, who worked alongside her, was injured in a road accident in November last year. A dumper truck hit him while he was returning from work, leaving him with a crushed ankle.First, a private hospital refused treatment citing the family’s inability to pay. Later, Sany Sadashiv got surgery which involved insertion of a metal rod. Months later, he is still unable to walk properly or resume work.The family – Shoba, her son, daughter-in-law and two grandsons aged 10 and 15 – spent Rs 2.75 lakh on treatment, largely out of pocket. Their contract with the urban body includes insurance, but the coverage is low at Rs 30,000, and only Rs 15,000 can be claimed per instance, Shoba said.India is among the countries with the highest road crash fatalities, with low- and middle-income countries accounting for a disproportionate share of global deaths despite having fewer vehicles per capita. In 2023, the country recorded 480,583 road accidents, resulting in 172,890 deaths and 462,825 injuries, up 2.6% from 2022, according to the Ministry of Road Transport and Highways data. Two-thirds of deaths (66.4%) occurred among individuals aged 18-45, in the productive working age, leaving families such as the Kshirsagars’ in financial ruin.Indian laws provide for road accident survivors in two ways: The mandatory third-party insurance helps with damages, while a Motor Vehicle Accident Fund provides compensation for treatment or in cases of death. The Motor Vehicles Act also provides for cashless treatment during the “golden hour,” aiming to reduce immediate out-of-pocket expenditure. But studies show this is not happening at scale and more importantly, in time.Shoba’s family, for instance, have filed a claim under the truck’s third party insurance, but the case is ongoing. They moved out of their home, putting it on rent, and took up a smaller place themselves on rent. Shoba saved Rs 200-300 a month through the waste-pickers’ collective, and has had to dip into the savings to sustain expenses.Income shockRoad accidents lead to losses of between 3% and 7% of gross domestic product (GDP) due to healthcare costs, productivity loss, and wider system impacts. These accidents, as we said, disproportionately affect individuals in the 15-49 age group, meaning the country is losing people in their most productive working years.Ranjit Gadgil, programme director at Parisar, a Pune-based transport advocacy organisation, argues that road crashes are increasingly understood through a public health lens rather than as individual failures. “The Safe System Approach recognises that crashes are less about individual mistakes and more about how the transport ecosystem is designed,” he said. “Better systems reduce both the likelihood of crashes and the severity of injuries—and this directly reduces the financial burden on individuals.”Poor households are particularly affected, both economically and in terms of survival and long-term outcomes, a 2021 World Bank study which examined accidents from four Indian states shows.For instance, only 64% of victims from low-income households survive crashes compared to 87.5% from high-income households. Less than 25% of low-income victims are aware of compensation and insurance processes, and only a small proportion actually receive payouts.Insurance coverage itself is also unequal, only 40% of truck drivers had life insurance and just 18% had medical insurance, while two-thirds were unaware of third-party liability insurance.Impact on different households after a road crash, source: World Bank, 2021. Photo: IndiaSpend.“Informal workers are most exposed,” explains Gogavale. They lack social security, paid leave, and insurance coverage, which makes “both income loss and medical expenses far more difficult to absorb.”Among low-income households, expenses on hospitalisation and medicines accounted for Rs 78,824 or about 52% of household income, according to the World Bank study. Among higher-income households, this was Rs 60,476, amounting to 30.5% of income. Poorer households were more likely to borrow money, and sell or mortgage assets to meet costs, leading to long-term distress.The bumps in the road to compensationEven for survivors who are financially better off, compensation procedures are long-drawn.Mitali (name changed), in her early 30s, working at a multinational company in Gurugram, was returning from a nearby petrol station late at night in 2025 when a car driving on the wrong side of the road hit her scooter and the driver fled the scene. She and her companion were wearing helmets, but she suffered multiple fractures and extensive damage to one leg. The injuries left her dependent on crutches for months.Initially, she required an attendant even for daily activities such as using the toilet. Between surgery, treatment, vehicle damage, and loss of income, she estimates her total losses at Rs 10-12 lakh. She was forced to take a six-month sabbatical from work before eventually resigning from her job altogether. She did not receive medical reimbursement.While CCTV footage helped police identify the vehicle involved, pursuing compensation proved difficult. She was informed about the Motor Accident Claims Tribunal process only after the FIR was filed and was told that she would need to appear physically in court and hire a lawyer. By the time she was physically able to initiate proceedings, months had already passed. Although the accident occurred in 2025, her case could only be formally brought before the court in 2026. The lawyer handling her case charged contingency fees amounting to 30% of the compensation sought, in addition to separate fees for documentation and court appearances. Her case remains pending.A January 2026 research by Crashfree India—drawing on over 50 legal and policy sources and field research with crash victims across Delhi-NCR—found that few victims receive formal support through compensation mechanisms such as insurance payouts and ex gratia support.Despite Supreme Court-mandated obligations on police to inform victims, 70% of low-income and 63% of higher-income households are unaware of compensation schemes, the report found. It explains why only 205 claims were filed against 25,000 eligible hit-and-run crashes in 2022-23. This number rose to 3,000 claims the following year.This appears to be driven primarily by the rollout and strengthening of the new compensation scheme, improved administrative processing by the General Insurance Council, and better claim registration—not necessarily by a sudden increase in accidents, says Ajay Gogavale, senior vice president, climate action & community resilience at United Way, Mumbai, a non-profit that works on road safety, among other issues.“First Information Reports are delayed or never filed as many of the victims are not even aware of this procedure, especially among vulnerable road users and informal workers,” says Kesar Kanjhlia, research lead of Crashfree India.Kanjhlia describes failures at every stage of the process. Police delays and misclassification of first information reports, lack of outreach by district officials, repeated back-and-forth between officials, and bottlenecks at disbursal all compound one another.“While the ideal timeline is three months for hit and run cases specifically, actual timelines can stretch to several months or longer,” she said. “Very few victims ultimately receive compensation.”Further, 921 of 1,026 pending claims (90%) as of July 2024 were stalled due to documentation deficiencies—including missing FIRs, hospital records, or insurance papers.To avoid such delays, victims often enter into out-of-court settlements. “Judicial compensation takes into account multiple factors—loss of income, future prospects, medical expenses, and funeral costs,” said Kanjhlia. “These structured calculations are often absent in informal settlements, leading to lower payouts.”Even successful claims fall shortThe Crashfree India study noted that the average compensation timeline is 3.6 years, with many cases stretching to 8-10 years, while 1.05 million cases worth Rs 80,455 crore remain pending nationwide as of May 2024. Meanwhile, compensation funds accumulate within the system. For example, Rs 282 crore in Gujarat high court, Rs 459 crore in Mumbai high court , Rs 361 crore in Goa High court remain unspent.In 2004, Deepak Kumar (name changed), then a government employee in his thirties, met with an accident where a van ran over his neck, leaving him with severe spinal cord injuries and near-total disability. He has since been bedridden and dependent on a wheelchair, requiring full-time care from his wife. His wife now supports the household while also acting as his primary caregiver, managing his daily needs and accompanying him to repeated court hearings.Although a lower court awarded compensation of 50% of the claim, the insurance company appealed the decision, resulting in prolonged litigation and a partial stay on payment. He alleges that insurance representatives repeatedly fail to appear in court, contributing to delays. According to him, hearings are routinely postponed, forcing the couple to spend entire days waiting in court with no resolution. Legal costs have added to the burden.“The key issue is not just the amount, but access,” said Gadgil. “By the time compensation arrives, families may already have taken on debt at high interest rates.”The study quoted insurance officials to say that 50-60% of motor accident claims settled outside courts through Lok Adalats.Gogavale identifies awareness as the central gap. The Ministry of Road Transport and Highways has a scheme covering medical expenses for the first 24 hours after a crash, but private hospitals are reluctant to implement it. “For such initiatives to work, two things are critical,” he said. “Strong enforcement to ensure hospitals comply, and widespread public awareness so that people know their rights.”IndiaSpend reached out to the Ministry of Road Transport and Highways for comment and will update this story when it receives a response.This story was originally published on IndiaSpend and has been republished with permission.