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Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC Traffic Crash Injuries and Disabilities: The Burden on Indian Society 20433, USA; fax: +1 (202) 522 2625; e-mail:  pubrights@worldbank.org TRAFFIC CRASH INJURIES AND DISABILITIES: THE BURDEN ON INDIAN SOCIETY 3 Traffic Crash Injuries and Disabilities: The Burden on Indian Society TABLE OF FOREWORD CONTENTS CHAPTER 1 Executive Summary 01 CHAPTER 2 09 Introduction CHAPTER 3 15 Research Methodology, Sample Design & Sample Coverage CHAPTER 4 21 Socio-Economic Impact of Road Crashes CHAPTER 5 53 Gendered Impact of Road Crashes CHAPTER 6 63 Psychological and Social Impact of Road Crashes CHAPTER 7 75 Impact of Road Crashes on Adolescents CHAPTER 8 81 Outcomes of the Insurance & Legal Compensation Process CHAPTER 9 101 Interactions with Institutions CHAPTER 10 107 Way Forward Annexure & Appendix 125 5 FOREWORD FOREWORD Road crash deaths in India, which are the highest in the world, are a burden on its demographic dividend and have a tangible impact on poverty. The disproportionate impact can be gauged by the fact that with only 1 percent of world’s vehicles, India accounts for 11 percent of all crash related deaths or expressed different, a crash death happening every four minutes. Crashes on India’s roads claim the lives of about 150,000 people and disable at least an additional 750,000 each year, large share of which are pedestrians and cyclists, mainly representing working age adults from the poorer strata of society. Traffic literature has confirmed that road crash injuries and deaths have a profound long-term impact on income growth and welfare loss that further constrains the human capacity in emerging economies. A previous macroeconomic study by the World Bank on road safety indicated that reducing road traffic injuries in half could translate into an additional 15 to 22 percent of GDP per capita income growth over 24 years. This means in practice that, for a country like India, failing to meet the UN Sustainable Development Goal target to halving road deaths by 2020—this is, the cost of inaction—accrues to about 2 - 3 percent points in unrealized per capita GDP growth for low- and middle- income countries. More recent work carried out by the India Ministry of Road Transport and Highways (MoRTH) have presented figures that crash costs may be equivalent to 3.14 percent of the national GDP. The impact of road injuries on economic productivity tells us only part of the story. Aside from their direct impact on Traffic Crash Injuries and Disabilities: The Burden on Indian Society the income growth of a country, road traffic injuries also low income households has been quantified along with cause individual and social welfare losses that cannot be providing insights into interactions of road crash victims ignored. The poor in particular are largely vulnerable to the and their families with systems, process and institutions impact of road crashes. In a country like India, pedestrians, like the police, insurance companies, and medical system. bicyclists and motorcyclists who mostly represent the poor income strata of the society also happen to have the Most importantly, this work reaffirms the importance of least safety protection in the event of a traffic crash. They looking at road safety as a cross-cutting development account for more than half the total road crash deaths. And issue for India. The emphasis being on improving India’s among those unfortunate ones who are involved in a crash crash reporting system, post-crash emergency care and do not have adequate access to medical and social safety protocols, and a proactive insurance and compensation net and the burden of the crash is borne not only by the scheme aimed at providing financial relief to the vulnerable victim but by their entire households and immediate family. sections of the society. Achieving a sustained reduction Such financial consequences of road traffic crashes and in road traffic injuries would be a significant milestone its impact on the poor makes this an impediment towards for India’s socioeconomic development, with far-reaching achieving World Bank’s goal of shared prosperity for the benefits for economic growth, wellbeing, and public health. bottom 40 percent of the society. While this is the beginning of the journey, such research and findings would arm policymakers with the knowledge While policymakers across sectors increasingly recognize and data they need to design solutions that benefit the road traffic injuries as a socioeconomic burden, there is poor, create resilient economies, and save millions of lives. limited evidence available in India which have purposely quantified the burden of road traffic injuries to the different Junaid Kamal Ahmad demographics of the society. The present survey-based Country Director, India study commissioned by the World Bank and implemented World Bank by Save LIFE Foundation – a national NGO focused on road safety – presents a novel and unique perspective into this data gap. The results from the study showcase links between poverty, gender, and road user-type by analyzing primary data collected from four states in India – Uttar Pradesh, Bihar, Tamil Nadu and Maharashtra. The novelty of the analysis is, for the first time in India, the disproportionate financial impact due to road crash crashes faced by 7 EXECUTIVE SUMMARY CHAPTER 1 ROAD CRASH STATISTICS GLOBAL • Globally, road crashes kill 1.35 million people and injure 50 million people every year; or more than 3000 persons every day. • Road Traffic Injuries (RTIs) are the 8th leading cause of death globally and leading cause of death among children and young adults aged 5-29. • There is ample evidence to suggest that RTIs affect the working age population most severely Traffic Crash Injuries and Disabilities: The Burden on Indian Society Road crashes endanger the lives and livelihoods of millions of road users globally and in India (see Box 1). Owing to the epidemic of road crashes, in 2010, the United Nations General Assembly proclaimed 2011 – 2020 as the “Decade of Action for Road Safety” and the Sustainable Development Goals (SDGs) included two important targets on road safety. The risk of a road crash in low-income countries is INDIA three times higher than compared to that in high-income countries. Not only does it lead to untold and unaccounted • India tops the world in for suffering and loss for victims and their families, but also, it drains the GDP of countries by claiming millions road crash deaths (WHO, of economically productive young lives. The World Bank 2018), with more than 400 estimates the total cost of Road Traffic Injuries (RTIs) at fatalities per day. $172 billion (INR 12.9 lakh crore) for the year 2016. While it is recognized that RTIs affect the developed and developing • India has 1% of the world’s world in different ways, it also impacts poor households and disadvantaged sections of the population within developing vehicles but accounts for countries differently. 11% of all road accident deaths and 6% of total road World Bank commissioned a survey-based assessment crashes (MoRTH, 2018) study in association with the Save LIFE Foundation (SLF) to determine such differential impacts more objectively in India. • In the last decade alone, road crashes have killed 1.3 This study aims to capture the socioeconomic realities million and injured over 5 and nuances of road crashes at the sub-national level in million in India. India. It seeks to document inter-linkages between poverty, inequalities, road users, and road crash outcomes by analyzing data from four States in India, i.e., Uttar Pradesh, Bihar ,Tamil Nadu and Maharashtra. The four states have been selected on the basis of several criteria including demographic and geographical representation, magnitude of fatality burden and socio-economic parameters such as economic growth, poverty rate and social welfare. One state from each of the four geographical zones of the country were selected which cumulatively represents about one third of 2 EXECUTIVE SUMMARY total road crash deaths in the country. In terms of economic covered over 2400 interviews with LIH, HIH and truck parameters, Maharashtra and Tamil Nadu are selected to drivers, the qualitative part of the study included 3 Focus represent High Capacity States (HCS) whereas Bihar and Group Discussions (FGDs) with women in Bihar and Uttar Uttar Pradesh are selected to represent Low Capacity States Pradesh and 8 in-depth interviews with adolescents. (LCS). The study quantifies the differential financial impact of RTIs on poor disadvantaged households by comparing a test sample of victims and their family members from Some of the key findings of the report are : Low-Income Households (LIH, i.e., the bottom 40% of the population by per capita income) with a control sample • Overall, the post-crash impact was more severe for of High Income Households (HIH, i.e., the top 10% of the LIH in Low Capacity States compared to HIH in High population in terms of per capita income). It also reveals the Capacity States. gendered and psychological impact of crashes, a subject that has been hitherto unacknowledged in previous studies. • The incidence of fatality post-crash is higher among It sheds light on the interactions of road crash victims and victims from LIH than HIH. As high as 44% of the their families with systems, processes and institutions such households in rural areas reported at least one death as the police, insurance companies and the medical care after a road crash compared to 11.6% of households in system at large. Further, this study also captures the level urban areas. Similarly, LIH reported twice the numbers of understanding and awareness of truck drivers on the of deaths post-crash vis-à-vis HIH. Victims from LIH recently passed Motor Vehicles (Amendment) Act, 2019 and and rural areas are also twice more likely to suffer a on insurance and compensation in the event of a crash. The disability after a crash than their HIH counterparts. study reveals that social hierarchies and realities like class, gender and geographical location largely determine road • The socio-economic burden of road crashes is crash outcomes and the severity of their impact in India. disproportionately borne by poor households. The It highlights the nature and extent of the disproportionate decline in total household income was sharper among impact of road crashes in terms of fatalities and serious LIH (75%) than HIH (54%). The severe impact of decline injuries among poor and rich households. It elaborates on in income was highest among LIH in rural areas (56%) how socioeconomic inequalities affect households and in compared to LIH in urban areas (29.5%) and HIH rural turn contribute to widening that gap. (39.5%), and cases where victims died as well as where victims were males. A multi-stage purposive sampling method was used to select the target respondents for this study. The key target • The ability to cope with financial distress post crash groups include road crash victims/their family members was better for HIH than LIH. LIH were three times who had undergone a serious injury or fatal crash, and more likely to seek financial help than HIH. Debt truck drivers involved in a crash in the last 15 years (from rates were also almost three times higher among LIH January 2005 - July 2019). Both exploratory and descriptive compared to HIH. In addition to financial distress, poor research was included. While the quantitative surveys households experience a deterioration in their quality Traffic Crash Injuries and Disabilities: The Burden on Indian Society of life accompanied by psychological suffering and crash emergency care and protocols, insurance and emotional distress. compensation systems. It presents an opportunity for development agencies working in the sector to prioritise • Within households, women bear the brunt of their targets and budgets, and for policymakers and caregiving activities post-crash, leading to a double respective State Governments to mandate a complete burden of labour and mental load and exacerbated policy overhaul of the existing system and implement inequality of opportunities in returning to livelihoods sustainable, solution oriented, inclusive measures to and income generating tasks. improve their performance on road safety. The report provides related recommendations for policy reform under • Inequality in insurance coverage and delay in six key areas as follows: accessing compensation mars the quick recovery process for LIHs. Insurance coverage was significantly 1. Need for effective institutional mechanisms and higher among HIH and households in urban areas vis- awareness building. à-vis LIH and urban areas. There is a need to improve VRU safety especially for • Information asymmetry and poor awareness of legal LIH in rural areas, who are most at risk in road crashes. compensation among LIH compounds their distress. There is also a need for the State Governments to ensure Only less than a quarter of the LIH victims were aware greater sensitisation and awareness among stakeholders, of the compensation process and insurance clauses; especially the police who are often reluctant to file FIRs. just a handful of the victims availed of government compensation/ex gratia. 2. Institutionalise post-crash emergency care and make health infrastructure & coverage more accessible & • Low rates of insurance coverage and poor awareness inclusive. related to legal compensation processes among truck drivers. Only a fifth and two-fifths of truck drivers The Central Government should urgently implement the surveyed were covered under medical insurance and cashless treatment scheme under Section 162(2) of Motor life insurance respectively at the time of the crash. Vehicle (Amendment) Act, 2019, reducing Out-of-Pocket- Overall, two-thirds of truck drivers were not aware Expenses for LIH, increasing health insurance coverage of third-party liability insurance. None of the drivers and extending its scope to address post-crash disability had applied/benefited from cashless treatment at the and mental health effects. hospitals, Solatium Fund for hit and run case or ex- gratia schemes. 3. Provide a Social Security Net for crash victims from LIH through State Support. The above findings of the report highlight the need for immediate improvements in crash reporting, post- The Central and State Governments should introduce 4 EXECUTIVE SUMMARY vocational and educational support for victims and their 6. Strengthen post-crash support for children and young families through community programmes and special adults through state support. schemes for jobs, skilling &education. Comprehensive rehabilitation support also needs to be extended to crash State Governments should implement progressive victims especially those with post-crash disabilities. provisions on child road safety under Sections 194B, 129 and 199A of the Motor Vehicles (Amendment) Act, 2019, 4. Create an accessible legal framework for availing framing a rigorous policy on child road safety and provide insurance and compensation for road crash victims. support for children and adolescents affected by road crashes. The State Government should ensure a minimum The Central Government should create schemes to increase of three month moratorium on school fees for children insurance coverage and penetration for LIH. Insurance impacted by road crashes from LIH. agencies should broaden the scope of insurance policies by including rehabilitation and recovery of crash victims. Since The report provides detailed recommendations for most compensation payments take time to process, under strengthening institutional agencies to respond to the Section 164A of MVAA 2019, the Central Government must needs of VRUs and associated households. It lays out make provisions to provide interim compensation to crash suggestions for States to strengthen their institutional victims to provide for immediate relief. The comprehensive capacities, to respond better to the challenges presented coverage of MCTAP needs to be ensured through better by road crashes and improve their performance, and to mechanisms for effective coordination. create efficient mechanisms for LIH to get access to legal and insurance-based compensation after a crash to 5. Recognize the gendered impact of road crashes and mitigate their financial burden. These recommendations, address it through participative governance & special if implemented, have the potential to significantly improve schemes for women the lives of vulnerable road users and to create far-reaching positive road safety outcomes. Central and State Governments should incentivize employment opportunities for women affected by road This study was initiated during the Covid-19 national crashes. Steps could include: encouraging small businesses lockdown period and has its limitations: it is limited to four in work from home set up, providing low-interest loans States; it covers the financial impact on households for just and emergency cash transfers to post-crash turned the treatment period; it does not cover minor injury cases female-headed households. Women from households and their impact. It focuses on highlighting the differences who have lost the breadwinners in road crashes should in the short-term and long-term, direct and indirect impacts also be automatically enrolled in the State Government’s of road crashes on the victims and their households by employment database. comparing those having meagre resources and capacities to respond to a road crash (Low Income Households) Traffic Crash Injuries and Disabilities: The Burden on Indian Society with those having comparatively more resources and We acknowledge the work being carried out by the Ministry of social capital to mitigate a sudden crisis (High Income Road Transport and Highways (MORTH) to improve overall Households).Additionally, this report was conceptualised road safety in the country. The Ministry’s annual report on as a sub-national study to understand the impact of road ‘Road Accidents in India’ is a valuable and rich resource for crashes from the perspective of specific demographics. policy makers and researchers alike that provides detailed Central and State governments to build on this by initiating and comprehensive data on the causes, patterns, types and studies at a more granular level (municipality, census inter-state and global comparisons of road crashes in the tract or ward levels) to assess the impact of crashes. In country. Working across the 4Es of road safety, Engineering, addition, the analysis is based on self-reported data from Enforcement, Education and Emergency care; the Ministry victims and their family members, and as such may be is undertaking various initiatives that demonstrate its susceptible to associated potential biases, although care global commitment to reducing road crash fatalities by at has been taken to mitigate this wherever possible. The least 50% by 2030. One such commendable initiative is the data has been validated by asking respondents different Integrated Road Accidents Database (IRAD) Project under questions at different points of time and cross-verifying World Bank Assistance that will help capture information in and triangulating the information provided by them through a more unified and holistic manner to facilitate formulation other qualitative methods (that use other data sources and execution of targeted programs. such as insurance service providers data, and data from other similar studies etc). Efforts were made to weed out The robust framework created by MoRTH for any biases that might have crept into the data thorough operationalising the MVAA, 2019 will go a long way quality checks and statistical data validation exercises. Due in empowering states to strengthen their electronic to the pandemic, the methodology also had to be revised by enforcement and monitoring systems, automate and adopting a mix of face-to-face and telephonic interviews integrate all road safety databases through digitisation, (with shorter questionnaires), and this may somewhat provide speedier assistance to road crash victims, effect as well. It also needs to be stated that this is not a strengthen public transport and improve road user longitudinal study (i.e., looking at long-term impacts of behaviour. We hope that the recommendations offered road crashes). As such, this study could be a precursor in this report would also help evolve the subordinate to follow-on studies on road crash related disabilities to legislation/rules under the MVAA, 2019 to truly make it holistically assess its long-term impacts on victims and more inclusive and effective. their households (that are done routinely worldwide). Nevertheless, a baseline mapping of road users via such state-specific assessments can help inform the choice, design, and sequencing of alternative policy options, which in turn can improve the lives of millions of road users in India. 6 2 OVERALL The incidence of fatality post-crash is higher among victims from LIH than KEY FINDINGS HIH. As high as 44% of the households in rural areas reported at least one death after a road crash compared to 11.6% of households in urban areas. Similarly, LIH reported over twice the numbers of 1 deaths post-crash vis-à-vis HIH. The risk Overall, the post-crash of a victim undergoing disability after an impact was more severe crash was two times more for LIH in Low Capacity likely among LIH in States compared to HIH rural areas. in High Capacity States. LIH HIH 3 The socio-economic burden of road crashes is disproportionately borne by poor households. Decline in total household income was sharper among LIH (75%) than HIH (54%). The severe impact of decline in income was highest among LIH in rural areas (56%) compared to LIH in urban areas (29.5%) and HIH rural (39.5%). 4 54% The ability to cope with financial distress post-crash was better for HIH than LIH. 75% LIH were three times more likely to seek financial help than HIH. Debt rates were also almost three times higher among LIH compared to HIH after the crash. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 5 6 In addition to financial Within households, it is distress, poor women who bear the households experience a brunt of caregiving deterioration in their activities, leading to a quality of life double burden of labour accompanied and mental load, with psychological exacerbated inequalities su ering and of opportunities in emotional returning to livelihoods distress. and income generating tasks. 7 Inequality in insurance coverage and delay in accessing compensation further mars the quick recovery process among LIH households. Insurance coverage was significantly higher among HIH and households in urban areas vis-à-vis LIH urban areas. 9 Low rates of insurance coverage and poor awareness related to legal compensation processes among truck drivers: Overall, 2/3rd of the respondent truck drivers did not file an FIR after the crash. Only 40% of 8 the truck drivers were covered under Information asymmetry and life insurance and 18% under medical poor awareness on legal insurance at the time of the crash. compensation among LIH: Overall, 2/3rd of the truck drivers Only less than a quarter of were not aware of third-party liability the LIH victims were aware insurance. None of the drivers said of the compensation that they had applied/benefited from process and insurance cashless treatment at the hospital, clauses. Only a handful of solatium fund for hit and run case or the victims availed ex-gratia schemes. government compensation/ex gratia. 8 INTRODUCTION CHAPTER 2 As the world navigates through the COVID-19 pandemic, the road crash pandemic continues to fester the socio-economic landscape in India. India tops the world in road crash deaths and injuries. It has 1% of the world’s vehicles but accounts for 11% of all road crash deaths, witnessing 53 road crashes every hour; killing 1 person every 4 minutes. In the last decade, 1.3 million (13 lakh) people have died and another 5 million (50 lakh) have been injured on Indian roads. Furthermore, 76.2% of people who are killed in road crashes are in their prime working-age, i.e. 18 – 45 years (MoRTH, 2018). Globally, Road Traffic Injuries (RTIs) are the eighth leading cause of death (WHO, 2018). However, the road crash fatality rate is three times higher in low-income countries compared to high-income countries and statistics from India further reinforce this global trend. There is a distinct correlation between socio-economic status and road use patterns in Low- and Middle-Income Countries (LMIC)1 like India - “Poor people are more likely to be involved in a road traffic crash” (GRSP, 2018). In a country like India, where vulnerable road users are forced to share space with other less vulnerable road users, the income level of an individual has a direct bearing on the mode of transport used. This in turn further determines the level of risk faced by a particular road user. For instance, daily wage workers and workers employed as casual laborers and/or in informal activities are more prone to be defined as VRUs compared to workers engaged in regular activities.2 It is no coincidence, then, that it is often the poor, especially male road-users of working age, that constitute the category of Vulnerable Road Users (VRUs)3 in India. VRUs bear a disproportionately large burden of road crashes and account for more than half of all road crash deaths and serious injuries in the country (WHO, 2018). Poverty And Social Traffic Crash Impact Injuries and Disabilities: Assessment OfBurden The on Indian Road Safety Society Outcomes RTIs have a profound long-term impact on income growth the lack of a centralised licensing system and proper and welfare loss which further constrains the human standards for mandatory driver training had resulted in capacity in emerging economies. The 2019 World Bank various ill practices like a person holding multiple licenses report “Guide for Road Safety Opportunities and Challenges: from different states. The fines levied under the Act were Low- and Middle-Income Countries Country Profiles” puts also not rationalised. There was a need for an overhaul of the road crash and serious injury cost estimate at 7.5% of the transport sector and for a policy framework that would India’s GDP i.e. INR 12.9 lakh crore ($166.43 billion) for the focus on improving road safety in the country. year 2016, which is more than twice the figure cited by the Government of India, i.e., 3% of GDP (Planning Commission, Keeping in mind the need to bring about progressive 2011), or INR 4.3 lakh crore ($58.19 billion). A recent study changes through provisions like cashless treatment of road commissioned by the Ministry of Road Transport and crash victims, electronic enforcement and monitoring and Highways (MoRTH) estimates the socio-economic costs of a higher deterrent against committing traffic offences, the road crashes at INR 1,47,114 crores in India i.e. equivalent Motor Vehicles (Amendment) Act, 2019 was introduced in to 0.77% of nation’s GDP.4 Considering the under reporting Parliament on 9th August, 2016 and was passed after three phenomenon and using the crash ratios for MoRTH crash years of public mobilisation and political advocacy. numbers, the same study estimates the crash costs at INR 5,96,820 crores i.e. equivalent to 3.14%. At the individual On 1st September 2019, the Motor Vehicles (Amendment) level, road crash injuries and deaths impose a severe Act, 2019 came into effect nationally, with the objective financial burden. They push entire (non-poor) households to create an enabling framework to improve road safety into poverty and the already poor into debt. in India. The Act consists of a total of 93 Amendments including several provisions such as a scheme for cashless treatment of road crash victims, state involvement in making rules for movement of non- motorised transport, 2.1 CURRENT ROAD SAFETY provisions for safety of children during commute, POLICY FRAMEWORK IN INDIA electronic monitoring and enforcement, and liability on road engineers and authorities for faulty road design and The Motor Vehicle Act, 1988 has been the primary legislation engineering. These provisions can substantially reduce governing road safety scenario in India for over 30 years till road crash fatalities and alleviate the economic burden of 2019. Over years, the Motor Vehicle Act became outdated road crashes in the country. and had limited impact. Even though it covers many aspects like licensing, registration of vehicles, setting standards for heavy motor vehicles, penalties for traffic offences etc, yet it was silent on some key issues like child road safety, or the safety of pedestrians and non-motorised users. Also, 1. Lower-middle-income economies are those in which 2019 GNI per capita was between $1,036 and $4,045. 2. Definitions have been drawn from Employment-Unemployment Rounds of the NSSO 3. VRUs are defined as pedestrians, cyclists, two-wheeler users and other non-motorized transport users. 4. Socio-Economic Cost of Road Accidents in India” (September, 2020) DIMTS Ltd. in association with TRIPP-IIT Delhi, MoRTH 10 INTRODUCTION The Act empowers the road users by providing certain key to economically weaker sections of society, and face rights, including: larger exposure to road traffic injury in comparison with motorised transport users. Section 138(1A) in the Act 1. RIGHT TO LIFE empowers States to regulate activities of pedestrians and non-motorised road users in public places. • Protection of Good Samaritans from any Criminal or Civil Liability :Section 134A protects a Good Samaritan 3. RIGHT TO SAFE ROADS from any civil or criminal action while providing emergency medical care or any sort of assistance to a • 198A ensures that any designated authority, contractor, road crash victim. consultant or concessionaire responsible for the design or construction or maintenance of safety standards • Timely medical assistance/cashless treatment to of roads shall comply with design, construction and road crash victims. The Centre has been given power maintenance standards. to make schemes for helping road crash victims under the following sections: Section 162 (1) directs • Section 215(B) sets up a National Road Safety Board insurance companies to provide for treatment of all for advising on all matters related to road safety and road crash victims including under the Golden Hour. traffic management. Section 162 (2) gives powers to the Centre to make a scheme for cashless treatment of victims of crashes during golden hour (the first critical hour after a road 4. RIGHTS OF CHILDREN TO SAFE COMMUTE crash). Additionally, it contains provisions for creation of a fund for such treatment. State Governments can MVAA, 2019 ensures safety of children through addressing also make rules for the cashless treatment of victims key risk factors: and can augment the coverage for cashless treatment under Section 164D of the Act. • Amendment to Section 129 of MVA, 1988 proposes that every child above the age of four years being 2. RIGHTS OF VULNERABLE ROAD USERS carried on a motorcycle must wear a helmet. • The Act has special provisions to protect the rights of • Section 194 B makes it mandatory for every child to be vulnerable road users such as pedestrians, cyclists, secured by a safety belt or a child-restraint system. rickshaw pullers, hand drawn cart users, and animal drawn cart users. These road users generally belong • Section 199A provides for adult accountability states Traffic Crash Injuries and Disabilities: The Burden on Indian Society that the guardian of the juvenile or owner of the vehicle at least 53 million people living in extreme poverty5. RTIs shall be liable in case an offence has been committed further add additional financial stress due to exorbitant by a Juvenile under this Act. health costs, with just medicine related OOPE pushing 38 million people into poverty in 2011-12. (Selvaraj, Farooqui, 5. RIGHT TO SEEK REDRESSAL: & Karan, 2018) This study primarily aims to understand the socio-economic and gendered impacts of road crash The Act provides right to seek insurance and settlement of outcomes on poor households, daily-wage, informal sector claims within a reasonable time frame: workers and its interplay with poverty. The study attempts to measure the economic impact of road crashes on • Section 149 deals with settlement of claims by households in four broad ways: direct financial costs of insurance companies and procedures to be followed. RTIs (the hospital costs, property damage, rehabilitation It provides for payment of compensation claim within and other costs with a monetary value), indirect costs a period of thirty days after acceptance of the offer by of RTIs (loss of quality of life and standard of living, the claimant. compensation), insurance and compensation-related challenges, and geographic and demographic disparities in • Section 164 B constitutes a Central Motor Vehicles terms of habitation (urban vs rural) and gender. Gauging Crash Fund to provide compulsory insurance cover to the awareness levels and accessibility of the insurance and all road users in the country. compensation systems for road crash victims and their families is an important component of this study. The Motor Vehicles (Amendment) Act, 2019 has brought a multi-dimensional change to the road safety landscape in This is achieved by engaging two categories of respondents India. From improving access to emergency medical care - a test sample of ‘Bottom 40 per cent of the population’ to improving enforcement measures, the Act has prioritised (hereafter referred as ‘Low Income Household’) and a improving safety of all road users, including the poor and control sample of ‘Top 10 per cent of the population’ vulnerable. (hereafter referred as ‘High Income Household’). In terms of gender, road crashes impact women (differently) than men. 86% of the total road crash victims are male 2.2 ABOUT THE TRAFFIC CRASH compared to 14% women (MoRTH, 2018). This complicates INJURY BURDEN ASSESSMENT the post-crash care scenario in India with the burden of caregiving activities always almost falling on women within India has the third-largest number of poor people with households. Thus, through structured FGDs, this study 5.. https://worldpoverty.io/map 12 INTRODUCTION captures the lived experiences of women in households Poor road safety outcomes and lack of institutional support that are often pushed into poverty. intensify the challenges faced by truck drivers, especially in the post-COVID-19 world. This study aims to fill a gap by further exploring the psychological and emotional impacts of road crashes The World Bank commissioned this study in association among households which are often invisible and with SaveLIFE Foundation (SLF) to determine the differential unacknowledged in academic literature and government impacts of road crashes more objectively in India. Though policy. Mental health is a sensitive subject and plays out in originally the study study was developed as “an analytical different forms. Determining the psychological well-being approach used to assess the distributional, poverty- post-crash is imperative to estimate the indirect costs related and social impacts of policy reforms on various associated with road crashes. stakeholder groups” (World Bank, 2016)6, this study can be treated as a baseline assessment study to document the Apart from the two key sample groups of Low-Income variation in impact of road crash outcomes on low- income Households (LIH) and High Income Households (HIH), this and high-income households. Once the policy framework study aims to probe into the impact of road crashes on key established under Motor Vehicles (Amendment) Act, 2019 vulnerable and high-risk individuals. One such category is is implemented, mid-term and end-term assessment adolescents aged 14-18 years. India’s productive potential studies can be undertaken to understand the impact of the is rising: Demographic transitions have led to rising worker- interventions. to-dependent ratio which will be a favourable 2.1 by 2050. The number of adolescents grew from 225 million in 2000 For this study, SLF further commissioned the survey to to 250 million in 2015 But the vast majority of youth are a Social and Market Research company, Marketing and unemployed or in vulnerable, low paid informal jobs Hence, Development Research Associates (MDRA) to assist in adolescents were identified to be a key cohort under the designing survey instruments and guidelines for qualitative study. Their post-crash experiences are captured through research, administer telephonic and face to face surveys structured In-depth Interviews (IDIs). as well as conduct Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs) for the Study; and prepare an The other socio-economically marginalized and high-risk analytical report based on outcomes of the survey road user category is that of truck drivers. Out of the 1.5 lakh people killed in road crashes in the country every year, over 15,000 road crash victims are truck and lorry drivers alone, comprising 10% of the total deaths (MoRTH, 2.3 OBJECTIVES OF THE STUDY 2018). In terms of vehicle category, trucks and lorries are involved in over 57,000 crashes in the country (MoRTH, The objective of the study is to analyze the socio-economic 2018). Despite this, 93% of the truck drivers do not get any impacts of road crashes on vulnerable individuals and social security benefits such as provident fund, pension, households below the poverty line, estimate collective life insurance, gratuity, etc. (SaveLIFE Foundation, 2020). economics losses resulting from gaps in the existing 6. http://documents1.worldbank.org/curated/en/701191479977368846/pdf/110453-REVISED-PUBLIC-PSIAAR.pdf Traffic Crash Injuries and Disabilities: The Burden on Indian Society architecture, and inform the regulatory framework across To assess the extent of awareness on high and low capacity states from a poverty and social compensation and insurance and other impact perspective. provisions and reforms brought in through the Motor Vehicles Amendment Act, 2019 among The specific sub-objectives of the study are : high risk and marginalized road user category of Truck Drivers. To assess the distributional impact of road fatalities and crashes on the poor, specifically the LIH. The study tests whether poor road safety outcomes disproportionately affect poor To map the procedural, legal, and social hurdles families and individuals leading to exacerbated faced in claiming insurance and compensation pre-existing inequalities. It also looks at money by road crash victims/families. outcomes in HCS and LCS and attempts to capture differences in outcomes. Through this assessment, we aim to generate ex-ante empirical evidence to identify and shape broad priority To assess the psychological and emotional areas, including sectors and policy initiatives needed impact of road crashes and fatalities on road to create an enabling framework to support poor and crash victims and their families and how they marginalized households that bear the brunt of road traffic cope with it. injuries. We do so by proposing a series of cost-effective policies and reforms that will focus on mitigation of the adverse impact of road traffic injuries. We hope to initiate a meaningful dialogue on the distributional impact of road crashes in India and to offer constructive measures to alleviate the cost burden on poor, vulnerable and high-risk To assess the gendered impact of road crashes groups of road users and their families. among poor and rich families. To assess the impact of road crash fatalities and crashes on vulnerable individuals like adolescents (14-18 years). 14 RESEARCH METHODOLOGY, SAMPLE DESIGN & SAMPLE COVERAGE CHAPTER 3 3.1 RESEARCH METHODOLOGY This study utilizes qualitative and quantitative methodologies for estimating the economic and social impact of road crash outcomes. Using purposive sampling, a multi-pronged approach was adopted to assess the impact of road traffic injuries and fatalities on victims. Based on the objectives of the study, the research methodology is divided into two phases: PHASE-I: EXPLORATORY RESEARCH A) DESK RESEARCH Desk research was undertaken to review the various provisions in MVAA 2019 regarding road safety provisions and compensation to road crash victims. During this stage, various data sets were explored with an effort to create a database that would be most suitable to generate contact details of road crash victims – both from urban and rural areas. B) PREPARATION OF SURVEY INSTRUMENTS Draft survey instruments were prepared for each respondent category separately. Survey instruments (questionnaires and guidelines for FGDs and IDIs) were created and later fine-tuned post the feedback from the pilot. C) PILOT SURVEY Due to the National Lockdown mandated by the Central Traffic Crash Injuries and Disabilities: The Burden on Indian Society Government due to COVID-19, the pilot survey was B) QUALITATIVE RESEARCH - FGDS AND IDIS conducted telephonically. The sampling design and survey instruments were tested with a small sample of 30 Qualitative surveys were used to understand the perspective interviews. The pilot survey was carried out from May 7, of the victim/victim’s family member regarding the impact 2020 -May 13, 2020. of fatality/crash on their social condition as well as their emotional health. In-depth interviews were conducted among adolescents (aged 14-18) who have been survivors D) POST-PILOT FINE-TUNING OF SURVEY INSTRUMENTS of a road crash or have lost a family member in a road crash. These interviews were conducted through a mix of As part of the revised sampling strategy, more detailed video calls and face-to-face interviews. questionnaires were retained for face to face interviews and a slightly shorter version of the questionnaire was Similarly, FGDs were conducted among women and men used for telephonic surveys. These survey instruments with participants who had either been involved in a road were translated into regional languages to enhance their crash or their immediate family member was in a road comprehensibility. crash. These FGDs were conducted in Patna (Bihar) and Lucknow (UP) by an experienced researcher and moderator with adequate precautions and adherence to social PHASE-II: DESCRIPTIVE RESEARCH distancing protocols. The field survey was conducted between 19th June, 2020 3.2 SAMPLING DESIGN – July 23, 2020. The following stages were covered in this phase of the study: A multi-stage sampling procedure was adopted to select the target respondents for this study. The first unit of sampling A) QUANTITATIVE RESEARCH: was the State. Looking at the number of crashes during the last 15 years and the geographical location of states, the top The survey was conducted among respondent 4 states were selected for conducting this survey, i.e. Uttar categories using structured questionnaires administered Pradesh in North India, Maharashtra in West India, Tamil by experienced investigators. The respondents were Nadu in South India and Bihar in East India. Additionally, approached via two sampling strategies: Maharashtra and Tamil Nadu represent High Capacity States (HCS) demonstrating a higher economic growth and Additionally, awareness levels about motor insurance, better performance in Human Development indicators while compensation and other provisions of the Motor Vehicles Uttar Pradesh and Bihar represent Low Capacity States (Amendment) Act, 2019 (MVAA, 2019) was also tested (LCS) demonstrating a sluggish economy, higher poverty among truck drivers. rates and low levels of social and administrative progress. 16 RESEARCH METHODOLOGY, SAMPLE DESIGN & SAMPLE COVERAGE In the next stage of sampling, in each of the selected states, from each state. After identification of respondents, a mix 4 districts were selected to find out relevant respondents. of telephonic and face to face surveys was conducted These districts were also selected based on the number of among road crash victims or their family members. crashes and geographical location (diversity) in the state. The quantitative survey aimed at providing state-level 3.3 SAMPLE COVERAGE point estimates to key aspects of economic and financial impacts on the families of road crash victims. Hence, at A total number of 2,499 interviews (against the target sample a 95% confidence interval and a 5% margin of error in the of 2,400) were conducted across 4 states. Category wise, sample size was calculated using the following formula - 1647 LIH, 432 HIH and 420 truck drivers were interviewed across 4 states7. In addition to the above, 3 FGDs and 8 IDIs were conducted among road crash victims/their family SS = Z2 * p*(1-p) members. The summary table 3A.1 in the annex provides C2 a snapshot of descriptive statistics about the participants. Statistically, a 95% confidence interval and a 5% margin where: of error in a sample size of 384 is sufficient to conduct Z = Z value (e.g. 1.96 at 95% confidence level) multi variate analysis of the data. Thus, statistically each p = percentage picking a choice expressed as a decimal category (LIH, HIH and truck drivers) has an adequate (since we do not have estimates of the p-value, we have sample size and the comparison between LIH and HIH is taken it as 0.5 to maximize the sample to avoid any under- justified and stands valid for deriving conclusions. Further, sampling) for comparison purposes, the proportion figures have been C = confidence interval, expressed as decimal (e.g., .05 = ±5) quoted instead of absolute numbers. Using the above formula, the population, the number of road crash in each state during 2005-18 and other aspects 3.4 PROFILE OF LOW INCOME AND of the target group, the sample size was calculated for each state. HIGH-INCOME HOUSEHOLDS During the field survey, purposive and snowball sampling The study was conducted among low -income and high- was used to select an adequate number of respondents income households in 4 selected states across urban and 7. Out of total, 986 (47%) interviews among victims/ family members were conducted through face to face mode while remaining 1093 (53%) interviews were conducted telephonically. All interviews among truck drivers were conducted through face to face mode. Traffic Crash Injuries and Disabilities: The Burden on Indian Society rural areas in 4 zones (East – Bihar, West – Maharashtra, the national average by 2030. Progress is measured by the North – Uttar Pradesh, South – Tamil Nadu). difference between growth in the consumption or income of the bottom 40 percent and growth in the consumption or As per the latest estimates (WB, 2015), the world’s 73.6 income of the mean of the population as a whole. crore (736 million) people are living in extreme poverty (less than US$1.90 a day) with a poverty rate of 10%. After carefully analyzing the World Inequality Database (that aims to provide open and convenient access to the most In the case of India (Census of India, 2011) about 21.9 extensive available database on the historical evolution of per cent population of India is extremely poor and lives the world distribution of income and wealth, both within under the poverty line (as per Tendulkar committee). The countries and between countries), the control sample of HIH poverty rate in rural areas is higher (25.7%) than the urban was defined as comprising of the top 10% of the population population (13.7%). in terms of income. Across the world, the income earned by the top 10 percent is often larger, sometimes much larger, Further, 41% of road crashes were recorded in urban areas than the share earned by the bottom 40. The ratio of the and 59% in rural areas. The proportion of persons killed in share of income between the top 10 percent and bottom 40 urban areas and rural areas was 34% and 66% respectively percent is known as the Palma ratio. For this study, LIH and HIH were defined based on income To monitor progress against its goal of boosting shared and ownership. The upper threshold pre-tax income of prosperity, the World Bank tracks growth in the consumption a LIH sample was taken as INR 13,450 per month per or income of the poorest 40 percent of the population in adult8. Similarly, for HIH category, the lower threshold each country—the bottom 40 percent. Shared prosperity pre-tax income of INR 50,000/- per month per adult was focuses on the poorest 40 percent of the population in each considered. economy (the bottom 40) and is defined as the annualized growth rate of their mean household per capita income or The Low Income Households’ test sample, comprising their consumption. the bottom 40% of the population was selected keeping in mind standard models of population representation used This 40% and 10% population ratio is thus an important globally by the United Nations (UN) and World Bank in its and useful development indicator for the World Bank to poverty related research. UN SDG target 10.1 aims for the measure socio-economic impact in any given country, income of the bottom 40 percent to be growing faster than especially developing countries. It helps to juxtapose 8. https://wid.world/country/india/ 18 RESEARCH METHODOLOGY, SAMPLE DESIGN & SAMPLE COVERAGE various socio-economic realities and highlights the levels of the survey and their responses gave a fair widening gap amongst sections of the population more indication of their household income. The framing of short clearly. It also helps to make the data in this report more pointed questions on whether the household had to borrow globally comparable with other nations. money/ sell or mortgage valuables and whether anyone in the family had to quit study/relocate, etc. helped in verifying On comparing the income profile of LIH and HIH categories their income-brackets. at a global level while keeping all factors the same (World Inequality Database); LIH population of India that earn a A pre-testing of the methodology was conducted to finetune pre-tax income of up to INR 13,500 per month per adult the approach and to ensure rigrous data collection. would be among the bottom 19% population globally (refer to Table 3A.2). Similarly, HIH population of India that earn Among the LIH crash victims, 86.2% were male while 13.8% pre-tax Income of INR 50,000 or above would be among were female. Among HIH crash victims, such a proportion the top 42% globally9. of males and females was 78.7% and 21.3% respectively. 71% of the LIH respondents were from rural areas, while for Similarly, age-group wise, about every 2nd road crash HIH, it was opposite as major proportion (82%) were from victim from LIH was in the 26-45 yrs age bracket, whereas urban areas (Refer to Table 3A.4). This is very close to the among HIH such proportion was about 64%. Across actual distribution of poor population in rural (about 20%) households, more than half of the all victims (54% for LIH and urban (about 80%) areas in India (as per Census 2011). and 64% for HIH belonged to the productive age group of 26-45 years. A probable reason is that most commute/ Based on income and self-declaration, every 2nd LIH travel is work related and hence the working age population surveyed was found below the poverty line. In each LIH, is more prone to road crashes. there were average 5.6 (median value = 5) members while the average size of HIH was 4.8 (median value = In terms of educational qualification, with ample facilities 4). Cognizance was taken of the fact that respondents and resources for the HIH category, they were found to be might not disclose their real income during the surveys. more educated than the LIH victims. About two-third of HIH To overcome this limitation, the surveyors visited the victims had at least completed graduation. While among locality for more than half of the respondents surveyed and LIH it was opposite, as about two-thirds of victims were verified their range of income through these field visits. In educated only up to 12th standard and only one-fourth case of telephonic surveys (53% of the total sample), the were either graduate or above. The link between educational tallying was done with a verifiable database. Additionally, qualifications and recovery to work has not been captured/ respondents were asked about their expenses at various established directly in this study. Though it can be said that 9. For more details see Annexure. Traffic Crash Injuries and Disabilities: The Burden on Indian Society over 40% of the LIH victims were either unemployed or engaged in the agriculture or informal sector as unskilled labourers before the crash while 83% of the HIH victims were either self-employed or doing business or working in the formal sector as salaried employees. A combination of factors like higher educational levels, family savings to dip into and better social status did facilitate their early transition back to the workforce and previous learning levels. However, disability adds another dimension/layer of analysis that delays the process of resuming work or finding meaningful and well-paid work across households after the crash. Most of the victims in LIH were engaged as unskilled labour/ farmers in the agriculture sector or shop owner/ petty traders and about 4 out of 10 were engaged in businesses/ self-employed or working as salaried employees. On the other hand, over 8 out of 10 victims in HIH were engaged in businesses/ self-employed or working as salaried employees. 20 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES CHAPTER 4 INTRODUCTION Road Traffic Injuries (RTIs) in India are closely interlinked with on-ground socioeconomic realities like class, gender and geographical location that often intersect and affect various sections of the population differently. This chapter highlights the disproportionate impact of road crashes among LIH and HIH in the four selected States by capturing the situated hierarchies and lived experiences of respondents, i.e., it discusses the differential impact of crashes among various States, male and female, poor and rich and urban and rural areas. The extent and degree of disproportionate economic impact among LIH and HIH is estimated by determining the direct and indirect costs borne by households after an crash. Direct costs are tangible, paid upfront and include medical expenses, property costs, vehicle costs etc. In contrast, indirect costs are hidden, often difficult to determine and are characterised by a deterioration in the standard of living, loss of productivity/ income etc. The ability to mitigate risks associated with an crash and the capacity to respond to it also varies among poor and rich households. This chapter highlights that differential response among LIH and HIH w.r.t how they meet their financial burden after a crash. KEY FINDINGS The key findings of this chapter can be summarised under two broad points of inter-state variations in the impact Traffic Crash Injuries and Disabilities: The Burden on Indian Society of road crashes among LIH and HIH households and who stated that they had to sell off or mortgage the mechanisms used to cope with the sudden financial their assets, take up extra work, and avail for burden. Inter-state variations also include pointers on compensation from the insurance company and urban and rural disparities and how they further deepen other parties involved in the crash in order to deal the impact on households. The mechanisms to cope with with their financial burden, was highest in Tamil Nadu. socio-economic burden posed by road crashes highlight the differential abilities of LIH and HIH to deal with it. This could be because Tamil Nadu has the highest pendency of Motor Accident Claims Petition in India. With over one lakh fifty thousand pending cases, Tamil INTER-STATE VARIATIONS Nadu has almost double the pendency in comparison to the National level pendency10. Tamil Nadu also 1. Decline in total household income was sharper reported the highest number of married road crash across all States among LIH vis-a-vis HIH. A greater respondents11. Additionally, the State also had the percentage of LIH across States reported borrowing highest number of CWE respondents among all money and selling land/mortgaging family assets States (34%). Since it is mostly men getting involved to meet their financial expenses vis-à-vis HIH. For in road crashes (79% of the victims in TN were male), instance, In Tamil Nadu, 30% of the respondents from it is highly probable that Tamil Nadu has the highest LIH reported selling/mortgaging assets compared to number of female headed household’s post-crash 10% of the respondents from HIH. In Maharashtra, 44% and therefore limited resilience to deal with financial of LIH had to borrow money compared to 8% from HIH. burdens. While the State has performed well on gender reforms and access to maternal healthcare, it still lags 2. In the event of a crash, LIH are disproportionately behind in female labour force participation rate. On the affected in both Low Capacity States (LCS) and High work front, women have been leaving the labour force Capacity States (HCS). However, the socio-economic in large numbers since 2005 (WB, 2017)12. Women impact on LIH in LCS is the most severe. have slightly more casual-wage jobs than men in rural areas in the State. 3. Resilience of households to deal with financial impact of road crashes was however most fragile 4. Bihar had the lowest average costs borne by LIH across in Tamil Nadu. The proportion of LIH respondents all expenditure heads except Out Of Pocket Expenses (OOPE) on treatment of the victim and amount paid to 10. https://njdg.ecourts.gov.in/njdgnew/?p=main/pend_dashboard 11. 85% of the victims were married at the time of the crash. 12. World Bank (2017). “Tamil Nadu – Gender”, July: http://documents1.worldbank.org/curated/en/154201504176664933/pdf/119264-BRI- P157572-Tamil-Nadu-Gender.pdf 22 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES other parties involved in the crash. It was the opposite 9. The highest expense among LIH on victims’ funerals for Tamil Nadu where average costs were higher across was incurred in Tamil Nadu (Rs 42, 010) while the most of the heads except for out of pocket expenses lowest amount was spent in Uttar Pradesh (Rs 12, on treatment and legal/administrative expenses. 517). 5. Among the LIH, Maharashtra and Tamil Nadu fared 10. Decline in living standards was drastic across all states better with a higher survivability rate of 75% compared with Bihar reporting the sharpest decline among LIH to UP and Bihar that showed a survivability rate of 53%. (73%) followed by Uttar Pradesh (72%). 6. The household income in HCS declined by 64% 11. In terms of the amount arranged to tide over the after the crash whereas it decreased by 78% among economic crisis, LIH from Maharashtra managed households from LCS. to raise the highest amounts whereas among HIH, a similar trend was observed in Tamil Nadu. 7. Similarly, while living standards of the household deteriorated by 49% among HCS, it fell by 64% in LCS. 12. LIH in Uttar Pradesh (over 2.5 lakhs on an average) received the highest compensation from Government 8. There was a wide contrast in proportion of LIH that schemes at the central and local level followed by availed of loans to deal with resulting financial burdens: Maharashtra (around 1lakh average). The pendency of 48% of LIH from Uttar Pradesh vis-a-vis 15% of the compensation cases in UP is one of the lowest in the HIH from Tamil Nadu. Further, the ability to obtain a country at 1.80% of total Original Civil Cases in UP13. loan from institutional sources also depends on one’s Additionally, there has been extensive digitisation of socioeconomic status and makes the process of Courts in India through the eCourts Mission. Most of repayment more strenuous for poor households. 27% the Courts including Motor Accident Compensation of the LIH in urban areas and 48% of the LIH in rural Tribunals (MACT) are part of the Case Information areas availed of loans to mitigate the financial crisis. System (CIS) software under which courts have A similar trend was noticed among HIH. 7% of HIH been provided flexibility to customize cause lists, in urban areas and 30% of HIH in rural areas availed mechanism for e payment etc. However, there is of loans, indicating greater financial stress among dearth of data on actual on-ground practices and how households in rural areas. much has this system being implemented as district and taluka level. 13. The National Judicial Data Grid was accessed on 29th October 2020 and the pendency rate is calculated till 28th October 2020. Traffic Crash Injuries and Disabilities: The Burden on Indian Society VARIATIONS IN RURAL AND URBAN crash compared to 78% of respondents from rural HOUSEHOLDS areas. 1. The severe impact of decline in income was higher 6. Expenditure on OOPE in urban areas was higher among rural households, and cases where victims died compared to rural areas across households. Among as well as where victims were males. the LIH in urban areas, OOPE was slightly higher at 66% of the total expense compared to 60% of the total 2. Income decline was the most severe for LIH rural expense among HIH in rural areas. households (56%) compared to LIH urban (29.5%) and HIH rural (39.5%). However, on comparison of the monthly household income and financial losses GENDER DIFFERENTIATED IMPACT (expenditure and loss of income) due to road crashes, it was found that the loss among LIH was equivalent 1. LIH respondents stated that in the absence of any to about 7.6 months household income while among steady primary source of income (especially in the HIH it was equivalent to less than 1 month household case of death of a breadwinner), the women of the income (0.84 month)14 household often had to step up and take additional jobs to mitigate the financial burden. Further, the burden 3. The total average costs (direct and indirect costs of non remunerative caregiving work mostly falls on combined) borne by HIH (Rs.1,98,042) after the females within the household after a crash. This is non crash was higher than the total costs borne by LIH quantifiable and does not come under the purview of (Rs.1,52,826). economic activity. 4. Medical costs constituted a bulk of the total costs of 2. Across household categories, the proportion of male LIH, i.e., Rs. 78,824 (52% of total costs) followed by Chief Wage Earners (CWE) was higher than female loss of productivity/loss of income costs, i.e. Rs. 37, CWE; the number being higher among LIH. 50% of the 572 (25% of total costs). women from LIH and 55% from HIH were CWE of the household before the crash whereas 81% of the men from LIH and 74% men from HIH were CWE before the 5. Across households, 34% of the respondents from crash. urban areas said they had to borrow money after the 14. Please note MHI was calculated by taking mid points of ranges. 24 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES 3. 31% of the female members in LIH were severely 3. 24% of the LIH respondents said they had to sell/ affected by the decline in household income after the mortgage their assets (land, jewellery) to meet their crash compared to 53.5% of the male members. Among daily expenses and repay their debt, compared to only HIH, 18.5% of female members of the household were 7% of the HIH respondents. severely affected compared to 26.5% of the male members in the household. 4. About 14% of LIH respondents reported taking up extra work to deal with the situation, compared to 4% of HIH 4. The male (dead) victims’ contribution to household respondents. income was significantly higher than female victims’ (more than double) across both categories of 5. A higher percentage of respondents from LIH in rural households. For instance, among LIH, male (dead) locations opted for a loan (lenders, bank, relatives victims contributed to 63.5% of the total monthly etc.), sold off/mortgaged their assets and took up household income whereas female victims contributed extra work to cope with the financial burden than their to 29% of the same. counterparts in urban areas. 6. While LIH were more dependent on loans and selling MECHANISMS TO COPE WITH FINANCIAL off their assets to meet their expenses, they were BURDEN less likely to receive compensation from insurance companies compared to HIH. Only 14% of the LIH 1. The financial crisis after an crash was more aggravating received compensation from insurance companies for LIH than HIH. Compared to HIH, LIH were three compared to 24% of HIH respondents. The average times more likely to seek financial help in order to cope amount of compensation received by LIH, i.e., with the financial burden post-crash Rs.89,215 was also less than the average amount received as compensation for HIH, i.e., Rs.1,62,562. 2. Higher debt among LIH - About 42% of the LIH respondents reported that their household 7. A higher percentage of respondents from HIH (90%) underwent debt after borrowing money (through than that in LIH (70%) relied on their savings to meet both formal and informal sources) to cope with the their additional expenses post-crash. The amount additional expenses after an crash, compared to 11% of savings used to meet related expenses was also of respondents from HIH. higher in the case of HIH (Rs.1,45,401) as compared to LIH (Rs. 92,060) Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.1. DISPROPORTIONATE IMPACT ON prioritises their safety. State Governments should select districts with a high VRU crash rate and prioritise their VICTIMS’ SURVIVAL, safety through dedicated Annual Action Plans. EMPLOYMENT STATUS AND INCOME LEVEL The socioeconomic realities and victim’s status in the hierarchy determines his/her chances of survival and speedier recovery. The financial impact of road crashes is often severe especially among LIH and can deeply impact victims and their families in terms of loss of employment and income, decline in productivity and lost opportunities. One of the most significant findings of this study is that the survival rate post-crash was higher among victims from HIH compared to LIH : around 87.5% of the crash victims from HIH survived compared to 64% of the crash victims from LIH. The vast difference in road crash outcomes among victims from rich and poor households can be attributed to various factors like access to medical treatment immediately after the crash and the ability to afford long- term and effective post-crash care. The nature of the crash, and the risk assessment of the mode of transport used for commuting also influences the chances of survival/death among victims. The findings of this study confirm that the highest proportion of LIH victims from Uttar Pradesh and Bihar were at the time of the crash using a bicycle/ auto rickshaw/ commuting on foot as “VRUs”, thereby making them more susceptible to road crash linked mortality and morbidity. States especially LCS need to urgently spend more on VRU friendly infrastructure in rural areas that 26 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES TABLE 4.1: TABLE INDICATING HOUSEHOLD SPLIT OF ROAD CRASH OUTCOMES: LOCATION/HABITATION Overall Location / habitation Category (State, gender) Urban Rural Total Urban LIH HIH LIH HIH LIH HIH LIH HIH Overall 57.5% 42.5% 93.9% 6.1% 79.2% 20.8% 56.4% 43.6% Male 60% 40% 95.1% 4.9% 80.9% 19.1%% 58.4% 41.6% Female 50.9% 49.1% 90.5% 9.5% 74.6% 25.4% 50.5% 49.5% Bihar 54.1% 45.9% 93.8% 6.3% 78.2% 21.8% 51.9% 48.1% Male 57.6% 42.4% 94.5% 5.5% 79.6% 20.4% 54.8% 45.2% Female 42.9% 57.1% 91.8% 8.2% 73.9% 26.1% 41.9% 58.1% Maharashtra 51.8% 48.2% 98.4% 1.6% 78.6% 21.4% 51.5% 48.5% Male 50.9% 49.1% 98.8% 1.2% 79.7% 20.3% 49.7% 50.3% Female 54.1% 45.9% 96.6% 3.4% 74.8% 25.2% 57.4% 42.6% Tamil Nadu 70.7% 29.3% 85.9% 14.1% 79.8% 20.2% 68.8% 31.2% Male 75.8% 24.2% 88.3% 11.7% 83% 17% 73.8% 26.2% Female 61.6% 38.4% 82.5% 17.5% 74.9% 25.1% 59.7% 40.3% Uttar Pradesh 54% 46% 97.4% 2.6% 80.4% 19.6% 53.4% 46.6% Male 58.5% 41.5% 97.1% 2.9% 81.9% 18.1% 58.5% 41.5% Female 37.2% 62.8% 98.5% 1.5% 74.8% 25.2% 33.3% 66.7% Traffic Crash Injuries and Disabilities: The Burden on Indian Society Survived Died Location / habitation Location / habitation Rural Total Urban Rural Total LIH HIH LIH HIH LIH HIH LIH HIH LIH HIH 92% 8% 73.6% 26.4% 66% 34% 96.2% 3.8% 91.7% 8.3% 93.3% 6.7% 75.4% 24.6% 73.8% 26.2% 97.6% 2.4% 94.3% 5.7% 88% 12.% 68.% 32% 52.8% 47.2% 93% 7% 86% 14% 88.9% 11.1% 68.4% 31.6% 77.8% 22.2% 98.2% 1.8% 96.2% 3.8% 91.3% 8.7% 71.7% 28.3% 91.7% 8.3% 98.2% 1.8% 97.5% 2.5% 77.8% 22.2% 55.7% 44.3% 50% 50% 98.3% 1.7% 93.8% 6.3% 97.4% 2.6% 74% 26% 54.2% 45.8% 100% 0% 91.9% 8.1% 98.2% 1.8% 74.9% 25.1% 70% 30% 100% 0% 96.7% 3.3% 92.3% 7.7% 69.9% 30.1% 42.9% 57.1% 100% 0% 82.6% 17.4% 88.1% 11.9% 79.2% 20.8% 93.8% 6.3% 80.2% 19.8% 82.4% 17.6% 88.1% 11.9% 81% 19% 100% 0% 88.7% 11.3% 90.5% 9.5% 88.2% 11.8% 76.3% 23.8% 83.3% 16.7% 66.7% 33.3% 69.2% 30.8% 94.4% 5.6% 71.2% 28.8% 56.4% 43.6% 99.5% 0.5% 92% 8% 94.3% 5.7% 74.5% 25.5% 58.6% 41.4% 99.3% 0.7% 92.3% 7.7% 95% 5% 56.6% 43.4% 50% 50% 100% 0% 91.4% 8.6% 28 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES UP and Bihar are one of the highest populated states and “High Capacity States”. All these factors contribute to home to the largest proportion of poor in India. Further, differing levels of vulnerability and survivability of road both the states are comparatively less developed, and the users in crashes. level of education is also low. Based on several factors like proportion of urban population, literacy rate, poverty rate Overall, the victim survivability rate15 in high capacity states and per capita net State GDP, Bihar and Uttar Pradesh (77%) was found to be higher than that in low capacity have been categorised as “Low Capacity States”, while states (61%). For instance, Uttar Pradesh (UP) registered Maharashtra and Tamil Nadu have been categorised as the highest death rate among LIH. 50% of crash victims TABLE 4.2: TABLE INDICATING HOUSEHOLD SPLIT OF ROAD CRASH OUTCOMES: VICTIMS WHO SURVIVED/DIED AFTER A ROAD CRASH FROM STATE, HABITATION AND GENDER LENS. 12.5% 36.1% Overall LIH HIH N-1647 N-432 63.9% 87.5% 6.1% 17.8% 43.2% 50.4% Low Survivability Bihar Uttar Bihar Uttar N-412 Pradesh Pradesh (53%) N-413 N-115 N-413 among LIH 56.8% 49.6% 93.9% 82.2% 20.6% 9.7% 17.5% 30.1% High Survivability Maharashtra Tamil Nadu Maharashtra Tamil Nadu (75%) N-415 N-407 N-113 N-103 among HIH 69.9% 79.4% 90.3% 82.5% Died Survived 15. Survivability here refers to the ability of a road accident victim to remain alive/continue to live after an the accident. It depends on several factors like timely access to emergency care and the quality of care etc. Traffic Crash Injuries and Disabilities: The Burden on Indian Society from LIH in UP died after the crash compared to 18% Before the crash, 82% of the victims from LIH and 86% of of crash victims from HIH. Similarly, in Bihar, 43% of the the victims from HIH were earning members of their family victims from LIH died after the crash compared to about (Table 4.3). The proportion of male victims as earning 6% of the victims from HIH. Among the LIH (refer to Table members of the family was higher than female victims. 4.2), Maharashtra and Tamil Nadu fared better with a Rural areas had more victims who were earning members higher survivability rate of 75% compared to UP and Bihar of their family compared to urban areas. that showed a survivability rate of 53%. Compared to pre-crash income levels, the monthly earnings Victims from rural areas were more likely to die in an of victims from LIH remained the same or reduced across crash while victims from urban areas were more likely to all income brackets (refer to table 4.5). Nearly one-third survive an crash. 46% of the LIH victims and 28% of the (32%) of the victims from LIH experienced a decrease in HIH victims from rural areas died post-crash whereas 87% their incomes on resuming work after the crash, compared of the LIH victims and as high as the 91% of the HIH victims to only one-fifth (22%) of the victims from HIH. 52% of the from urban areas survived post-crash. The reasons for LIH victims continued to earn the same income compared difference in survival rates of urban and rural crash victims to 73% of the HIH victims. can be explained by the better availability of tertiary care medical facilities and the accessibility (including distance) Even the proportion of unemployed or non-earning victims to emergency care in urban areas. The distribution of from LIH increased significantly after the crash. 18% of the qualified health workers is skewed towards urban areas; respondents reported that the victim was a non-earning 77.4% of all qualified workers are in urban areas, even member of the household before the crash which increased though the urban population accounts for only 31% of the to 27% after the crash. This proportion was later reduced to total population. The density of qualified health workers is 22% as on 31st Jan 2020. In a sharp contrast to the data 22.7 per 10,000 population in urban areas, as compared to on LIH, among HIH, surveyed respondents said that the 3.0 per 10,000 population in rural areas (WHO South-East monthly earnings of victims were not impacted to a great Asia Journal of Public Health, 2016). extent, reducing only gradually across all income brackets (refer to Table 4.6). The non-earning members decreased Due to serious injuries and disabilities accruing from an from 14% before the crash to 11% on resuming work after crash, the surviving victims experience a drastic change in the crash. their employment status and income levels. Many victims either lose their pre-crash jobs or face a sharp decline in This indicates that road crashes cause greater financial their income post-crash. Respondents were asked details shocks and income disruptions among victims from LIH of the victims’ monthly earnings, i.e., pre crash, on resuming compared to HIH. A plausible explanation for this is better work post-crash and present earnings (as on 31st January placement in the job market, greater bargaining power and 2020). Additionally, respondents were asked about the higher social standing enjoyed by victims from HIH. 41.5% recovery period of victims and the time taken to resume of HIH victims were salaried employees whereas another their existing work or find a new job. 42% were doing business/were self-employed whereas a 30 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES majority of the victims from LIH were either unemployed with mental disability, disabled women and those in or working as unskilled labour/farmers in the agriculture rural areas are most neglected (ILO, 2011). In the event sector. Working in the formal organized sector guarantees of a road crash, PwD require medical rehabilitation and social security benefits and the extension of the social support services including counselling with regard to any safety net to fall back upon in the event of a tragedy. Being technical assistance, equipment, wheelchairs, artificial involved or running a family business also helped the HIH limbs and so on which may be required. Additionally, once victims dip into their savings reserve to make up for any rehabilitated, PwD require vocational rehabilitation, equal losses owing to the crash. Moreover, unlike victims from educational and employment opportunities, protective and poorer households who are struggling to make ends meet, supportive socio-economic measures and the creation of victims from non-poor households can afford to halt a barrier-free environment to guarantee their vocational work or take a break till their recovery is complete. This and social integration. PwD also require their legal rights combined with good medical care hastens their recovery to be determined by appropriate legislation. This can after a crash. assure protection against discrimination, non-exclusion in social welfare, entrenched rights at the workplace, equal The severity of injuries and the quality of post-crash recovery opportunities and accessibility to public places. The quota plays a vital role in the rehabilitation of road crash victims. It system that requires a certain percentage of employees is pertinent to note that a higher proportion of victims from to be PwD (followed by European countries and Japan) both categories of households that had undergone any should be implemented at the State level. Fines may sort of disability received a lower salary/wage on resuming be levied on employers who fail to meet the prescribed work after the crash compared to what they were earning quota. Further, States should also create self-employment earlier (refer to Table 4.8). Owing to disability, the decline in opportunities for PwD through entrepreneurship drives the monthly income of victims intensified further across and special employment schemes. The rights of the PwD households. Among LIH, the decline of income was 12% arising from a road crash can be furthered within the sharper for victims who underwent a disability post-crash legislative framework provided by the Rights of Persons vis-à-vis victims who did not. Similarly, among HIH, the with Disabilities Act, 2016 that replaces the Persons with decline in income was 25% lower than the previous income Disabilities (Equal Opportunities, Protection of Rights and for victims who underwent any sort of disability compared Full Participation) Act, 1995. The Act defines 21 types of to victims who did not. This indicates that irrespective disabilities and also addresses the needs of children with of poor or rich households, disability adds another layer disabilities. Responsibility has been cast upon the state of disadvantage among road crash victims and cripples governments to take effective measures to ensure that their life choices, putting them at a disadvantage in PwD enjoy their rights equally with others. The progressive terms of job prospects and earning a decent income. In provisions of this act like reservation in higher education the absence of technological advancements, disability (not less than 5%), government jobs (not less than 4 intensifies the impact of a road crash both at the individual %), reservation in allocation of land, poverty alleviation and household level. 73.6% of the disabled in India are schemes (5% allotment) for people with benchmark still outside the labour force (ILO,2011).16 Of these, those disabilities should be effectively implemented by all States. 16. Persons with Disability and The India Labour Market: Challenges and Opportunities’ ILO, 2011: https://www.youth4jobs.org/pdf/ilo-study-pwd.pdf Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.2. HABITATION & STATE-BASED compared to 78% of respondents from rural areas. VARIATIONS Similarly, 24% of the LIH respondents stated they had to sell/mortgage their family assets like land, jewellery etc Road crashes impact the entire household; not just the to meet their financial expenses, compared to 7% of the victim. About three-fourth (75%) of LIH respondents respondents from HIH. Compared to urban areas, a higher confirmed that their household income declined due to percentage of LIH in rural locations opted for a loan (lenders, the crash compared to less than six-tenth (57%) of the bank, relatives etc.), selling/mortgaging assets and taking HIH respondents. The financial impact on the household up extra work, to cope with the financial burden. LIH in rural intensifies due to loss of income of the victim in case of areas reported a slightly higher percentage (25%) of selling/ an earning member. A higher proportion of LIH and HIH mortgaging assets compared to urban areas (21%). respondents reported a sharper decline in their household income in case the victim died (79%) compared to cases Similarly, 33% of the respondents from LIH said that they where the victim survived (72%). Apart from income had to relocate for treatment either for more than 30 days loss, expenses like out of pocket medical expenditure on or permanently after the crash compared to only 13% of treatment of victims including hospitalization, medicine, etc. the respondents from HIH. Relocation increases the cost of also aggravates the financial distress among households. treatment and mounts additional costs on the household. The overall OOPE was higher for LIH (62%) than HIH (59%). Irrespective of the type of habitation (rural or urban), LIH in urban areas reported a 6% higher OOPE than LIH a higher percentage of LIH respondents said they had in rural areas. Similarly, HIH in urban areas reported a 3% relocated after the crash compared to HIH. higher OOPE than HIH in rural areas. Decline in total household income was sharper across all On the question of borrowing money post-crash, there was States among LIH vis-a-vis HIH. A greater percentage of a stark difference between LIH and HIH. Respondents from LIH across States reported borrowing money and selling LIH were three times more likely to borrow money and sell/ land/mortgaging family assets to meet their financial mortgage their family assets to cope with the financial expenses vis-à-vis HIH. For instance, In Tamil Nadu, 30% burden post-crash. 42% of the LIH respondents stated of the respondents from LIH reported selling/mortgaging they had to borrow money compared to 11% of the HIH assets compared to 10% of the respondents from HIH. In respondents. In the absence of institutional and credible Maharashtra, 44% of LIH had to borrow money compared sources of financial support and lack of income, LIH to 8% from HIH. were more likely to borrow money from informal sources like relatives/friends after an crash. Banks ask for proper documentation (that most LIH find difficult to produce) and take a longer time to approve loans as opposed to informal sources. Across households, 34% of the respondents from urban areas said they had to borrow money after the crash 32 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES TABLE 4.3: TABLE INDICATING STATE-WISE URBAN-RURAL AND GENDER SPLIT OF FINANCIAL IMPACT ON HOUSEHOLD LIH HIH LIH (N=1647) HIH (N=432) LIH (N=1647) HIH (N=432) Financial impact (N=1647) (N=432) on the victim household Overall Overall Urban Rural Urban Rural Male Female Male Female Decline in total income 74.8% 57.4% 65.1% 78.8% 55.1% 68.4% 77.4% 58.6% 60.9% 44.6% of household OOPE increased due to 62% 59.3% 66% 60.3% 59.8% 56.6% 62.1% 61.2% 61.5% 51.1% medical treatment Had to sell/ mortgage 23.6% 7.4% 20.7% 24.8% 5.1% 18.4% 24.4% 18.9% 7.4% 7.6% family assets Had to borrow money 41.6% 11.1% 26.6% 47.8% 7% 30.3% 43% 33% 12.4% 6.50% (from anyone) Had to relocate for treatment for more 17.7% 7.4% 18.5% 17.3% 6.2% 13.2% 18% 15.9% 8.2% 4.3% than 30 days Had to sell/ mortgage 15.4% 6% 14.5% 15.8% 4.5% 13.2% 15.5% 15% 6.2% 5.4% family assets Traffic Crash Injuries and Disabilities: The Burden on Indian Society LIH (N=1647) HIH (N=432) Bihar Maharashtra Tamil Nadu Uttar Pradesh Bihar Maharashtra Tamil Nadu Uttar Pradesh 79.4% 76.9% 59% 83.8% 66.10% 51.30% 47.60% 64.40% 62.6% 66.3% 53.3% 65.6% 72.2% 59.3% 35.9% 68.3% 22.8% 17.6% 30% 24.2% 10.4% 4.4% 10.7% 4% 43% 44.1% 31.2% 47.9% 11.3% 8% 14.6% 10.9% 24.8% 14% 13.8% 18.2% 17.4% 0.9% 1.9% 8.9% 24.8% 9.6% 11.1% 16.2% 14.8% 0.9% 1.9% 5.9% 34 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES While LIH were more dependent on loans and selling Overall, LIH are disproportionately affected in both Low off assets to meet their expenses, they were less likely Capacity States (LCS) and High Capacity States (HCS). to receive compensation from insurance companies However, the socio-economic impact on LIH in LCS is compared to HIH. One-fourth of HIH respondents (24%) the most severe. For instance, the chance of survival of a said that they received compensation of about Rs.1,62,562 LIH crash victim from low capacity states was only 53% from insurance companies (including vehicle/ medical/ life while that from high capacity states was as high as 75%. insurance, etc.) whereas only 14% of LIH respondents said Whereas the survivability rate was almost similar in case of they received an average compensation of Rs.89,215. This HIH crash-victims from both categories of states (87% for gap highlights the asymmetry in insurance penetration and victims from high capacity states and 88% for victims from reach, and a skewed claims to coverage ratio among the low capacity states). rich and poor. From the findings of the report its clear that across In terms of severity of decline in household income, every households, respondents in rural areas had to look at second respondent (50%) from LIH confirmed that their different mechanisms to cope with financial burden, household underwent a severe impact whereas it was this included borrowing money, taking a loan, selling, every fourth respondent (25%) among HIH who affirmed mortgaging assets and taking up extra work. The State the same. Additionally, 41% of the respondents from HIH Governments should ensure better implementation of reported no impact on their household income compared social security schemes in rural areas to increase the to 24% of LIH respondents. Income decline was the most resilience of households to cope with economic burden severe for LIH rural households (56%) compared to LIH of road crashes. Additionally only 14% of LIH respondents urban (29.5%) and HIH rural (39.5%). received state compensation. Anecdotal evidence gathered through FGDs also points at reluctance of police officials As part of this study, 61% of the surveyed households in low to file FIRs in rural areas which further complicates the capacity States (UP, Bihar) and 46% in high capacity States compensation process for them. State Governments (Maharashtra, TN) belonged to the BPL category. The should also address underreporting of crashes. average monthly household income of LIH in low capacity States (Rs.15,430) was found to be lower than that in high capacity States (Rs.24,702). 17. The institutional capacity of states refers to the ability of states to respond to developmental challenges, the strength and resilience to take decisions and effectively implement them for better governance. Institutional capacity is a function of infrastructure, i.e., the better the quality of infrastructure, the higher is the preparedness of the State in meeting sudden challenges. A delay in making decisions also increases the cost and puts the State under greater pressure. 18. Tamil Nadu ranks third in the country with a high score of 67 out of 100 followed closely by Maharashtra with a score of 64 (NITI Aayog’s Composite SDG India Index, 2019). This indicates that the States have crossed their half way mark in meeting the SDG targets for 2030. Compared to Tamil Nadu and Maharashtra, Uttar Pradesh scores 55 while Bihar scores 50 on the index. Tamil Nadu also scores the highest on the SDG goal of no poverty. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.3. INSTITUTIONAL CAPACITY OF poor in urban as well as rural areas of UP and Bihar are comparatively higher than that in Maharashtra and Tamil STATES 17 Nadu. Also, the proportion of qualified health workers per 10,000 population and labour participation rate are Maharashtra and Tamil Nadu are comparatively more comparatively low in Bihar and UP. economically advanced and urbanized states of India than the states of Uttar Pradesh and Bihar. The Low Capacity When it comes to framework for Road Safety, all four States States of Bihar and Uttar Pradesh have historically have a Road Safety Policy with fixed targets20. Following a experienced a sluggish growth rate and have had weak Public Interest Litigation (PIL) in 2012, Supreme Court of administrative and legal structures. Due to high poverty and India appointed a Committee on Road Safety in 2014 in a rampant law and order problem, their delivery mechanisms the case of S. Rajaseekaran Vs. UOI & Ors. W.P. ( C) 295 of are weak and governance institutions and structures are 2012. The committee was formed to oversee the efforts of underdeveloped. In terms of State performance on meeting Central and State Governments to improve road safety. The the SDG goals18 and on Governance Performance Index Supreme Court Committee on Road Safety (SCCoRS) has (GPI)19, HCS perform better than LCS. been issuing directives to all states to create a standardised policy framework. SCCoRS has directed all States to In the LCS, the development framework has to be formulate Road Safety Policies, Annual Action Plans, State Government-led since the private sector is weak and less Road Safety Councils, establish a Road Safety Fund and a developed. Expanding its institutional capacity and quality Road Safety Cell.21,22 of service is the only way these states can catch up with the developed states. The per capita state GDP, share of All four States under the purview of this study have urban population, share of adults (age 15+ years), and constituted Road Safety Cells and Road Safety Councils. literacy rate are higher in Maharashtra and Tamil Nadu They have a Road Safety Fund and Action Plan as well. The compared to UP and Bihar. At the same time, Bihar and UP Maharashtra Road Safety Cell was created last year and is are amongst the highest populated states and home to the supervised by the State Transport Commissioner. In Tamil largest proportion of poor in India (9.6 Crores). The poverty Nadu, the cell has been reconstituted as a Lead Agency to rates in Bihar (34%) and UP (29%) are significantly higher assist the Joint Transport Commissioner (Road Safety)23. It than the all India poverty rate of 22%. The proportion of comprises of 5 members, i.e., Inspector of Police, Assistant 19. The quality of governance as service delivery is measured using the overall Governance Performance Index (GPI). On the GPI, Tamil Nadu and Maharashtra have consistently featured in the top 10 best performing states whereas Bihar and Uttar Pradesh have held the slot for the worst performing states. 20. http://morth-roadsafety.nic.in/index1.aspx?lsid=492&lev=2&lid=445&langid=1 21. https://transport.uk.gov.in/files/RoadSafetyDocs/24-09-2018.pdf 22. The Supreme Court recently appointed Mr. Justice Abhay Manohar Sapre, former Judge of this Court, as the Chairman of the aforesaid Committee on Road Safety vide Order 14-01-2020. 23. Transport Commissionerate, Government of Tamil Nadu: https://tnsta.gov.in/roadsafety_legalagency.jsp 36 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES Engineer, Highways, Office Superintendent, Medical decline in road crashes between 2018 and 2019 alone. Education, Deputy Director, IRT and Assistant Director, The State’s efforts have been acknowledged by the Centre School Education. Besides acting as the Secretariat for the that has recently awarded it for ‘Best Performance in State Road Safety Council, the Cell notifies all the targets Road Safety’ One of the biggest reasons for an over 22% for reduction of crashes and draws the Annual Action reduction in fatalities in Tamil Nadu between 2016-18 Plan. Additionally, it manages the State Road Safety Fund could be attributed to improved post-crash care in the and monitors all district level programmes on road safety. State. Since VRUs are the most at risk especially in LCS, Further, the Tamil Nadu State Government under its Road marginal improvement in post-crash emergency care and Safety Mission has mandated the creation of Road Safety trauma services can go a long way in saving lives of road Cells in Chennai, Madurai and Coimbatore corporations. crash victims. In addition to all these functions, Road Safety Cells/Council If we look at the pendency of Motor Accident Claims should also be entrusted with the task to ensure that all States Petition (MACP) at national out level, over 8 lakh cases are mandatorily publish their targets on road safety annually pending at district and taluka level courts24. To put that so that their performance can be measured against these in perspective, nationally, out of all original civil pending targets. Additionally, their budgets should be reviewed by a cases, 12.4 percent of the cases are MACP. As far as relevant authority to maintain transparency and efficiency. inter-state variations are concerned, Tamil Nadu has the Since High Capacity States have higher spending power highest pendency at 28.4% (1,54,847 cases) followed by and more effective institutional mechanisms to implement Maharashtra (9.11%), Bihar (4.66%) and Uttar Pradesh targets, a multi-level agency should be set up in every State (1.8%). to oversee road safety efforts and guide HCS in drawing out detailed plans. As far as Road Safety funding in concerned, Maharashtra State Government allocated 50 lakhs for publicity and Tamil Nadu, Maharashtra and Bihar have also seen a education of road safety in its Annual Scheme 2019-2025. In decline in road crash deaths over the last 4 quarters (since terms of emergency health facilities, Maharashtra has over July 2020) with Tamil Nadu seeing a consistent drop in 930 ambulances and 23 District Hospitals as of date. The fatalities over the last 5 years. The state witnessed a 10% State Government has a State scheme for cashless and 24. https://njdg.ecourts.gov.in/njdgnew/?p=main/pend_dashboard 25. https://plan.maharashtra.gov.in/Sitemap/plan/pdf/Annual%20Secheme%20(Departmentwise)%202019-20.pdf Traffic Crash Injuries and Disabilities: The Burden on Indian Society free treatment in designated hospitals.26 The Department of Medical Health & Family Welfare, Government of Uttar Pradesh has also issued detailed post-crash Guidelines for strengthening Trauma Care response system in the State through a sectoral approach (Trauma Care Guidelines for Road Traffic Injuries 2018-2025)27. The guidelines cover a wide range of topics like pre-hospital care, hospital care, rehabilitative care and establishing trauma centres in the vicinity of National Highways traversing through the State. Looking at the data from the survey, compared to High Capacity States, a higher proportion of households in low capacity states reported an adverse impact due to crashes. This was indicated by decline in household income, living standard, food consumption, increase in OOPE on medical treatment and rising household debt. 26. https://www.hindustantimes.com/mumbai-news/maharashtra-approves-free-treatment-scheme-for-road-crash victims/story- FDPR09XLfM9eym8rDUq9lI.html 27. http://uphssp.org.in/Tenders/Traumacareguidelines.pdf 38 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES TABLE 4.4: TABLE INDICATING SUMMARY OF FINDINGS FOR HIGH AND LOW CAPACITY STATES High Capacity States Low Capacity States (Overall – LIH and HIH) (Overall – LIH and HIH) Particular LIH HIH LIH HIH N 1038 1041 Female victims 20% 11% BPL households 46% 61% Avg. Monthly household income – LIH (INR) 24,702 15,430 Victims earning members of household before 86% 79% crash 77% 61% Victim survived in crash 75% 87% 53% 88% 64% 78% Decline in household income after crash 68% 50% 82% 65% Living standard of household decreased due to 49% 64% crash Increase in household OOPE on medical treatment 57% 65% Increase in household debt due to crash (borrowed 32% 38% money) Food consumption decreased after crash 34% 40% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.4. OUT OF POCKET EXPENDITURE golden hour. Some other States like Delhi, Odisha, Gujarat and Karnataka have also been running their own cashless (OOPE) AND TIME TAKEN TO GET assistance schemes. Though there is no standardization BACK TO WORK in terms of the cap offered on the cost of treatment, list of injuries covered and the funds available for the same. However, most State schemes cover treatment up to 48 Direct financial costs are one of the major consequences of hours after the crash except Maharashtra which covers road crashes to be borne by victim households. These are treatment up to 72 hours. Under the Maharashtra State tangible and can be quantified. These costs include medical scheme, cashless and free treatment is provided up to 1.5 costs, funeral costs, damage costs, rehabilitation costs, lakh per family per year. property costs and other such costs that have a monetary value. The five direct costs included for discussion in this Medical costs constituted a bulk of the total costs of section are medical costs, property/vehicle costs, legal LIH, i.e., Rs. 78,824 (52% of total costs) followed by loss and administrative costs, funeral costs, compensation of productivity/loss of income costs, i.e. Rs. 37, 572 (25% cost and other additional costs. Indirect costs associated of total costs). Property damage is one of the key costs with crashes are often hidden and constitute a much larger resulting from a road crash and refers to the damage caused cost burden than direct costs. These include job losses, to any personal/public property and to the vehicle involved productivity/income losses, reduced quality of life/decline in in the crash. LIH incurred a lower property cost (average standard of living and even psychological impact. The loss amount of Rs. 12,752, comprising 8% of the total income) in income, especially of a breadwinner of the family can be than HIH (average amount of Rs. 28,845, comprising almost a crippling cost incurred on the household after a crash. 15% of their total costs). The legal and administrative costs reported by LIH were higher compared to HIH. While LIH Overall, the total average costs (direct and indirect combined) spent an average amount of Rs. 6,627 (4% of total costs), borne by victim households was about Rs.1,52,339 for LIH HIH spent an average amount of Rs. 5,629 (2.8% of the victims. This was lower than the average costs recorded total costs) on legal and administrative costs incurred by respondents among HIH, i.e., Rs. 1,98,037. Owing to the post-crash. The main heads under legal and administrative high medical costs borne by road crash victims, especially costs include police costs, costs of fire services and other from LIH that further pushes them into poverty and debt, emergency services (excluding transportation of casualties the Centre has proposed a scheme for cashless treatment to hospital, which is part of medical costs), insurance of road crash victims under Section 162 of the Motor costs, costs of legal cases resulting from road crashes, and Vehicles (Amendment), Act, 2019. A draft of the scheme costs of imprisonment etc (Wijnen et al, 2017).There is an suggests a cap of Rs 2.5 lakh for the victim’s treatment urgent need to lower the OOPE for LIH by improving health per crash and designates the National Health Authority as infrastructure, especially in rural areas, investing in better the nodal agency to implement the scheme under Pradhan training of manpower, making post-crash emergency care Mantri Jan Arogya Yojana. Immediately implementing more accessible and efficient, ensuring more efficient this scheme will help save a lot of lives during the crucial penetration and coverage of LIH under health insurance. 40 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES TABLE 4.5: TABLE INDICATING STATE WISE COMPARISON OF AVERAGE COSTS PAID BY VICTIM HOUSEHOLDS LIH (Rs.) Losses incurred due to the Gender wise Habitation wise State wise road crash Male Female Urban Rural Bihar Maharashtra Tamil Nadu Uttar Pradesh N 1420 227 482 1165 412 415 407 413 Total expenditure 155950 131768 136767 159204 1,09,227 1,89,621 1,42,350 1,64,230 Loss of income (victim & family members) 38,259 33,281 39,563 36,749 19,825 48,381 52,399 29,805 during period of treatment Loss of property/ vehicle etc. due to road 13,034 10,988 13,463 12,458 6,915 10,863 20,201 13,133 crash Out of pocket expenses on treatment of victim 81,723 60,689 64,424 84,782 66,659 1,10,029 58,701 79,433 Legal/ administrative/ compensation 6,740 5,916 3,694 7,840 4,192 6,512 6,190 9,600 expenses including police, lawyer, etc. Amount paid to other vehicle/ person 2,565 2,160 3,469 2,112 1,033 969 4,857 3,216 involved in crash Others (hospital visits, loss of belongings, food expenses, travel, 13,629 18,733 12,154 15,264 10,604 12,867 -- 29,042 etc.) Traffic Crash Injuries and Disabilities: The Burden on Indian Society HIH (Rs.) Losses incurred due to the Gender wise Habitation wise State wise road crash Male Female Urban Rural Bihar Maharashtra Tamil Nadu Uttar Pradesh N 340 92 356 76 115 113 103 101 Total expenditure 197712 236354 222992 198189 1,47,156 1,62,907 2,49,081 2,30,800 Loss of income (victim & family members) 79,159 61,465 74,316 80,422 68,957 73,885 1,13,340 45,699 during period of treatment Loss of property/ vehicle etc. due to road 30,999 20,886 28,681 29,616 28,496 19,331 40,097 28,414 crash Out of pocket expenses on treatment of victim 64,278 46,424 59,871 63,309 27,083 68,221 74,913 75,110 Legal/ administrative/ compensation 5,899 4630 4,391 11,428 6,896 872 11,391 3,634 expenses including police, lawyer, etc. Amount paid to other vehicle/ person 7,233 2949 5,699 9,234 12,224 598 9,340 2,943 involved in crash Others (hospital visits, loss of belongings, food expenses, travel, 10,143 100000 50,033 4,180 3,500 -- -- 75,000 etc.) 42 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES The compensation costs28 made up a minor chunk of the destabilises family budgets, especially among middle- total costs among both LIH and HIH. While LIH paid Rs. and low-income households.” The interim compensation 2,509 (1.6% of the total costs) as the average amount to envisaged under Section 164A of the Motor Vehicles the other party; HIH paid double the amount at Rs. 6,321 (Amendment) Act, 2019 should be implemented to ensure (3.2% of total costs). Under the purview of this study, other mechanism for quick compensation as direct credit in costs were included to be all other miscellaneous and Aadhar linked bank accounts of the family member. additional costs incurred by households on travel, hospital visits, food expenses, and other arrangements during the In terms of indirect costs, LIH incurred a 25% (Rs. 37, 572) victim’s treatment. LIH spent an average amount of Rs. loss in their household income owing to the inability to 14,054 (9.2% of total costs) while HIH spent a slightly work/loss of employment whereas HIH incurred a loss of higher average amount of Rs. 21,375 (10.8% of total costs) 38% (Rs. 75, 391). This made up the most significant cost on additional costs. for HIH followed by OOPE that comprised 30% of their total costs. Costs incurred due to loss of income was highest in Overall, the average expense incurred on the victim’s funeral Tamil Nadu among both HIH and LIH. was Rs.22,242 (16% of the total costs) among LIH whereas the average costs incurred on the victim’s funeral among Bihar had the lowest average costs borne by LIH victim HIH households was 51,498 (23% of total costs), i.e., almost across all expenditure heads except out of pocket expenses double the LIH costs. The highest expense among LIH on on treatment of the victim and amount paid to other parties the victim’s funeral was incurred in Tamil Nadu (Rs 42, 010) involved in the crash. It was the opposite for Tamil Nadu while the lowest amount was spent in Uttar Pradesh (Rs where average costs were higher across most of the heads 12, 517). It must be noted that in none of the cases funeral except for out of pocket expenses on treatment and legal/ expenses were covered through insurance. Respondents administrative expenses. Property costs were highest among LIH were either not aware of this or did not claim among households in Tamil Nadu. Legal and administrative funeral compensation under insurance. costs were highest among LIH in Uttar Pradesh. Among LIH, highest OOPE related costs were recorded for Maharashtra A mixed-methodology study by Archana Kaushik followed by Uttar Pradesh. estimated that on an average (across religious affiliations), about  `8,000–`10,000 is the minimum amount spent only Out of pocket expenditure (OOPE) is the payment made on cremation/burial of the deceased29. Additionally a large directly by individuals at the point of service where the amount of money is spent on death rituals. The study entire cost of the health good or service is not covered concluded that the “expenditure on death rituals invariably under any financial protection scheme. The out of pocket 28. Compensation costs refer to the amount paid by the victims/their families as compensation to the other party involved in the crash in case the crash happened due to the victim’s fault. 29. https://www.epw.in/engage/article/can-you-afford-die-estimates-expenditure-rituals-and-impact-ecology Traffic Crash Injuries and Disabilities: The Burden on Indian Society medical expenditure in India is over 62.4% of the overall The Central Government should notify and implement the cost of healthcare (FICCI-KPMG Report, 2017). This is scheme for cashless treatment of road crash victims under an indicator of low government investment in healthcare Section 162 of the Motor Vehicles (Amendment) Act’ 19. and such expenditure is typically financed by household The cashless treatment scheme will help in alleviating the revenues (71%). The highest percentage of out of pocket OOPE on victim’s treatment. health expenditure (52%) is made towards medicines (Rao, Nivedita, 2018, PRS). This is followed by private OOPE varies enormously by type of disease, health care hospitals (22%), medical and diagnostic labs (10%), patient provider (public/private), quality of care and geographical transportation, and emergency rescue (6%). 72% in rural region. This study illustrates that OOPE related costs and 68% in urban areas is spent on buying medicines for were higher among males than females. Additionally, non-hospitalised treatment. The private sector provides expenditure on OOPE in urban areas was higher compared more than 80% of outpatient care and 60% of inpatient to rural areas among both households. Among the LIH in care. Out of the total household expenditure, 45% is spent urban areas, OOPE was slightly higher at 66% of the total on outpatient care (including both general and special expense compared to 60% of the total expense among treatment) as compared to 35% on inpatient care. Due HIH in rural areas. Across both categories of households, a to high out of pocket healthcare expenditure, about 7% higher proportion of respondents (almost double) reported population is pushed below the poverty threshold every an increase in their OOPE in case the victim survived. year (NSSO Survey, 2014). Interestingly, among HIH, the highest OOPE related household costs were recorded in Bihar (72%) and the Under this study, respondents were asked to provide an lowest were recorded in Tamil Nadu (35%). estimate of their household’s medical expenses after the crash. Medical costs cover the entire post-crash expenditure Not only do LIH spend more on medical costs, victims from on the victim’s treatment. It includes the Out of Pocket LIH also take double the time to recover from their injuries Expenditure (OOPE) on hospitalisation costs, costs on and resume work after an crash compared to victims medicines and other medical apparatus etc. The findings from HIH. While victims from LIH took about 92 days, i.e. revealed that on an average, LIH spent a little more than half 3 months to resume work, victims from HIH took 43 days, (52%) of all their income as out of pocket expenses on the i.e., about 1.5 months to return to their jobs. Similarly, victim’s treatment (hospitalisation, medicines, care). In terms victims from LIH also took nearly double the time to find of the average amount, out of pocket expenses on treatment a new job after the crash compared to victims from HIH. of LIH victims accounted for Rs.78,824. On the other hand, While victims from LIH took 107 days to assume a new job, HIH reported spending 30.5% of their household income, i.e., victims from HIH took 65 days for the same. Rs.60,476 on the victim’s post-crash treatment and recovery. 44 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES 4.5. GENDER-DIFFERENTIATED Out of the 1724 crash victims identified as earning members of the household by the respondents of this TRENDS AND IMPACTS study, 1353 were identified as Chief Wage Earners of the household30, i.e., almost 79% of all crash victims were the While road fatalities continue to be disproportionately Chief Wage Earners (CWE) of their households. 78% of the higher among male road users, the consequences of a road LIH victims were CWE whereas 71% of the HIH victims crash create an unfavourable impact among the female were CWE. Across household categories, the proportion of members of a household. It helps us better conceptualise men reported as the Chief Wage Earners was significantly the impact of road crashes on women, especially from poor higher than women, men from LIH being the highest. 50% households in the framework of functioning and capabilities of the women from LIH and 55% from HIH were CWE of the (Sen and Nussbaum). Functionings are ‘beings and doings’, household before the crash whereas 81% of the men from that is, various states of human beings and activities LIH and 74% men from HIH were CWE before the crash. that a person can undertake. Capabilities are a person’s Uttar Pradesh had the highest number of CWE as victims real freedoms or opportunities to achieve functionings. (80%) from LIH while Maharashtra had the highest CWE as According to the capability approach, functionings and capabilities are constitutive of a person’s core being and can be used as the best yardstick to evaluate one’s well- being and freedom (Sen, 1992). These beings and doings together hold what makes a life valuable. Road crashes can be conceptualised as a sudden unforeseen assault on capabilities and functionings that curtails the freedom “He received the salary for that of victims to realise their best optimal potential and live a month but for 5-6 months he was dignified life. Crashes not only derail the lives of the victims but they also jeopardise the realizations and potential on a complete bed rest. All the of family members of victims, coercing them into untold load fell upon me.” misery and suffering. In case the sole breadwinner of the household expires post- - Female FGD Respondent crash or a key earning member suffers serious injuries and hospitalisation, the burden of running the household falls on the shoulders of female members. 30. Chief Wage Earner refers to a person who contributes the maximum to the monthly expenses of the household. Traffic Crash Injuries and Disabilities: The Burden on Indian Society victims from HIH (78%). both household types; the highest being among HIH rural households (69%). The involvement of the CWE in the crash affects the household’s financial status adversely, especially among Along with income, the pattern of (surviving) victims’ LIH. The severe impact of decline in income was higher contribution to household income was also examined. among rural households, and cases where victims had died Respondents were asked to report the victims’ contribution as well as where victims were males. 31% of the female to the household’s total income pre-crash, on resuming members in LIH were severely affected by the decline in work after the crash and the current status as on 31st household income after the crash whereas 53.5% of the Jan 2020. Among LIH, while victims were contributing male members were severely affected by the same. Among 56% of the total household income before the crash, their HIH, 18.5% of female members of the household were share was reduced by 10% after the crash with 46% of the severely affected compared to 26.5% of the male members. surviving victims contributing to total household income Income decline was severe for rural LIH rural (56%) on resuming work. With a reduction in monthly income, the compared to urban HIH (29.5%) and rural HIH (39.5%). contribution to total household income was also reduced among the LIH. An almost similar trend was observed As per survey findings, the contribution of LIH victims across all the States with Uttar Pradesh registering the (60%) who succumbed to their injuries after the crash to sharpest decline. the total household income was a little higher than that of the victims belonging to HIH (57%). State-wise, the During the survey, LIH respondents had stated that in highest contribution of victims was reported from LIH in case of the victim being the breadwinner of the family, Maharashtra (64%) while the lowest was reported from LIH other family members had to shoulder responsibility for in Tamil Nadu (56%). the sudden unforeseen expenses. In many cases, they had to arrange for loans from lenders/banks/relatives or The male (dead) victims’ contribution to household income sell/mortgage assets like land, jewellery, etc. to manage was significantly higher than female victims’ (more than household expenses. LIH respondents also stated that in double) across both categories of households. For instance, the absence of any steady primary source of income, the among LIH, male (dead) victims contributed to 63.5% of the women of the household often had to step up and take total monthly household income whereas female victims additional jobs to mitigate the financial burden. contributed to 29% of the same. Similarly, the contribution of victims from rural areas to the total household income Women and labour can be used interchangeably. Women was higher than the victims living in urban areas across who enter the labour market for remunerative work often 46 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES “No, I started doing this (stitching) after the crash as the “It was a tough period and person, from whom I borrowed hard task. We had to wake up money at the time of the crash, early in the morning. We had started asking for money. I had to look after the children and to take a micro finance loan and provide for the medicines. In since I had to repay it, I had to fact, we had to do everything take up stitching work. I took all alone” around Rs.30,000 and with interest gave back around Rs 36,000.” - FGD Respondent, Patna. - FGD Respondent also perform additional household labour in developing and unacknowledged within research studies and policy countries. Caregiving is an unacknowledged undervalued making. States need to acknowledge that gender responsive activity predominantly undertaken by women within reporting and monitoring is essential to evaluate the households. This includes nursing and looking after the impact of road crashes on women. WHO also recommends daily needs of an injured person or dependent within the that “Gender differences in the social and economic household, cooking for them, administering medicines consequences of temporary and/or permanent disability to them, making their bed, assisting them to clean up resulting from injury have to be taken into account when etc. In terms of economic value, these activities are non- planning rehabilitation services” (WHO, 2002). To ensure remunerative in nature and add to the double burden of rehabilitation services as well as adequate support to either work for women and also lead to time-poverty. women road crash victims or families which are left to deal with loss of male breadwinner, gender disaggregated data This section was thus an attempt to highlight the gendered at state and district level would be imperative to create impact of road crashes that is mostly underreported gender responsive post-road crash safety nets. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.6. DIFFERENTIAL ABILITY TO COPE/ of income is the biggest component while looking at total costs. OOPE further adds to the burden for both LIH & HIH RESPOND TO A FINANCIAL CRISIS and drives them into financial distress. POST-CRASH - LIH VS HIH Economic resources, including both cash and noncash income, determine the economic well-being of households. Road crashes alter the socio-economic realities of families Cash income is the most widely employed measure both in the short and long run. Road crashes chronically of household economic well-being, but it excludes lower the Quality of Life (QoL), as measured by pain/ considerable amounts of resources received in a noncash discomfort during usual activities, mobility, self-care, and form (Smeeding, 1993). These include health care, housing, mental issues. The main cost item related to serious road education, child care, transportation, food, and other injuries is loss of opportunities to participate in market subsidies from governments or from other third parties production due to disability or sick leave. It includes (i.e., employers), and in-kind transfers received from the loss of productivity and loss in income due to not relatives, friends and others in the form of food, clothing being able to work. During the study, the loss in income/ and/or shelter (Smeeding, 1993). Standard of living under productivity and other additional costs were self-reported the purview of this study has been defined as the level of by the respondents in terms of an average estimate while wealth, comfort goods, material goods and necessities the standard of living costs were determined based on a required to live a comfortable and fulfilling life; it includes qualitative assessment of the responses collected from non-cash resources that make a good life. respondents among both households. Nearly two-third (63.5%) of the respondents from LIH said The loss in income was self-reported by respondents that their family had undergone a deterioration in their living on the basis of days of work they had to forsake during standards after the crash compared to less than three treatment/recovery post-crash care. This also includes the out of ten (29%) respondents from HIH who confirmed income forsaken of the family member/s accompanying the same. An adverse impact on the living standard was the victim to the hospital for treatment or looking after him/ confirmed by a higher proportion of respondents in cases her at home, thus not being able to report to work. In terms where victims had died as well as where victims were male of average loss of income reported by the respondents earning members of the family. Bihar reported the sharpest during the period of treatment, including that of the victim decline in living standards among LIH (73%) followed by and family member(s), the average loss was estimated to Uttar Pradesh (72%). The decline was consistently low be Rs.37,572 for LIH, i.e., 25% of their total costs. While it across all States for LIH (50% and above). Similarly, among was estimated to be Rs. 75, 291 for HIH, i.e., 39% of the HIH, Bihar again recorded the highest decline in living total costs. It’s also important to note that for HIH, loss standards (40%) followed by Tamil Nadu (35%). 48 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES Financial impact on the living standards of poor victims mortgaged their assets to meet their daily expenses and and their families (LIH) is more severe than those for rich repay their debt, compared to only 7% of HIH. At the same victims and their families (HIH). Lack of financial resources time, about 14% of LIH reported taking up extra work to leads to poor households making many compromises deal with the situation, compared to 4% of HIH. in terms of food consumption levels and cutting down on everyday items, even essentials to make ends meet. Compared to urban areas, a higher percentage of LIH in Financial distress affects the quality of life and can lead to rural locations availed a loan, sold/mortgaged their assets health complications, depression, sleeping problems and and took up extra work, to cope with the financial burden. In other health issues among the victim/family. Among LIH, the absence of institutional and credible sources of financial 38.5% of the respondents reported a severe deterioration in support and lack of income, LIH were more likely to borrow their living standards after the crash while among HIH, only money from relatives/friends. Banks usually ask for proper 13% of the respondents said the same. Around 69% of the documentation (that most LIH find difficult to produce) and respondents from HIH chose the option “none”, i.e., they did take a longer time to approve loans as opposed to informal not witness any change in their living standards and could sources. 48% of the LIH in Uttar Pradesh availed for a loan comfortably tide over the post-crash situation. to deal with the financial burden while 15% of the HIH from Tamil Nadu did so, exposing a wide contrast between the To cope with the excessive financial burden caused due to households. The ability to take a loan from institutional the crash, various mechanisms are used by victims/their sources also depends on one’s socioeconomic status and family members to tide over the crisis. Mechanisms such as further makes the process of repayment more strenuous availing of loans, selling assets or taking up extra additional for poor households. work by household members, dipping into family savings, etc. are exercised by victims and/or their family members. Compared to other states, the highest proportion LIH This section examines such mechanisms and contrasts from Tamil Nadu sold/mortgaged their assets, took on the differences in which they are used by members of poor extra work and received compensation from the insurance and rich households. The findings reveal that compared to company as well as other parties involved in the crash HIH, LIH were three times more likely to seek financial help to deal with their financial burden. While LIH were more in order to cope with the financial burden post-crash. They dependent on loans and selling off assets to meet their took mostly informal loans from close friends/relatives, expenses, they were less likely to receive compensation sold/mortgaged their family assets (land, jewellery, motor- from insurance companies compared to HIH. One-fourth vehicle) to meet their expenses. of HIH (24%) received compensation of about Rs.1,62,562 from insurance companies (including vehicle/ medical/ About 42% of LIH reported that their household underwent life insurance, etc.) while only 14% of LIH received an debt after borrowing money (through both formal and average compensation of Rs.89,215. This gap highlights informal sources), compared to 11% of respondents from the asymmetry in insurance penetration and compensation HIH. The average value of loans taken by LIH was Rs. claims by the rich and poor. Though merely increasing 99,850. Similarly, about one-fourth of the LIH (24%) sold/ insurance coverage is also not enough. There exists Traffic Crash Injuries and Disabilities: The Burden on Indian Society an information asymmetry on awareness of insurance scheme and its benefits, Health insurance coverage in India particularly remains poor because the private health insurance industry is still at a nascent stage, the pool of people who are able and willing to pay for insurance is low, and insurance premiums are high. Further because LIH, especially in rural India, have limited access to healthcare services such as doctors and hospitals, they are less likely to buy health insurance. Additionally, insurance policies need to be made more comprehensive and inclusive by including mental health and rehabilitative care for road crash victims under its scope. A higher percentage of respondents from HIH said they relied on their savings to meet their additional expenses post-crash. While about 7 out of 10 LIH dipped into their family savings (averaging at Rs.92,065), as high as 9 out of 10 HIH households used their family savings (averaging at Rs.1,45,401) to meet the additional expenses. In terms of the amount arranged to tide over the economic crisis, LIH from Maharashtra managed to raise the highest amount whereas among HIH, a similar trend was observed in Tamil Nadu. Interestingly, LIH in Uttar Pradesh (over 2.5 lakhs on an average) received the highest compensation from Government schemes at the central and local level followed by Maharashtra (around 1lakh average). The lowest government compensation was received by LIH in Bihar (44,000). LIH in Maharashtra (1.8 lakhs) received the highest compensation from insurance companies followed by Uttar Pradesh (around 1.4 lakhs). HIH in Uttar Pradesh reported the highest compensation amount at around 4 lakhs followed by Bihar (2.3 lakhs). 50 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES TABLE 4.6: TABLE INDICATING MECHANISMS TO COPE WITH FINANCIAL BURDEN - LIH VS HIH Arrangements LIH [N=1647] Yes % and Average amount (Rs.) to cope-up Gender wise Habitation wise State wise with the Overall financial burden Male Female Urban Rural Bihar Maharashtra Tamil Nadu Uttar Pradesh Arranged a loan (lenders, 41.8% 43.2% 33% 27.0% 47.9% 43.2% 44.1% 31.4% 48.2% bank, relatives, etc.) Rs.99,850 Rs.1,01,927 Rs.82,880 Rs. 85,874 Rs.1,03,107 Rs. 96,874 Rs.1,27,421 Rs. 74,024 Rs. 93,771 Sold/ mortgage assets (land, jewellery, motor 23.7% 24.4% 19.4% 21.0% 24.8% 22.8% 17.6% 30.2% 24.2% vehicle etc.) Rs.98,608 Rs.1,03,034 Rs.63,807 Rs. 51,228 Rs.1,15,167 Rs. 1,07,468 Rs. 1,43,566 Rs. 49,033 Rs. 1,18,440 Took on extra work by 14.4% 15.6% 6.6% 11.8% 15.5% 17.2% 12.3% 19.4% 8.7% household members Rs.5,475 Rs.5,359 Rs.7,200 Rs. 5,414 Rs. 5,494 Rs. 4,201 Rs. 4,539 Rs. 7,384 Rs. 5,125 (monthly extra earning) Compensation from the 14.1% 13.8% 16.3% 13.2% 11.9% 16.4% 7.2% 29.0% 8.7% insurance company Rs.89,215 Rs.95,753 Rs.54,581 Rs. 84,190 Rs. 84,239 Rs. 99,009 Rs. 1,80,483 Rs. 53,203 Rs. 1,37,967 (including vehicle/ life insurance, etc.) Received compensation 8.3% 8.7% 5.7% 5.4% 9.5% 13.1% 4.3% 5.2% 10.7% under schemes (govt., local Rs.1,20,478 Rs.1,27,411 Rs.54,346 Rs. 50,981 Rs. 1,36,757 Rs. 44,019 Rs. 1,04,222 Rs. 45,333 Rs. 2,56,830 authorities, funeral expense, etc.) Received compensation 6.0% 6.3% 4.0% 7.5% 5.3% 8.7% 6.3% 5.2% 3.6% from employer Rs.52,729 Rs.54,253 Rs. 37,667 Rs. 20,147 Rs. 71,648 Rs. 31,414 Rs. 79,692 Rs. 50,076 Rs. 60,867 Dependent was provided job by employer/ govt. 3.2% 3.3% 2.2% 4.6% 2.6% 7.3% 0.5% 2.2% 2.7% (monthly income) Rs.7,721 Rs.7,309 Rs. 11,600 Rs. 6,623 Rs. 8,527 Rs. 4,957 Rs. 16,500 Rs. 11,222 Rs. 10,800 Received compensation 9.8% 9.2% 13.7% 13.3% 8.4% 10.2% 5.3% 21.6% 2.4% from other party involved in Rs.64,572 Rs.70,301 Rs. 40,361 Rs. 31,007 Rs. 86,492 Rs. 19,778 Rs. 1,69,000 Rs. 47,852 Rs. 1,70,100 a road crash Spent from family savings 74.7% 74% 79.3% 87.3% 69.5% 67.0% 82.2% 77.9% 71.9% Rs.92,065 Rs.93,818 Rs. 81,833 Rs. 94,251 Rs.90,930 Rs.70,509 Rs. 96,487 Rs.110195 Rs.87,671 Traffic Crash Injuries and Disabilities: The Burden on Indian Society Arrangements HIH [N=432] Yes % and Average amount in (Rs.) to cope-up Gender wise Habitation wise State wise with the Overall financial burden Male Female Urban Rural Bihar Maharashtra Tamil Nadu Uttar Pradesh Arranged a loan (lenders, 11.1% 12.4% 6.5% 7.0% 30.3% 11.3% 8.0% 14.6% 10.9% bank, relatives, etc.) Rs. 92,218 Rs. 92,294 Rs. 91,683 Rs. 1,20,004 Rs. 62,015 Rs. 30,881 Rs. 1,34,444 Rs. 1,15,333 Rs. 98,636 Sold/ mortgage assets (land, jewellery, motor 7.4% 7.4% 7.6% 5.1% 18.4% 10.4% 4.4% 10.7% 4.0% vehicle etc.) Rs. 74,969 Rs. 81,920 Rs. 50,143 Rs. 1,01,444 Rs. 40,929 Rs. 19,083 Rs. 44,000 Rs. 1,40,909 Rs. 1,00,000 Took on extra work by 3.9% 4.1% 3.3% 0.8% 18.4% 8.7% 0.9% 4.9% 1.0% household members Rs. 18,765 Rs. 19,214 Rs. 16,667 Rs. 16,667 Rs. 19,214 Rs. 5,000 Rs. 20,000 Rs. 44,800 Rs. 25,000 (monthly extra earning) Compensation from the insurance company 24.1% 26.2% 16.3% 22.8% 30.3% 17.4% 31.9% 25.2% 21.8% (including vehicle/ life Rs. 1,62,562 Rs.1,81,319 Rs. 51,267 Rs. 1,89,844 Rs. 66,478 Rs. 2,32,450 Rs. 31,706 Rs. 89,846 Rs. 3,99,091 insurance, etc.) Received compensation 2.5% 2.9% 1.1% 1.1% 9.2% 7.0% 0.9% 1.0% 1.0% under schemes (govt., local Rs. 55,500 Rs. 60,900 Rs. 1,500 Rs. 25,750 Rs. 72,500 Rs. 57,375 Rs. 1,500 Rs. 1,00,000 Rs. 50,000 authorities, funeral expense, etc.) Received compensation 3.5% 4.4% 2.2% 9.2% 7.0% 3.5% 2.9% from employer Rs. 45,287 Rs. 45,287 Rs. 54,388 Rs. 34,886 Rs. 25,288 Rs. 63,000 Rs. 75,000 Dependent was provided job by employer/ govt. 2.8% 2.9% 2.2% 0.8% 11.8% 7.8% 0.9% 1.0% 1.0% (monthly income) Rs. 11,917 Rs. 11,900 Rs. 12,000 Rs. 22,000 Rs. 8,556 Rs. 3,111 Rs. 15,000 Rs. 50,000 Rs. 50,000 Received compensation 9.7% 10.9% 5.4% 6.5% 25.0% 10.4% 5.3% 20.4% 3.0% from other party involved in Rs. 89,786 Rs. 99,484 Rs. 18,020 Rs. 57,222 Rs. 1,29,205 Rs. 17,917 Rs. 1,13,333 Rs. 1,24,571 Rs. 86,667 a road crash Spent from family savings 91.9% 90% 98.9% 93.8% 82.9% 87.8% 96.5% 94.2% 89.1% Rs. 1,45,401 Rs. 1,53,170 Rs. 1,19,279 Rs. 1,44,517 Rs. 1,50,089 Rs. 1,25,813 Rs. 1,32,450 Rs. 1,87,374 Rs. 1,37,832 52 SOCIO-ECONOMIC IMPACTS OF ROAD CRASHES 6-POINT POLICY RECOMMENDATIONS: of awareness on life-saving protocols among local communities and first responders, low doctor-patient ratio and inefficient emergency management increases the costs 1. Differentiated Support for VRUs, especially from for post-crash care. There is an urgent need to lower the Rural LIH. OOPE for LIH by improving health infrastructure, especially in rural areas, investing in better training of manpower, The findings of the study show linkages between VRUs, making post-crash emergency care more accessible and LIH and road crash outcomes, indicating the need to invest efficient, ensuring more efficient penetration and coverage more in VRU friendly infrastructure that prioritises their of LIH under health insurance.31 safety especially in rural areas. State Governments should select districts with a high VRU crash rate and prioritise 3. Make insurance policies more inclusive by covering their safety through dedicated Annual Action Plans. for rehabilitation and recovery of road crash victims. 2. Urgent need to lower the OOPE for LIH. Additionally, insurance schemes should also account for the mental health impact of road crashes on victims and Out of Pocket Expenses (OOPE) is the most significant design more progressive policies. Establish a neuro-spinal direct cost borne by victim families among LIH. The risk Rehab centre at the District level for all States. Merely of catastrophic expenditure is inversely proportional to increasing insurance coverage is not enough as not all those increasing income per capita, i.e., it is significantly larger for who are enrolled know about the scheme or its benefits, those belonging to lower-income quartiles than for those not all the poor are covered, and not everyone has access belonging to the highest income quartile. to healthcare. Health insurance coverage in India remains poor because the private health insurance industry is still The Central Government needs to urgently notify the at a nascent stage, the pool of people who are able and scheme for cashless treatment of road crash victims and willing to pay for insurance is low, and insurance premiums publicize the Good Samaritan Law in order to save more are high. Further because LIH, especially in rural India, have lives during the critical golden hour. Currently, the Centre limited access to healthcare services such as doctors and has proposed such a scheme under Section 162 of the hospitals, they are less likely to buy health insurance. Motor Vehicles (Amendment), Act, 19. The proposed scheme suggests a cap of Rs 2.5 lakh for the victim’s 4. Better Gender Disaggregated Data. treatment per crash and designates the National Health Authority as the nodal agency to implement the scheme Gender responsive reporting and monitoring is essential to under Pradhan Mantri Jan Arogya Yojana. evaluate the impact of road crashes on women. WHO also recommends that “Gender differences in the social and The lack of infrastructure at the primary level, lack economic consequences of temporary and/or permanent 31. India ranks 145th among 195 countries on the Global Healthcare Access and Quality Index (HAQ) created by the Global Burden of Disease Index study (Lancet, 2016). While the global average per capita spending on healthcare is $822, the WHO estimates India’s per capita health expenditure per year to be $63 that translates to Rs 4,200 (WHO, 2018). Unfortunately, post-accident emergency healthcare is not given the attention or resources it deserves in a country that witnesses over 400 road vtv in a day. Among the poorest households, 90% do not have private or government health insurance. While richer households fare better, coverage among them also remains poor as 67% of urban households lack insurance (NSS, MoSPI, 75th Round Social Consumption in India Survey, July 2017-June 2018). Traffic Crash Injuries and Disabilities: The Burden on Indian Society disability resulting from injury have to be taken into account can be measured against these targets. Additionally, their when planning rehabilitation services” (WHO, 2002). To budgets should be reviewed by a relevant authority to ensure rehabilitation services as well as adequate support maintain transparency and efficiency. Since High Capacity to either women road crash victims or families which are left States have higher spending power and more effective to deal with loss of male breadwinner, gender disaggregated institutional mechanisms to implement targets, a multi- data at state and district level would be imperative to create level agency should be set up in every State to oversee road gender responsive post-road crash safety nets. safety efforts and guide HCS in drawing out detailed plans. To ensure rehabilitation services as well as adequate 6. Sensitisation among the media and police for greater support to either women road crash victims or families reporting on crash cases and filing of FIRs. which are left to deal with loss of male breadwinner, gender disaggregated data at state and district level would Road safety educational programmes need to be enhanced be imperative to create gender responsive post-road for the education and sensitisation of targeted sections. crash safety nets. This can be achieved by conducting For instance, the WHO Media Fellowship offers reporters gender-disaggregated rapid surveys with commuters, bus a curriculum to help make their reporting around road conductors and public transport officials to assess their crashes more nuanced. A similar model needs to be awareness and perceptions of sexual harassment in urban replicated at State level to ensure in-depth comprehensive public spaces. and science-based coverage. Additionally, States can also conduct universal accessibility High levels of underreporting of crashes and the poor state and women’s safety audits to assess the quality of of post-crash care exacerbates the problem of estimating urban transport infrastructure (bus and IPT stops, trains the cost of road crashes among LMICs (WB, 2020). The stations, terminals and interchanges) using the indicators invisibility of indirect costs further adds to the difficulty in and service level benchmarks identified by agencies like estimating an accurate and fair compensation amount to Safetypin and evaluate gaps. States can also assess the be awarded to victims by the court and governments. feeder roads/services in providing last mile connectivity. 5. Mandatory publishing of Real-Time Data, Road Safety Targets by every State to ensure Planned, Targeted Spending It should be made mandatory for all States to publish their targets on road safety annually so that their performance 54 GENDERED IMPACT OF ROAD CRASHES CHAPTER 5 As per the Accidental Deaths and Suicides (ADSI) in India 2019 report, 1,54,732 people were killed and 4,39,262 people were injured in 4,37,396 road crashes in India in 2019. Out of this, 14.31% (22,143) were women. Out of the total 22,143 female victims over 60% women died in rural areas. Similarly, over 60% of the women were also injured in rural areas. The fact that the majority of female road crashes happened in rural areas highlights the exposure to risk on rural roads. Even though crash victims are predominantly male, ‘the impact on household livelihood due to death or injury places significantly more burden on women’ (Turner & Fletcher, 2008). This is due to multiple reasons. The burden of care disproportionately falls on the woman which further causes time poverty for women. Additionally, women also have to cope up with ‘loss of significant male income’. Considering the nature of Indian society, prevalence of patriarchy and gender-based stereotypes, the need to map the linkages between gender, road safety and poverty is important. Since the majority of male road crash victims also die on rural roads, understanding and addressing the impact of these linkages in rural areas is even more important. In the context of the current COVID-19 pandemic, the impact of socio-economic vulnerabilities on women has further deteriorated their position at household and state- level. “COVID-19 has led to a sharp rise in unequal burden Traffic Crash Injuries and Disabilities: The Burden on Indian Society of unpaid care work, depletion of household assets, income the victim suffered serious injuries were directly involved in shocks and liquidity constraints, decline in female labour caregiving activities. force participation, and significant impacts on health and nutrition, exacerbated by existing inequities in health access.” Its therefore even more pertinent to understand the impact of road crashes on households from a gender perspective. “Being a woman, we face a lot of There has been a data bias towards the male point of problems. Whether a man meets view and experience in research generally (Perez, 2019) and this is also true for the issue area of road safety. For a with an crash or a woman, it is comprehensive perspective on the impact of road crashes on the woman who has to handle women their ‘lived experiences’ were documented through everything. From household female-only focus group discussions. Respondents’ activities to serving the patient. perceptions on solutions as well as institutional benefits In case the woman herself is the were also captured. victim, then the whole house As part of the study, two focus group discussions were gets disturbed as the men are conducted with women. Since both Bihar & UP are one of not able to handle household the poorest states in India, and lag behind Maharashtra & chores and caregiving.” Tamil Nadu in crucial human development outcomes such as health and nutrition, education, food security as well as gender development indices, FGDs were conducted - FGD Respondent Patna in the capital cities of Uttar Pradesh and Bihar with LIH respondent group. Most of the women were middle aged (in their 30s and 40s) and were mostly housewives. Most of them had experienced the crash of a male member of the family (husband or brother- in- law) and in cases where 56 GENDERED IMPACT OF ROAD CRASHES FGD participants were probed to discuss various aspects whose brother eventually died after months of treatment, related to the post-crash situation. As per data from the narrated how and it took them eventually two years to field for the quantitative survey for this study, out of the repay the money they had borrowed from relatives and total sample covered, 85% of road crash victims (deaths neighbours. and serious injuries) were male. In cases of severe injuries, the financial burden did not Being head of households or chief wage earners, men end with the discharge of the victim from hospital, rather contribute a major share in household earnings. In case of medical expenses related to victims’ recovery continued a fatality or serious injury, households not only experience and included costs related to medicines, recommended unexpected loss of income, but the responsibility also shifts food/ diet, transportation for doctor/ hospital visits, doctor to the female members of the household. These temporary consultation fee, etc. The financial shock created by the Female Headed Households (FHH) are more vulnerable expenses related to the victims’ medical treatment also and need better social support. These recently turned, FHH permeated other spheres of their family life. experience the sudden shock of income dip and are pushed into further poverty. Following key areas emerged from the Women also found it difficult to arrange the school fee FGDs with women: for their children. Some participants also mentioned that initially, they had to arrange money by mortgaging gold jewellery. 5.1 FINANCIAL IMPACT OF THE CRASH ON THE HOUSEHOLD “We reduced our expenses on FGD participants shared that their families were not unnecessary things such as financially strong to bear the additional expenses due clothes, going on a vacation or to the road crash . Most of the participants agreed that going to parties but we couldn’t the medical bills created a financial drain which further impacted the economic condition of their household. This cut our expenses on daily needs was echoed by respondents with the cases of death as well like food and medicines”. as serious injury. Due to the loss of regular income and sudden financial - FGD Respondent Bihar shock, households were forced to take formal loans or borrow money from relatives or friends. One participant Traffic Crash Injuries and Disabilities: The Burden on Indian Society 5.2 SOCIAL IMPACT ON THE Changes in the food, clothes and lifestyle choices were reported by most of the participants during discussion. Their HOUSEHOLD households had to compromise on food choices as well as other discretionary expenses related to entertainment, Taking social impact into consideration, participants shared celebrating festivals etc. how the crash impacted their social life. The experiences were different for women who reported a road crash death. For example, one of the respondents mentioned that her 5.3 DIRECT IMPACT OF ROAD sister in law moved to her parents’ house after the death CRASH ON WOMEN of her husband in a road crash. This was to provide better education to the children. In fact, a lot of women spoke One of the biggest impacts which women reported is “time about the support they received from their maternal house poverty32”. Respondents reported spending most of their in terms of monetary support as well as load-sharing. time on caregiving activities and household chores. Some of the respondents had to also take up a job as well and The crash also impacted children’s education. Since there that led to further time poverty. wasn’t enough money to pay school fees, in many cases children had to either delay school admission or had to completely drop out of school. “Husband got injured and then the entire burden fell upon my When the elder brother died, the shoulders. I can never forget that younger brother had to pay for time. My husband used to feel regular household expenses despite irritated with me post the crash. his income being low. He had two So, I had to raise my kids look daughters, so he had to ask one of his after their education and well- daughters to drop out of school due to being, on my own” the financial crisis. - FGD Respondent, Bihar - FGD Respondent, Lucknow 32. Time Poverty is defined as working long hours and having no choice to do otherwise. An individual is time poor if he/she is working long hours and is also monetary poor, or would fall into monetary poverty if he/she were to reduce his/her working hours below a given time poverty line.https://elibrary.worldbank.org/doi/abs/10.1596/1813-9450-4961 58 GENDERED IMPACT OF ROAD CRASHES This was further validated through the quantitative survey. member of the household took care of the victim, cooked The role of family members for caregiving activities was all the meals in the household and took care of the daily examined. Overall, across both the categories (LIH & HIH), needs of the victim and the rest of the household. at-least 7 out of 10 respondents mentioned that the female TABLE 5.1: VICTIM CARE BY FAMILY MEMBERS – OVERALL | [N, LIH=569, HIH-269, ALL FIGURES IN PERCENT] 4.4% 1.9% 22.7% 21.9% LIH HIH Male Member Male Member Overall Female member Overall Female member N-569 N-269 Self Self 72.9% 76.2% Bihar (N-124) 26.6% 64.5% 8.9% Bihar (N-79) 25.3% 72.2% 2.5% Maharashtra (N-109) 23.9% 73.4% 2.8% Maharashtra (N-79) 17.7% 79.7% 2.5% Tamil Nadu (N-200) 16% 81% 3% Tamil Nadu (N-62) 30.6% 67.7% 1.6% Uttar Pradesh (N-136) 27.9% 68.4% 3.7% Uttar Pradesh (N-49) 12.2% 87.8% 0 20 40 60 80 100 0 20 40 60 80 100 Habitation Type (N-569) 22.7% 72.9% 4.4% Habitation Type (N-269) 21.9% 76.2% 1.9% Urban (N-346) 24% 72.5% 3.5% Urban (N-249) 21.7% 76.3% 2% Rural (N-223) 20.6% 73.5% 5.8% Rural (N-20) 25% 75% 0 20 40 60 80 100 0 20 40 60 80 100 Victim Gender (N-569) 22.7% 72.9% 4.4% Victim Gender (N-269) 21.9% 76.2% 1.9% Male (N-473) 18.8% 77% 4.2% Male (N-212) 16.5% 81.6% 1.9% Female (N-96) 41.7% 53.1% 5.2% Female (N-57) 42.1% 56.1% 1.8% 0 20 40 60 80 100 0 20 40 60 80 100 Traffic Crash Injuries and Disabilities: The Burden on Indian Society Even for outside chores like buying medicines and taking medical advice and medication. the victim to doctor, there wasn’t a huge gap between men and women sharing responsibilities. Across LIH and The third area of impact for women was their capacity to HIH respondent groups approximately 40% respondents access institutional support. A few respondents mentioned mentioned that women took care of these aspects as well. that they wanted to seek compensation, however, amidst conflicting priorities, the perceptions and the barriers The second fundamental impact was on women’s physical to access the system and seek compensation seemed and mental health. Many respondents mentioned facing a insurmountable. This sentiment was echoed by participants variety of health issues for which they sought continuous in both UP and Bihar. M: Have you received any compensation from the government’s side or any other insurance amount? R: NO. (emphasis original) After the crash, it was very difficult for us to decide who to look after - the husband who is injured, or our children or whether to pursue the offending party at fault. - FGD Respondent Lucknow 60 GENDERED IMPACT OF ROAD CRASHES 6-POINT POLICY RECOMMENDATIONS to increase women’s employment by encouraging entrepreneurship among women. (Niti Aayog, 2019). 1. Emergency cash transfers to vulneable female Women participants also reiterated this. They suggested headed households: simple business models like packaging,baking, pickle making as something that would help them monetarily As part of PM Garib Kalyan Yojana the Government has without leaving the house. Women also preferred a model already implemented the “Unconditional Emergency Cash where they could earn daily or weekly income instead of Transfer” (UECT) to women during the current COVID-19 monthly payments. crisis. (IWWAGE, 2020) The state governments can use a similar framework of UECT to give Aadhar linked DBT to 4. Ensuring quality of care at the hospital. recently turned FHHs. More vulnerable FHHs should be prioritised. The time frame of the emergency cash transfer Many respondents spoke about authorities with mistrust. should be standardised. A few participants suggested that there should be a mechanism to ensure quality of care at hospitals and that 2. Monetary schemes for low interest loans: the treatment of the road crash victims should be made free in government and private hospitals, especially for poor During the FGD, many participants suggested schemes families. They further suggested that awareness on these for low interest or no interest loans to support regular rights should be raised amongst the general public. Since household expenses. The women suggested that the low most of the women who either die or are injured in road interest loan should be easily accessible without much crashes are in rural areas, Accredited Social Health Activists paperwork. (ASHA) workers33 can be trained to provide information on various government schemes for road crash victims and 3. Provide Schemes to incentivize work from home small their families. business. Enrol women who have lost the breadwinner of their families in a road into the employment database 5. Foster Women’s Participation in Local Road Safety to facilitate their job search. Governance Frameworks. State Governments can also float schemes to support these Women’s participation in planning and decision making at women in running small home businesses. NITI Aayog also local road safety governance frameworks including State recommended this strategy to mitigate the declining female Road Safety Council and District Road Safety Committee labour force participation rates in India. It has proposed should be ensured. Adequate female representation shall 33. ASHA workers are the government’s recognised health workers who are usually the first point of contact in rural India, where there is often limited or no direct access to healthcare facilities. Traffic Crash Injuries and Disabilities: The Burden on Indian Society not only ensure Gender responsive monitoring, reporting The Oriental Insurance Co & Ors (2007), in its judgment and budgeting, but will also create opportunities for women dated 17th September 2020 directed Oriental Insurance to be trained for various roles including as paramedics, to pay Rs. 8,22,000/- along with interest at the rate of 6% backend operators for electronic enforcement architecture per annum as compensation for the woman’s death. The and other systems which will be created to ensure road Court while computing the amount considered various safety. factors such as loss of love and affection, funeral expenses, household work and other such factors. Therefore in light 6. Standardisation of Compensation for Non-Working of the subjective interpretation, it is of utmost importance Women. that the Central Government issues guidelines to set a definite criteria for determination of compensation payable The MACT has often taken a very conservative view to the dependents of a non-earning housewife/mother to on compensation for “house-wives”. In Sher Singh remove subjectivities and ensure that family members or vs. Raghubir Singh (2004), the Tribunal assessed the the disabled women (in case of serious injuries) receive dependency of the family on the housewife at as low as Rs. appropriate compensation. 600 per month. The Tribunal concluded that the ‘services rendered by the deceased woman could be replaced by 7. Set-up/Strengthen Safety Response Cell in coordination hiring a servant at the salary of Rs. 600/- per month.’ This with the police and health departments to respond to logic is highly fallacious. The unpaid work done by women victims of sexual exploitation and harassment. in households cannot be quantified by comparing it to the work done by a domestic help. This approach to compute MoRTH can also incentivize select states to create a the compensation by relying upon the minimum wages network of CSOs and service providers who can work payable to a skilled worker has also been criticised by with the State Road Safety Cells to strengthen preventive various members of Judiciary. In Arun Kumar Agarwal vs. approaches. National Insurance Company (2006), the Supreme Court also stated, “It is not possible to quantify any amount in lieu of the services rendered by the wife/mother to the family. The term `services’ is required to be given a broad meaning and must be construed by taking into account the loss of personal care and attention given by the deceased to her children as a mother and to her husband as a wife. The Bombay High Court in the case of Rambhau & Ors Vs 62 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES CHAPTER 6 Road Crash deaths and serious injuries have diverse impacts on the victims and their families. While many studies have documented the impact of road crash outcomes on victims, the impact of the crash at the household level is an understudied area. Death of a family member due to a road crash can have serious social and mental health impact on the rest of the family. Serious injuries on the other hand, impacts the quality of life of the whole household including the victim. This chapter examines the psychological, health and associated impact of mortality and morbidity due to road crashes. KEY FINDINGS • 50% of LIH and 1/4th of HIH category respondents stated “depression” among their family members due to the impact of the road crash; this was higher in cases where fatalities were reported. • Impact on sleeping pattern was found among around three-fourth (72.8%) of poor category (LIH) respondents while among richer counterparts (HIH), it was about six-tenth (60.7%). • A significant difference was found in the proportion of LIH (64%) and HIH (29%) respondents that have confirmed that their living standard has deteriorated since the crash. • Over 1/3rd of LIH respondents (38%) stated that members of their families suffered from health Traffic Crash Injuries and Disabilities: The Burden on Indian Society complications after the crash, while it was about 21% 6.1. MENTAL HEALTH ISSUES for HIH category. AMONGST THE HOUSEHOLD • Among those who survived road crashes, three out of ten (29.5%) victims from poor families (LIH) suffered In order to understand the impact of road crashes on disability, while among the victims from rich families the mental health of victims and their family members, (HIH) the percentage was 7.7% respondents were asked about mental health of household members. A direct question about anyone in their family • Among those who returned to previous occupation, suffering from depression34 was asked. LIH victims took 92 days while HIH victims took 43 days. And to find a new job, LIH victims took 107 days Overall, close to half (48.5%) of LIH respondents stated that and HIH victims took 65 days. their family members suffered from depression due to the impact of the road crash, while about one-fourth (26.2%) • Pre- crash, about 6.6 percent of LIH victims were HIH respondents stated the same. unemployed, while such proportion was increased by about 11 percent and accounted for 18% on resuming The respondents from Bihar & Uttar Pradesh reported a work after the crash. higher percentage than Maharashtra and Tamil Nadu. Further in the LIH category, a higher proportion of • In terms of impact on household, compared to respondents (75%) stated depression in their family where HIH category (27%), a significant proportion of LIH the victim had died compared to where the victim sustained respondents (43.9%) confirmed change in working serious injuries (43.2%). patten of family after crash. Similarly, in cases amongst LIH families where the road The financial impact of road crashes on LIH respondents crash victim was an earning member of the family, is disproportionate and more severe in comparison to road depression was reported by 50% of the respondents. crash impact on HIH respondents. A broad overview of the However, in the case of HIH respondents the proportions responses on various aspects of psychological, emotional were 30 percent. This again demonstrates that depression and social impact suggests that poor families suffer more. could be more related to financial impacts on the family Out of the total sample, about 42 percent victims shared due to crashes. their first-hand experience while 58 percent respondents were family members who responded on behalf of family Further, overall, over one-third of LIH respondents (38%) members as well as the whole household. stated that members of their families suffered from health 34. The respondents were asked to self-evaluate their mental health and therefore undiagnosed cases, where respondents ‘felt’ depressed were also considered. Further the questionnaires were translated in Hindi and other vernacular languages and the respondents were asked if they felt “low or sad without any reason” 64 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES complications, while such proportion of respondents was resources, they could not afford the same over a long time. about 21 percent for HIH category. Category-wise, two Ensuring better nutritional intake for victims impacted the trends were observed amongst both LIH and HIH category nutritional intake of children since they were not able to respondents: respondents reported more adverse impact provide them with certain food categories like dairy and in cases of death and compared to non-earning members, animal protein. more complications were reported when road crash victims were earning members of the family. 6.3. IMPACT ON LIVING STANDARD Motor vehicle crashes  can result in ‘significant post- OF VICTIMS’ HOUSEHOLD traumatic psychiatric morbidity’. The psychological impact of road crashes is an understudied area and the data on Road crash outcomes and their consequences affect the subject is extremely fragmented or non-existent. victims and their families both in short and long term. Academic and other institutions should analyse the trends This includes wage loss, loss of employment, financial for psychological distress due to road crashes in India. The hardships, reduced quality of life and negative impact on Ministry of Health and Family Welfare should also update the functioning of the whole family. During the survey, the National Mental Health Policy (NMHP) notified in 2014. respondents were probed about the social impact of road NMHP acknowledges the linkage between poverty and crashes. mental health however it does not categorise crash victims as “Vulnerable Population”. The state government should A significant difference was found in the proportion of also ensure implementation of NMHP right from Primary LIH and HIH respondents reporting decline in their living Health Care level. standards. While close to two-third (63.5%) of poor families (LIH) reported decline in living standard, less than three out of ten 6.2. DIP IN NUTRITION AMONGST (29.4%) rich families (HIH) have faced such consequences. HOUSEHOLD MEMBERS The impact on living standard was confirmed by a higher With respect to change in dietary habits/ food intake, about proportion of respondents where road crash victims died 44 percent respondents in LIH category stated that there as well as where victims were male earning members of was a negative change in the dietary habits of the household the family. In order to understand the severity of impact on members after the crash. Compared to LIH category, such the household, respondents were asked to rate the level of impact was lower amongst HIH respondents where one- impact on 3-point scale i.e. ‘Severe’, ‘Moderate’ and ‘None’. fourth of respondents (24.3%) confirmed the same. The proportion of those who said there was a severe decrease in living standard were almost three times (38.5%) more in During Focus Group Discussions, respondents also poor families. Further, compared to male respondents, more mentioned that after the crash certain food items were female respondents have confirmed the same. prescribed to the victims, however due to lack of financial Traffic Crash Injuries and Disabilities: The Burden on Indian Society TABLE 6.1: TABLE INDICATING STATE- WISE, HABITATION- WISE, AND GENDER- WISE DETAILS ON WHETHER HOUSEHOLD MEMBERS/ VICTIM DEVELOPED HEALTH ISSUES DUE TO ROAD CRASH [ALL FIGURES IN PERCENT] 3.2% 2.3% 21.3% 37.6% LIH HIH Yes Yes Overall No Overall No N-681 N-305 DK/CS DK/CS 76.4% 59.2% Bihar (N-146) 37% 56.2% 6.8% Bihar (N-83) 16.9% 78.3% 4.8% Maharashtra (N-127) 22% 78% Maharashtra (N-87) 24.1% 75.9% Tamil Nadu (N-245) 34.3% 65.7% Tamil Nadu (N-73) 35.6% 64.4% Uttar Pradesh (N-163) 55.2% 37.4% 7.4% Uttar Pradesh (N-62) 6.5% 88.7% 4.8% 0 20 40 60 80 100 0 20 40 60 80 100 Habitation Type (N-681) 37.6% 59.2% 3.2% Habitation Type (N-305) 21.3% 76.4% 2.3% Urban (N-394) 32.7% 63.2% 4.1% Urban (N-274) 19.3% 78.1% 2.6% Rural (N-287) 44.3% 53.7% 2.1% Rural (N-31) 38.7% 61.3% 0 20 40 60 80 100 0 20 40 60 80 100 Victim Gender (N-681) 37.6% 59.2% 3.2% Victim Gender (N-305) 21.3% 76.4% 2.3% Male (N-573) 38.7% 57.6% 3.7% Male (N-244) 21.3% 76.2% 2.5% Female (N-108) 31.5% 67.6% 0.9% Female (N-61) 21.3% 77% 1.6% 0 20 40 60 80 100 0 20 40 60 80 100 66 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES TABLE 6.2: TABLE INDICATING STATE-WISE, HABITATION- WISE, AND GENDER- WISE DETAILS ON WHETHER THE FOOD CONSUMPTION OF HOUSEHOLD MEMBERS OF THE VICTIM HAS DECREASED 2.6% 5.9% 24.3% 44.2% LIH HIH Yes Yes Overall No Overall No N-681 N-305 DK/CS DK/CS 69.8% 53.2% Bihar (N-146) 41.8% 54.8% 3.4% Bihar (N-83) 21.7% 67.5% 10.8% Maharashtra (N-127) 34.6% 63.8% 1.6% Maharashtra (N-87) 29.9% 69% 1.1% Tamil Nadu (N-245) 43.7% 55.5% 0.8% Tamil Nadu (N-73) 35.6% 64.4% Uttar Pradesh (N-163) 54.6% 39.9% 5.5% Uttar Pradesh (N-62) 6.5% 80.6% 12.9% 0 20 40 60 80 100 0 20 40 60 80 100 Habitation Type (N-681) 44.2% 53.2% 2.6% Habitation Type (N-305) 24.3% 69.8% 5.9% Urban (N-394) 45.7% 51.8% 2.5% Urban (N-274) 23.7% 70.1% 6.2% Rural (N-287) 42.2% 55% 2.8% Rural (N-31) 29% 67.7% 3.2% 0 20 40 60 80 100 0 20 40 60 80 100 Victim Gender (N-681) 44.2% 53.2% 2.6% Victim Gender (N-305) 24.3% 69.8% 5.9% Male (N-573) 45.7% 51.5% 2.8% Male (N-244) 25.4% 69.3% 5.3% Female (N-108) 36.1% 62% 1.9% Female (N-61) 19.7% 72.1% 8.2% 0 20 40 60 80 100 0 20 40 60 80 100 Traffic Crash Injuries and Disabilities: The Burden on Indian Society 6.4. DISABILITY DUE TO ROAD CRASH This section of the report looks at the social impact of road crashes on households and specifically focuses on cases of serious injuries. This part of the survey was conducted amongst the respondents who reported to have either survived the road crash themselves or family members who were speaking on behalf of a victim who suffered serious injuries. Among those who survived the road crash, about three out of ten (29.5%) respondents from poor families (LIH) reported undergoing disability. Amongst (HIH respondents 7.7% reported disability. The vulnerability of poor families was four times higher than those from rich families probably due to the lack of safe mode of transport at the time of crash. Amongst the LIH category, proportion of victims that have undergone any sort of disability was higher in rural areas (39%) compared to urban areas (15%). Almost the same trend was seen for the HIH category as well. 68 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES TABLE 6.3: TABLE INDICATING THE STATE- WISE, HABITATION- WISE, AND GENDER- WISE DETAILS ON WHETHER THE VICTIM WAS AFFLICTED WITH A DISABILITY 29.5 % Overall (N-1052) 7.7% 42.3 % Bihar (N-234) 17.6 % 30.3 % Maharashtra (N-290) 5.9 % 14.6 % Tamil Nadu (N-323) 4.7 % 37.1 % Uttar Pradesh (N-205) 0% 29.5 % Habitation Type (N-1052) 7.7 % 14.8 % Urban (N-418) 6.2 % 39.1 % Rural (N-634) 16.4 % 29.5 % Victim Gender (N-1052) 7.7 % 31.7 % Male (N-884) 8.5 % 17.9 % Female (N-168) 4.7 % 0 10 20 30 40 50 LIH HIH Traffic Crash Injuries and Disabilities: The Burden on Indian Society The respondents who reported disability were further government also launched Bihar State Disability Pension probed the severity of disability, type of disability and the Scheme to cover those persons with disabilities who are not need for assistance. Respondents were asked if the road covered under the Indira Gandhi National Disability Pension crash victims have undergone any sort of disability required Scheme (IGNDPS). Additionally Bihar Government has also on-going mobility assistance i.e. wheelchair, walking launched, Mukhyamantri Viklang Shashaktikaran Yojna frames etc. Overall, about 6 out of 10 respondents in LIH – “SAMBAL- An Integrated Scheme for PwDs”, to protect (64%) and HIH (62%) category require on-going mobility & promote the rights of PwDs. SAMBAL was approved in assistance. 2012 and has three major components to empower PwDs - Educational Rehabilitation, Economic Rehabilitation and Among the respondents (N=339) that reported victim Social Rehabilitation. disability a follow up question was asked to ascertain the severity of the disability. About four out of ten (39%) LIH respondents stated that road crash victims suffered from serious disabilities while among HIH category, such 6.5. PROCESS OF REHABILITATION OF proportion was about one in five (20.7%). THE VICTIM In the LIH category, Bihar has the highest proportion of This section analyses the rehabilitation process of the victims that have undergone serious/permanent disability victims back into their pre-crash social and work life. (45.5%), followed by Maharashtra and Uttar Pradesh. This section covers aspects such as return to previous Gender wise, a higher proportion of male victims (51%) occupation, days taken for recovery, change in occupation suffered from serious/permanent disability than female etc. victims (33%). For cases where victims had sustained serious disability (N=121), respondents were further asked All the respondents who reported that they themselves or about the type of disability. Overall, about two-third of LIH the victim survived the road crashes were further probed victims survived amputation of a limb followed by brain on whether they/ victim could return to the previous injury (22%). occupation/ educational institution after the crash. Overall, three-fourth of LIH respondents and 90% of HIH According to 2011 census, nearly 50% of the disability respondents confirmed that the victims returned to their burden is borne by one of the five States namely Uttar previous occupation/ educational institution after the Pradesh (15.5%), Maharashtra (11.05%), Bihar (8.69%), crash. Andhra Pradesh (8.45%), and West Bengal (7.52%)35. Bihar 35. Censuse 2011, MoSPI: https://censusindia.gov.in/census_and_you/disabled_population.aspx 70 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES Gender-wise, compared to men, less proportion of women explored if the victims could find a new job. The time taken victims returned to their previous profession after the to find the job after the crash was also captured. Out of total, crash. Profession wise, about one-fourth of LIH students about 36 percent of respondents confirmed that victims of could not return to studies after the crash. their household found a job. Further those victims that have found a new job (N=104) were further asked about the time Respondents (N=1142) were asked a follow up question they had taken to find a new job. Overall, on an average LIH about the average time they had taken to return to the category victim took about 107 days to find a new job from previous occupation. Among LIH category, the average the day of the crash whereas it was about 65 days in case time taken to rejoin the previous occupation was about 92 of HIH victims. days (about 3 months) whereas it was 43 days (about 1.5 months) amongst HIH category. This marked disparity between the two categories indicates that victims in the LIH category faced more difficulty in Amongst HIH category the average number of days it getting a new job post-crash. This might be also because took to return to work is significantly less (nearly less of better social integration and support systems available than half in most of the cases). This is a direct indicator of for the HIH category. disproportionate impact of road crashes on LIH category. State-wise, the highest time was taken by LIH victims of Bihar and HIH victims of Uttar Pradesh to return back to 6.6. CHANGES IN EMPLOYMENT their previous occupation. Comparatively, lowest time was taken by victims of Tamil Nadu across both the categories. STATUS Habitation wise, urban victims took less time than rural The comparison of the victims’ employment status at three victims to return to the previous occupation after the crash. different times – a) pre-crash, b) on resuming work after Similarly, gender-wise, men victims took a longer time to the crash and c) current (as on 31st Jan 2020) was also return to the previous occupation than women victims. done. Respondents were asked to mention the occupation of victims during these phases. Those respondents who informed that crash victims could not return to their previous occupation (N=288) were further Pre- crash, about 6.6 percent of victims were unemployed, while such proportion increased by about 11 percent and Traffic Crash Injuries and Disabilities: The Burden on Indian Society accounted for 18 percent on resuming work after the taken by household members and dropping out of school crash. Further, this proportion reduced to 14.4 percent as due to financial constraints. on 31st Jun 2020. This increase in unemployment could be Compared to the HIH category (27%), a significant understood due to injuries and disabilities among victims difference was observed among the LIH category where after crashes. a higher proportion of respondents (43.9%) stated that the working pattern of household members changed Among LIH category, the highest proportion of victims were due to road crash. While about 14 % of LIH respondents salaried employees’ pre-crash (33.5%), on resuming work acknowledged that someone in their household had to take after crash this reduced (28.3%), whereas a slight increase up additional jobs/ shifts because of a road crash, a smaller was observed in the current scenario to 33 percent (as on 4% of HIH respondents acknowledged the same regarding 31st Jan 2020). A similar trend was observed in occupations their families. In cases where the victim had died due to an like agriculture labourer/ farmer and petty trader/ shop crash, more respondents confirmed the same. owners. Further, as high as one in five (20%) respondents of LIH A decline was observed in sectors like farming and skilled category have mentioned that someone in their household and unskilled manual labour. This indicates that the labour- had to give up education due to the crash. Again, such a intensive jobs are more difficult to resume post-crash proportion of respondents among the HIH category was simply due to the injuries, disabilities, and nature of the job only 5 percent. In cases where the crash victim was male where more physical strength is required, which resulted in and the earning member of the family, a higher proportion more unemployment. of respondents had to give up education. In rural habitations, such changes were more prevalent 6.7. OCCUPATIONAL IMPACT AT THE than in urban habitations, amongst both the categories (LIH and HIH). HOUSEHOLD LEVEL Respondents were also probed on factors such as a change in working pattern of household members, additional jobs 72 PSYCHOLOGICAL AND SOCIAL IMPACT OF ROAD CRASHES 6-POINT POLICY RECOMMENDATIONS: who should receive such care and support them through community based programmes. 1. Integrating Road Crash Victims as a special category in Social Security Schemes. 3. Mental Health Support Policymakers need to acknowledge the interplay between Motor vehicle crashes can result in ‘significant post- road crashes and various social hierarchies of class, gender, traumatic psychiatric morbidity’. The psychological impact location that intersect to render certain disadvantaged of road crashes is an understudied area and the data on groups more vulnerable to the shocks of crashes. The the subject is extremely fragmented or non-existent. spatial context and lived experiences of poor households Academic and other institutions should analyse the trends makes it harder for them to respond to the harsh impact of for psychological distress due to road crashes in India. road crashes, pushing them into a vicious cycle of debt and The Ministry of Health and Family Welfare should also suffering. Therefore, all existing social security schemes update the National Mental Health Policy (NMHP) notified should recognize victims of road crashes as a special in 2014. NMHP acknowledges the linkage between poverty category that needs Government support at various levels. and mental health however it does not categorise crash victims as “Vulnerable Population”. The state government 2. Comprehensive Rehabilitation Support. should also ensure implementation of NMHP right from Primary Health Care level. State Governments should also Injury caused by crashes is the 3rd largest cause of conduct awareness drives on already existing schemes like disability. According to a report by NIMHANS, ‘nearly 100% – ‘KIRAN 24x7 Mental Health Rehabilitation Helpline. Most of the severely injured, 50% of the moderately injured and importantly, mental health of road crash victims should be 10-20% of the mildly injured will have lifelong disabilities’. covered under health insurance. In India there are multiple structural, social and economic barriers to accessing Rehabilitation. The Central and State Ministers of Social Welfare and Empowerment should 4. Access to Upskilling and Jobs. create comprehensive programmes for rehabilitation of crash victims. Similarly, District Road Safety Committees The National Skill Development Corporation (NSDC) can should also maintain a database of people in each district undertake a special programme to upskill crash victims from rural areas. The programme can set up specific Traffic Crash Injuries and Disabilities: The Burden on Indian Society targets of skilling 1 million people for the next 5 years and requirements in the country. An automatic enrolment policy so on. should be created at the district level for road crash victims or their family members who had to dropout of schools or Most rural poor are injured in road crashes, this is also forsake education owing to a road crash. validated by the 2011 census data as 71% of India’s 26.8 million Persons with Disability (PwD) live in rural India. Out 6. Improving access to emergency medical care. of the total population of PwD, about 15 million are male and 11.8 million, female. Poor households have a lesser ability to There is a need to publicize emergency numbers and create respond to road crashes and find it difficult to mitigate their more awareness around it. 112 has been declared a pan- financial burden in the event of an unforeseen emergency. India emergency helpline number for immediate assistance Since the impact is more severe on LIH than HIH. Ministry services for police, fire, health and women. People in rural of Social Welfare and Empowerment, Ministry of Small and areas have poor access to medical facilities. Primary Care Medium Enterprises, Ministry of Skill Development and and Secondary Care infrastructure and resources in rural Ministry of Agriculture should create priority programs for areas are inadequate to provide proper care to victims of upskilling of PwD in rural areas and also create specific road crashes. The Central and State Governments should programs for female PwD in rural areas. ensure placement of adequate number of Basic Life Support (BLS) and (ALS) ambulances with life support 5. Support to Continue Education. equipment, and a trained paramedic. Each district should be equipped with a secondary trauma care facility Throughout FGDs and IDIs many respondents stated the with infrastructure and resources for initial evaluation, impact of crash on Education with many male respondents resuscitation, stabilization and initiation of transfer to a having to leave education to support the household higher-level trauma care facility. financially. Ministry of Education should create specific schemes to ensure children from households that have been impacted due to road crashes can continue their education. Indian Training Institutes (ITIs) impart skills in various vocational trades to meet the skilled manpower 74 IMPACT OF ROAD CRASHES ON ADOLESCENTS CHAPTER 7 The most common cause of death among children is unintentional injury, and the most common cause of unintentional injury is related to road crashes36. Children in India are exposed to the risk of road crashes on multiple occasions while commuting to schools- in private vehicles, in public transport vehicles, and as pedestrians. In 2018, 23 school children died when their school bus fell into a deep gorge in Nurpur in Himachal Pradesh. A similar crash occurred on 5th August 2019, where 10 children were killed when their school bus fell into a gorge in Tehri Garhwal Since 2008, over 55,000 children have lost their lives in road crashes in India and a large majority of these are adolescents. Every day around 42 children including 31 adolescents die in road crashes in India with a 10% contribution to the total road crash deaths. Most of these deaths happen near schools and colleges. To understand the qualitative aspects of the financial, social and psychological impact of road fatalities/ injuries on adolescents, In-Depth Interviews (IDI) were conducted with adolescents. IDIs were conducted among adolescents (aged between 14-18 years) across Uttar Pradesh, Bihar, Tamil Nadu, and Maharashtra. Overall 8 adolescents were selected and interviewed. Respondents were probed on different aspects of the crash and its impact on them as an individual as well as the impact on their household. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 7.1. IMPACT ON ADOLESCENTS AS for 30 minutes before he was taken to the hospital. Even though the Police were there, they waited for his mother to INDIVIDUALS arrive and arrange transport. Throughout the interview, he often used the words “sadness”, “emptiness” to describe Road Crashes devastate families. Other than financially his feelings after his brother’s death. draining the family and tearing apart the familial fabric, road crashes also take a toll on the mental health of family members. Many studies have pointed out that “Psychiatric “I used to keep thinking about my symptoms and disorder are frequent after road crash injury. mom’s crash. I found it difficult to Post-traumatic symptoms are common and disabling.” (Mayou R., et al., 1993). Most of the respondents spoke concentrate on anything else. Like about the emotional impact of road crashes on them and when I used to sit down to study...I their families. In this chapter, we attempt to highlight some would see flashes of that day and its key areas of impact. aftermath. “ One of the IDI’s respondents, Shivam (name changed), was just 12 years old when his teenage brother who was - IDI Respondent Maharashtra riding a bicycle was killed in a road crash near their house in 2016. As per Shivam, his brother was lying on the road Like Pinky, (name changed) most of the respondents also “An uncle (neighbour) … took me spoke about the impact of the crash on their education. For along with him and on the way, he many respondents, the impact was both direct and indirect. Pinky was not able to find time to study since she played told me, ‘Imagine you never had any the role of primary caregiver for her injured mother as brother’.” well as she cooked for the whole family. These additional responsibilities meant she had less ‘study time’. She was - IDI Respondent, Uttar Pradesh also not able to ‘focus’ while studying and that impacted her education as well. 36. https://mhrd.gov.in/sites/upload_files/mhrd/files/statistics-new/ESAG-2018.pdf 76 IMPACT OF ROAD CRASHES ON ADOLESCENTS Another respondent from Tamil Nadu mentioned that since his father couldn’t take off from work, and they needed the money, he missed his school twice every week for a month M:Were there any changes in till his mother recuperated. the time you spent with friends? The other aspect in which education got affected was due to non-payment or late submission of school fees. A couple R: Like we used to play with our friends; of respondents mentioned that due to their dire financial so, it all stopped completely. I have not situation, their parents couldn’t pay school fees on time. played cricket for almost 4 years now. One respondent even mentioned how the school penalized him by asking him to stand outside the examination hall, since his parents couldn’t pay the school fee on time and - IDI Respondent, UP as a result, he had to drop a year. 7.2. IMPACT ON SOCIAL LIFE OF 7.3. IMPACT ON THE HOUSEHOLD AS ADOLESCENTS REPORTED BY ADOLESCENTS After analyzing the respondent transcripts, another Adolescents were also probed on their understanding of common area of impact that emerged is the impact road the financial impact the crash had on their family. While crash outcomes have on respondents’ social life as well as most of them were unaware of the exact costs incurred, the time available for playing with friends. Irrespective of they spoke about the impact on their lifestyle as well as the the road crash outcome, respondents mentioned that post- social impact of the crash on the household. crash, either they couldn’t find time to go out and play or their friends weren’t keen to play with them. Another reason Respondents narrated different ways in which the crash for curtailing time spent outside with friends was to ensure impact ed their quality of life. Since their family had to that no unnecessary expenses were incurred. incur expenses on treatment, they were forced to reduce Traffic Crash Injuries and Disabilities: The Burden on Indian Society the quantity and quality of food consumed. This was buying clothes. For others, it manifested more acutely. One narrated by different respondents and it affected their food respondent narrated how he had to leave school due to the consumption as well as the food consumption of the family. financial situation at home R: I left school in the 9th standard. “I stopped buying clothes. Mother asked me to stop as we had to cut M: Why? You did not like school? down on our expenses. I felt bad, I never thought I would have to see such R: I liked it. But I did not go due to the days.” financial situation in the house. “My mother always stored extra provisions. However, she stopped buying extra provisions. We had to give - IDI Respondent Maharashtra more fruits and vegetables to father, but we were not able to do that, it took more Many respondents articulated the characteristics of intra- time for his recovery.) family dynamics after the crash with the use of words like “sadness”, “strange” and “fear”. Concerning dynamics with the rest of the community, most of the respondents had - IDI Respondent, Tamil Nadu positive experiences barring a couple who spoke about hesitant relatives. Additionally, most of the female adolescent respondents Respondents also spoke about the compromises they conveyed how they had to support the household with had to make. For some, it manifested in less money for cooking and other caregiving activities. This meant that 78 IMPACT OF ROAD CRASHES ON ADOLESCENTS they had less time for studies or leisure activities. Even though other respondents did not have such experience, many mentioned that their families moved Two respondents, one from UP and one from Tamil Nadu, to a private hospital to receive better quality of care. This also spoke about the apathy of government stakeholders. has also been validated by the quantitative survey. 69.8% The respondent from UP spoke about how the police failed of the LIH respondents were not attended immediately at to take his brother to the hospital or call the ambulance. His the hospital, in comparison, only 37.9% of HIH respondents brother had to wait at the crash site for 30 minutes before were not attended to immediately. being taken to hospital. The respondent from Tamil Nadu spoke about the lack of 6-POINT POLICY RECOMMENDATIONS: care received at Government Hospital and how her father’s treatment was delayed since the hospital waited for the 1. Enactment and Implementation of Child Road Safety police case to be registered. provisions in MVAA, 2019 MVAA, 2019 has provisions for mandating the use of Child They (Government Hospital) were not Helmets, Child Restraints and also penalizes juvenile treating him (her father) and they said driving. These sections should be notified by the Central that (police)case has to be filed. Only Government under the Central Motor Vehicle Rules and the State Governments should ensure that effective after that, they will treat him. He was implementation. The Enforcement agencies should also bleeding ... In such a case, they have ensure enforcement of child safety provisions. all the facilities but still they didn’t treat 2. Educational Institute based Support System. my father. They gave me cotton and asked me to clean the blood. I didn’t Children and adolescents who are impacted by a road like it at all. crash directly or indirectly should be provided support from the State. Since the main institution of interaction for them are schools, the education department can ensure - IDI Respondent from Tamil Nadu access to qualified child therapists. Since road crashes impact nutritional intake of household members, the State Traffic Crash Injuries and Disabilities: The Burden on Indian Society Government can also create a better mechanism to monitor 5. Enacting Rules on Safe Transport to School their calorie intake and ensure they get adequate nutrition through the School Mid-Day Meal Scheme. Governments should address safety issue faced by children while commuting to school by making rules regarding 3 Support for Payment of School Fees for Children from school buses, vans, auto rickshaws and other means of Vulnerable Families. transport, for safe transportation of school children. In the IDIs, adolescents mentioned that financial constraints In 2018, over 4500 children died in road crash deaths in due to road crash led to either late admission or dropping the 4 surveyed states out of which over half the deaths out of school completely to support their family financially. happened in UP. Rules around school transport should This was stressed more by male adolescent participants. be formulated by State Governments to help safeguard The State Government should ensure that children from children. Standardization of rules for all school transport vulnerable families don’t have to leave school due to including personally organized transport will ensure that financial constraints. Since almost 80% of adolescents children coming from poor families don’t have to be in who die in road crashes are male, the Government should overcrowded personally organized transport to cut costs. ensure that this policy is gender neutral. This is important since parents around 70% of parent respondents from Mumbai, Chennai and Lucknow admitted 4. Ensuring Safe School Zones that their children travel in overcrowded personally organized vehicles. (SaveLIFE, 2019) Considering around 9% of all road crashes in India are reported near schools and colleges it’s imperative to 6. Issuance of Child Road Safety Policy. ensure that all road owning agencies ensure that children and adolescents are safe while commuting on roads. State Governments as part of their State Road Safety Urban Local Bodies (ULB) and Rural Local Bodies (RLB) Policy, Annual Action Plan and Road Safety Fund should in villages should create safe school zones by slowing prioritize road safety for children and adolescents. The down vehicles by design and improving infrastructure by State Government should standardize rules for safety of providing walkable pavements, safe crossings etc. The children by issuing a child road safety policy. They should Union Government should also prescribe standards for this highlight information for parents and guardians in local under Section 198A of MVAA, 2019. languages. Concrete measures should be budgeted and made part of State Road Safety Annual Action Plan. 80 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS CHAPTER 8 Legal37 and insurance-based38 compensation can be considered as an instrument of social policy and one of the tools to provide a social safety net for those involved in a road crash. However, in India insurance coverage is quite low and as a consequence, RTI victims frequently do not receive adequate compensation. Long procedural delays are another common cause of insurance-related problems. Even though MVAA, 2019 mandates the compulsory requirement of third-party, no-fault insurance, a high percentage of vehicles are still not insured. In many instances, payments are made only after lengthy judicial processes, and not when the funds are needed for medical and other costs. Even in cases where vehicles are properly insured, compensation payments are commensurately low and usually insufficient to cover medical treatment and other personal costs. Therefore, as part of this Study, an evaluation of the effectiveness of the legal and insurance compensation framework has been mapped by capturing experiences of LIH, HIH victims and truck drivers. Truck drivers have a unique trait as a road user- they constitute one of the biggest victim categories as well as offending category road users. They often undertake long arduous and unsafe journeys on Indian roads and still have abysmal social security conditions and low insurance coverage. The lack of Traffic Crash Injuries and Disabilities: The Burden on Indian Society awareness of the compensation process makes it difficult • Medical insurance - 7.5% of LIH and 17% HIH victims for them to file claims and receive adequate compensation availed medical insurance. in the event of a road crash. • Life insurance - slightly higher for HIH at 4.2% compared to 3.8% among LIH. FINDINGS 3. About 11% of LIH and 8% of HIH victims/family members 1. Overall, the insurance coverage of HIHs (in terms of the availed compensation under ex-gratia. Among those that motor vehicle, medical, life insurance) was higher compared availed compensation under ex-gratia (N=219), just over to LIHs at the time of the crash. half of the LIH victims (52%) and one-fourth (25%) of HIH victims received the eligible compensation. • Motor vehicle insurance - 43% of vehicles from LIH and 65% vehicles from HIH covered. 4. 70% of respondents of LIH and 63% of HIH were not aware of compensation clauses and schemes in the event • Medical insurance - 1/5th of LIH victims and 1/3rd of a road crash. HIH victims were covered under medical insurance. 5. Only 21 % of the LIH in urban areas availed motor third • Life insurance - As high as 3/4th of HIH victims were party insurance , whereas 31.7% of the HIH residing in covered under life insurance at the time of crash urban areas availed motor vehicle insurance. However, whereas LIH victims accounted for only 18%. this proportion is still larger than the proportion of LIH that availed compensation in rural areas. Only 11% of the LIH 2. Similarly, a higher proportion of HIH victims/family availed motor vehicle insurance compensation, whereas members availed insurance (motor vehicle, medical, life 25% of HIH availed motor vehicle insurance compensation. insurance) compared to the LIHs. 6. Time taken for receiving compensation from motor • Motor vehicle insurance - About 14% of LIH and 31% vehicle, medical, and life insurance was higher for urban of HIH victims/household members availed motor areas than for rural areas for both LIH & HIH. The only insurance compensation after the crash. exception was motor vehicle insurance, where high income 37. Legal Compensation is the amount payable by the owner of the motor vehicle or the authorised insurer, or the Central Government (in hit and run motor accident cases), in case of death or grievous hurt due to accident arising out of the use of motor vehicles. Such amount is payable to the legal heirs ,or nominee, or the victim, as the case may be. Legal compensation for road accidents involving motor vehicles is adjudicated by MACT as established under the Motor Vehicles Act, 1988. Appeal lies in the High Court and then the Supreme Court. 38. Insurance-based Compensation is defined as the amount paid by an insurance company to the insured person to cover for the bodily injuries, deaths, or property damage caused by a road crash. 82 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS urban households received compensation sooner than third-party liability insurance. high income rural households. 13. None of the drivers said that they had applied/benefited 7. A mere 6.1% of the LIH in rural areas availed medical from cashless treatment at the hospital, solatium fund for insurance compensation, whereas 26.3% of the HIH residing hit and run case or ex-gratia schemes. in rural areas availed medical insurance compensation. 8. Over half of the respondents in LIH and HIH categories PART A: HOUSEHOLD LEVEL (56%) said that they had not filed any case under MACT after the crash. 38% of the LIH respondents stated that they did not feel the need to file a case under MACT followed 8.1: INSURANCE AND COMPENSATION by those who did not want to be involved in legal hassles AMONG LIH AND HIH (31%) The following section discusses the variations in insurance 9. Overall, 2/3rd of the respondent truck drivers did not file claims among LIH and HIH further filtered by gender, an FIR after the crash. It was highest in Bihar (95%) and geography and habitation. lowest in Tamil Nadu (56%). Overall, insurance coverage (life, vehicle, medical) is lower 10. Over 9 out of 10 surveyed truck drivers had motor vehicle for LIH victims compared to victims from HIH39. 7 out of 10 insurance at the time of the crash: 47% were covered under victims from LIH are not covered under any insurance policy. comprehensive insurance & 25% under third party liability Further, the coverage is higher among urban households insurance. vis-à-vis rural households for all insurance policy types. More male victims are covered under insurance policies 11. Only 40% of the truck drivers were covered under life as opposed to female victims irrespective of LIH or HIH; insurance and 18% under medical insurance at the time of the contrast being the sharpest in the case of life insurance the crash. policy where there is a 10% difference among male and female victims. 12. Overall, 2/3rd of the truck drivers were not aware of 39. The question on insurance coverage was covered in the telephonic surveys. The N for coverage and availed, received compensation is different and thus they cannot be compared. Traffic Crash Injuries and Disabilities: The Burden on Indian Society In general, there is a huge difference in the proportion of reported the highest proportion of victim vehicles covered victims from LIH and HIH covered under a life insurance under insurance (63%) compared to Uttar Pradesh that policy. While three-fourth of HIH victims (77%) were covered recorded the lowest proportion of vehicle insurance under life insurance at the time of the crash, only 17.5% of coverage (25%) (Table 8A.4). However, among the HIH, the LIH victims were covered under the same. 38% of the 8 out of 10 respondents in Maharashtra stated that the victims in Bihar were covered under life insurance, followed victim vehicle was insured at the time of the crash, followed by Maharashtra (18%) and Tamil Nadu (8%) (Table 8A.2). by two-thirds in Uttar Pradesh (Table 8A.4). Further, a majority of the LIH victims were covered under third party The coverage for medical insurance is almost double insurance (58%) while another 28% were covered under for rich households compared to poor households. The comprehensive insurance (Table 8A.5). coverage of medical insurance among LIH was as low as 7% in Uttar Pradesh and 8% in Maharashtra (Table 8A.3). It is important to note that victims that had their vehicles insured were mostly educated till the graduate or 57% of the respondents from LIH said that the victims were postgraduate level. This indicates the role that literacy not covered under motor vehicle insurance compared to plays in insurance coverage. Lack of formal education 35% of the respondents from HIH40. Even though third-party disincentivizes the poor from availing any sort of insurance insurance coverage has been made compulsory for all due to the strenuous paperwork and procedures involved motorized vehicles (except State and Central Government therein. vehicles) under Section 146 of the MVAA, 19, the numbers across both types of households reveal a gap in motor Since more victims from LIH use two-wheelers to commute, vehicle insurance penetration and reach; that gap being the burden falls disproportionately on them after an crash, wider for victims from LIH. more so if they are unlikely to be covered by insurance. In terms of vehicle usage (refer to Table 5A.1), the respondents Nearly 58% of the LIH respondents stated that the revealed that about 65% of victims were using motorized victim’s vehicle was insured under Third Party Liability two-wheelers at the time of the crash while 11% of them Insurance while 28% mentioned that it was insured under were commuting by cars. 48% of those riding two-wheelers Comprehensive Insurance cover41. Among LIH, Bihar at the time of the crash were not covered under vehicle 40. Motor vehicle insurance being an essential instrument that covers policyholders in case of financial losses due to crash or related damages. The two major types of motor vehicle insurance are Comprehensive Insurance Policy and Third Part Liability or Limited Insurance. The policy premium for Comprehensive Insurance covers both third party liabilities and one’s damages, injuries and losses to any vehicles, passengers and other property. 41. Comprehensive vehicle insurance is more expensive than third party insurance because it covers a wide gamut of damages. 84 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS insurance whereas 59% of those using cars were insured 8.2: AWARENESS OF INSURANCE under motor vehicle insurance. AND COMPENSATION AFTER In general, due to lack of awareness, excessive THE CRASH AND MAPPING documentation, delay in receiving payments/compensation, and several other factors, people tend not to claim insurance OF COMPENSATION PROCESS compensation after an crash. As per our survey findings, the UNDER MACT proportion of claims to coverage under various insurance instruments including a motor vehicle, medical and life Overall, 7 out of 10 (70%) respondents from LIH and insurance remains low, more so for LIH. 63% from HIH stated that they were not aware of any compensation clauses and schemes run by the Indian There is a need to increase the insurance coverage by Government42. This is a major gap in terms of accessing increasing accessibility and affordability of insurance these schemes. In the absence of concrete information , products to poor households. LIH miss out on their chances of availing these schemes. As low as 11% of LIH victims and 8% HIH victims/family Receiving a fair and adequate amount as compensation members availed compensation under ex-gratia (Table under the policy, based on the merits of the case, is an 8.20). The low rates could be indicative of low awareness undeniable and unquestionable right that the victims levels amongst LIH about these schemes and highlight possess. However, among the respondents who confirmed the need to conduct strategic awareness programmes for that they/the victim had filed for insurance (N=361), about these households. Among those that availed compensation 35% of the respondents from LIH and 40% from HIH said under ex-gratia (N=219), just over half of the LIH victims they had received less than the promised amount as (52%) and one-fourth (25%) of HIH victims received the compensation. Further, respondents from LIH in Bihar said eligible compensation. that they almost took over a year on an average to receive the compensation amount under motor vehicle insurance In terms of time taken, LIH victims received their (Table 8.1). compensation in about 13.7 months while HIH victims received it in about 20.1 months. The delay in receiving 42. The Government takes responsibility for certain instances of road accidents and offers compensation to the kin of victims by establishing a fund at the central or state level. For instance, under the MVAA, 19, those killed in a hit-and-run cases qualify for government compensation. Ex-gratia compensation is given mostly by the Government (State or Central) or local authorities in some instances in the event of a crash. It is given to the victims/their families in case the victim either dies in the crash or survives with severe injuries. Ex-gratia is majorly provided to those victims who are not financially capable of bearing the expense in the near future, i.e., if the victim survives with any sort of disability and cannot resume work. Or if a family loses their sole bread earner in a crash. Regarding payment, ex gratia is done voluntarily from a sense of moral obligation rather than the giver recognizing any liability or legal obligation or requirement. Traffic Crash Injuries and Disabilities: The Burden on Indian Society government compensation makes it difficult for LIH in coordination with the Legal Service Authorities as well as households to recover their losses and pay for the immediate the Director General of Police of the respective States. costs. HIH are usually not dependent on the compensation money for their survival and are financially prepared for The Delhi High Court further modified the Claims Tribunal follow-ups and court procedures. They can often afford Agreed Procedure vide order dated 12th December 2014. lawyers and are in no hurry to receive the amount. This is Post which, the Supreme Court directed all States to not the case for LIH households where waiting for more implement the Modified Claims Tribunal Agreed Procedure than a year to receive the eligible compensation can (MCTAP) vide order dated 06th November 2017 in the case jeopardize livelihood and survival chances. of Jai Prakash Vs. M/S. National Insurance Co. The delay in disbursing compensation often frustrates the The Delhi High Court also formulated the Motor Accident very purpose of seeking redress. However, from 2009, at Claims Annuity Deposit Scheme (MACAD Scheme) the instance of Justice J R Midha of the Delhi High Court vide order dated 01st May 2018, for ensuring receipt of and subsequently approved by the Supreme Court of India, compensation in the safe hands of victims & kin of victims various reforms have been introduced in the scheme of and for disbursement of compensation amount. The Delhi adjudication of motor crash claims. High Court then directed 21 banks to appoint a nodal officer for implementation of MACAD Scheme, vide order dated The modified Procedure43 that is now in force, has created 07th December 2018. a better implementation mechanism for motor crash compensation law and claimants can get compensation The Delhi High Court further modified the Claims Tribunal within 120 days of the crash. The Supreme Court of India Agreed Procedure vide order dated 07th December 2018. further directed all States to implement the Claims Tribunal The Supreme Court in its judgment dated 05th March Agreed Procedure vide order dated 13th May 2016 in the 2019 in the case of M.R. Krishna Murthi vs. The New India case of Jai Prakash Vs. M/S. National Insurance Co. SLP (C) Assurance Co. Ltd., SLP (C) No 31521-31522 of 2017, noted No 11801-11804/2005. In this case, the Hon’ble Supreme that “there was no proper implementation of the Claims Court directed that the Claims Tribunal Agreed Procedure Tribunal Agreed Procedure by the Claims Tribunals at all be implemented through the Motor Crash Claims Tribunals India level in terms of the directions of the Supreme Court” 43. TThe Claims Tribunal Agreed Procedure was formulated vide order dated 21st December 2009 in the case of Rajesh Tyagi v. Jaibir Singh, IV (2010) ACC 859. As per the Procedure, motor accident claims resulting in death and/or injuries, are settled in a time bound manner within 90 to 120 days. The Procedure which came into effect on 2nd April 2010 provided the following: Investigation by Police and DAR: The police to carry out complete investigation and submit a Detailed Accident Report (DAR) to MACT within 30 days of the accident. Computation by Insurance Company: The Insurance Company to compute the compensation within 30 days thereafter and inform the Tribunal. Acceptance of Claim: If the amount offered by the Insurance Company is fair and acceptable to the claimant, it shall be paid within 30 days. Award by Tribunal: If the offer is not acceptable or the Tribunal finds that the offer is not fair, the Tribunal shall pass an award within 30 days. Thus the claimant shall get the award amount within 90 to 120 days of the accident. 86 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS in Jai Prakash Vs. M/S. National Insurance Co. (Supra). The from LIH had not filed a case under MACT across all states Supreme Court further directed the following: except Tamil Nadu, where such a proportion was nearly 40%. • NALSA should take up the matter and monitor the same in coordination and co-operation with the various High Further, (in table 8A.7) the proportion of LIH respondents Courts. who had filed cases under MACT was significantly higher (about 3 times) for road crashes where victims had died • The State Judicial Academies should sensitize the (44%) compared to cases where victims had survived Presiding Officers of Claims Tribunal, Senior Police (13.5%). Officers of the State Police as well as Insurance Company for implementation of the Claims Tribunal An open- ended unaided question was asked to understand Agreed Procedure. the reasons for not filing cases under MACT. 38% of the LIH respondents stated that they did not feel the need to file • The Supreme Court also directed the Claims Tribunals a case under MACT followed by those who did not want in the entire country to implement MACAD Scheme to be involved in legal hassles (31%). 11% said they had a contained in the order dated 07th December, 2018 and lack of knowledge about FIR and legal proceedings while directed the twenty one banks to implement the same 8% mentioned their inability to afford a lawyer/fee to file a on all India basis. case with MACT. The LIH respondents also mentioned that immediately after the crash, they were in a rush to manage However the implementation has been debatable. During monetary help required for medical expenses and thus the survey, respondents were asked if they knew about the could not even think of filing a case. Similarly, over half of MACT, whether they had filed a case and their experience the HIH respondents did not want to get into legal hassles, through the process etc. Over half of the respondents in followed by those who did not feel the need to file a case LIH and HIH categories (56%) said that they had not filed (31%). Around 6% of the respondents said they had settled any case under MACT after the crash. However, one-fourth the case outside the court. of respondents from LIH and one-fifth of the respondents from HIH stated otherwise. Almost, 6 out of 10 respondents The High Court of Judicature at Madras in its recent Traffic Crash Injuries and Disabilities: The Burden on Indian Society Judgment dated 23rd September 2020 in the case of was getting difficult and legal aid is being provided in the Manager Vs. Shanmugam & Anr ( C.M.A.No.2854 of 2016) cases where it is required. This role should be taken up further stated that, “The MCTAP directed to be implemented by all State Legal Service Authorities specifically prioritising by the Hon’ble Supreme Court …has not taken off in Tamil victims from LIH. Nadu. No systemic change appears to have been brought about by the online platform by establishment of any specific procedure… There is no pre-litigation exercise by making use of the online facility initiated by the concerned authorities/ parties. As observed by this Hon’ble Court in the order dated 16.03.2020, the Insurance Companies still await the filing of claims before the Tribunal and the trial and adjudication still takes considerable length of time.” These findings point at the systematic intervention required by State Legal Service Authorities to support the LIH to navigate the legal system. The Supreme Court in a Civil Appeal No. 2476-2477 of 2019 had also directed that NALSA should NALSA should monitor the adoption of MCTAP in coordination and cooperation with various High Courts. Even the Delhi High Court in its initial order had felt that the DSLSA could play a significant role in the settlement of crash cases. Thus, it had directed the Police, in FAO 842/2003 titled “Rajesh Tyagi & Ors. Vs. Jaibir Singh & Ors.”, that it would place a copy of the Accident Information Report along with the FIR not only before the Motor Accident Claims Tribunals but also before the DSLSA so that DSLSA can intervene whenever settlement 88 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS TABLE 8.1: INSURANCE AND COMPENSATION OVERVIEW: CLAIMS FILED AND COMPENSATION RECEIVED Category LIH HIH (State, habitation, gender) Received eligible Avg. time taken Received eligible Avg. time taken Availed [N=1647] Availed [N=432] MOTOR VEHICLE INSURANCE COMPENSATION compensation [N=229] (months) [N=148] compensation [N=132] (months) [N=79] Overall 13.9% 64.6% 7 30.6% 59.8% 7.3 Bihar 10.7% 59.1% 12.6 21.7% 48% 17.6 Maharashtra 9.2% 55.3% 10.5 38.1% 76.7% 3.1 Tamil Nadu 28.5% 75.9% 3.9 32% 66.7% 6.4 Uttar Pradesh 7.5% 41.9% 11.1 30.7% 38.7% 10.3 Habitation Type 13.9% 64.6% 7 30.6% 59.8% 7.3 Urban 21% 64.4% 7.1 31.7% 54.9% 6.9 Rural 11% 64.8% 6.9 25% 89.5% 8.9 Victim Gender 13.9% 64.6% 7 30.6% 59.8% 7.3 Male 13.5% 63% 7.6 32.6% 58.6% 8.1 Female 16.3% 73% 4.2 22.8% 66.7% 3.4 Category LIH HIH (State, habitation, gender) Received eligible Avg. time taken Received eligible Avg. time taken Availed [N=1647] Availed [N=432] compensation [N=229] (months) [N=148] compensation [N=132] (months) [N=79] MEDICAL INSURANCE COMPENSATION Overall 7.5% 79% 2.5 16.9% 74% 2.7 Bihar 8.7% 69.4% 2.8 20.9% 45.8% 2.6 Maharashtra 2.4% 70% 3.4 19.5% 81.8% 2.4 Tamil Nadu 17.4% 88.7% 2.2 16.5% 94.1% 2.4 Uttar Pradesh 1.7% 42.9% 3.7 9.9% 90% 4 Habitation Type 7.5% 79% 2.5 16.9% 74% 2.7 Urban 11% 83% 2.8 14.9% 66% 2.8 Rural 6.1% 76.1% 2.2 26.3% 95% 2.5 Victim Gender 7.5% 79% 2.5 16.9% 74% 2.7 Male 7.7% 78.2% 2.5 19.4% 72.7% 2.8 Female 6.2% 85.7% 2.4 7.6% 85.7% 2 Traffic Crash Injuries and Disabilities: The Burden on Indian Society Category LIH HIH (State, habitation, gender) Received eligible Avg. time taken Received eligible Avg. time taken Availed [N=1647] Availed [N=432] compensation [N=229] (months) [N=148] compensation [N=132] (months) [N=79] LIFE INSURANCE COMPENSATION Overall 3.8% 77.4% 4.2 4.2% 77.8% 5.3 Bihar 4.1% 76.5% 4.5 4.3% 100% 4.4 Maharashtra 2.7% 81.8% 4.1 -- -- -- Tamil Nadu 2.5% 40% 3.8 1.9% 50% 5 Uttar Pradesh 5.8% 91.7% 4.1 10.9% 72.7% 5.9 Habitation Type 3.8% 77.4% 4.2 4.2% 77.80% 5.3 Urban 2.3% 81.8% 5.1 3.9% 78.6% 5.6 Rural 4.4% 76.5% 4 5.3% 75% 4.3 Victim Gender 3.8% 77.4% 4.2 4.2% 77.8% 5.3 Male 4.2% 79.7% 4.1 5.3% 77.80% 5.3 Female 1.3% 33.3% 6 -- -- -- 90 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS TABLE 8.2: STATE-WISE SPLIT: VICTIM/NOMINEE FACED DIFFICULTIES IN ACCESSING COMPENSATION 5.4% 5.8% 8.3% 14.6% 10.2% LIH HIH 10% Yes Yes Overall No Overall No N-1647 N-432 NA NA 70% DK/CS DK/CS 75.7% Bihar (N-412) 15.5% 6.3% 71.6% 6.6% Bihar (N-115) 8.7% 8.7% 63.5% 19.1% Maharashtra (N-415) 14.7% 9.4% 73.5% 2.4% Maharashtra (N-113) 6.2% 8.8% 84.1% 0.9% Tamil Nadu (N-407) 9.8% 11.3% 78.4% 0.5% Tamil Nadu (N-103) 5.8% 10.7% 83.5% Uttar Pradesh (N-413) 18.2% 13.1% 56.7% 12.1% Uttar Pradesh (N-101) 12.9% 12.9% 72.3% 2% 0 20 40 60 80 100 0 20 40 60 80 100 Victim Gender (N-1647) 14.6% 10% 70% 5.4% Victim Gender (N-432) 8.3% 10.2% 75.7% 5.8% Male (N-1420) 15.4% 10.1% 68.9% 5.6% Male (N-340) 8.8% 11.2% 73.5% 6.5% Female (N-227) 9.7% 9.3% 77.1% 4% Female (N-92) 6.5% 6.5% 83.7% 3.3% 0 20 40 60 80 100 0 20 40 60 80 100 Habitation Type (N-1647) 14.6% 10% 70% 5.4% Habitation Type (N-432) 8.3% 10.2% 75.7% 5.8% Urban (N-482) 8.7% 8.7% 76.1% 6.4% Male (N-356) 7.3% 8.1% 78.1% 6.5% Rural (N-1165) 17% 10.6% 67.5% 5% Female (N-76) 13.2% 19.7% 64.5% 2.6% 0 20 40 60 80 100 0 20 40 60 80 100 Traffic Crash Injuries and Disabilities: The Burden on Indian Society TABLE 8.3: FILED CASE IN MACT AFTER THE ROAD CRASH 19.1% 23.6% 20.4% 24.5% LIH HIH Yes Yes Overall No Overall No N-1647 N-432 DK/CS DK/CS 56.4% 56% Bihar (N-412) 23.8% 59.7% 16.5% Bihar (N-115) 17.4% 60% 22.6% Maharashtra (N-415) 24.8% 65.3% 9.9% Maharashtra (N-113) 20.4% 69.9% 9.7% Tamil Nadu (N-407) 17.7% 39.6% 42.8% Tamil Nadu (N-103) 19.4% 23.3% 57.3% Uttar Pradesh (N-413) 31.7% 60.8% 7.5% Uttar Pradesh (N-101) 24.8% 69.3% 5.9% 0 20 40 60 80 100 0 20 40 60 80 100 Victim Gender (N-1647) 24.5% 56.4% 19.1% Victim Gender (N-432) 20.4% 56% 23.6% Male (N-1420) 25.8% 54.9% 19.3% Male (N-340) 21.2% 56.8% 22.1% Female (N-227) 16.3% 66.1% 17.6% Female (N-92) 17.4% 53.3% 29.3% 0 20 40 60 80 100 0 20 40 60 80 100 Habitation Type (N-1647) 24.5% 56.4% 19.1% Habitation Type (N-432) 20.4% 56% 23.6% Urban (N-482) 16.6% 62.9% 20.5% Male (N-356) 17.7% 60.4% 21.9% Rural (N-1165) 27.8% 53.7% 18.5% Female (N-76) 32.9% 35.5% 31.6% 0 20 40 60 80 100 0 20 40 60 80 100 92 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS FIG 8.1: REASONS FOR NOT FILING CASE WITH MACT [OPEN-ENDED, ALL FIGURES IN PERCENT] Did not feel need 38.1% of filing case 31% Did not want to get 31.4% into legal hassles 51.2% Lack of knowledge about 11.1% FIR and legal proceedings 2.9% Unable to hire/ 7.5% afford lawyer/ fee 2.1% Out of court settlement 4.1% was done 5.8% To avoid work/ study loss 3.7% due to court hearings 2.5% Other vehicle ran and 3.6% couldn't be identified 1.2% Others 2% 3.3% 0 10 20 30 40 50 60 B40 (N-929) T10 (N-242) Traffic Crash Injuries and Disabilities: The Burden on Indian Society To address the issue of legal and procedural hassles, the repair” as among the top 5 challenges they face when their Supreme Court in its judgment dated 05th March 2019 trucks are involved in crashes (SaveLIFE Foundation, 2020). in the case of M.R. Krishna Murthi vs. The New India Assurance Co. Ltd., (Civil Appeal No. 2476-2477 of 2019) Out of the 420 respondent truck drivers surveyed as part of further recommended that “the Government (should) this study, 58% of them stated that they were involved in road examine the feasibility of setting up the Motor Accident crashes where they had sustained injuries. In Maharashtra, Mediation Authority (MAMA) in every district by making 96% of the respondents had been injured in a road crash necessary amendments in the Motor Vehicles Act itself.” whereas the proportion was less than 50% among the other three surveyed States. Among the respondents who said that they had experienced injuries in the crash (N=244), PART B: TRUCK DRIVERS about 50% of them were severely injured while the other half (50%) had sustained minor injuries. Nearly 47% of the Truck drivers form the backbone of the economy, controlling respondents stated that they were admitted to a hospital 67% of India’s freight and logistics sector (Road Transport for treatment. Year Book 2015-16). Out of the 1.5 lakh people killed in road crashes in the country, 15,000 of the total (10%) road One of the biggest challenges in claiming compensation crash victims are truck and lorry drivers (MoRTH, 2018). In after an crash for truck drivers has been the under- terms of vehicle category, trucks and lorries are involved reporting of the crash and non- filing of FIRs. Overall, about in over 57,000 crashes (MoRTH, 2018). It is not surprising two-thirds (66%) of truck drivers hadn’t filed an FIR after then that 61.5% of the truck drivers feel unsafe driving on the crash. State wise (refer to Table 5A.11), only 2.5% of roads (SaveLIFE Foundation, 2020). The living conditions the truck drivers from Bihar reported filing an FIR after the of truck drivers are abysmal with no standardization in crash, followed by Uttar Pradesh (27%), Maharashtra (42%) wages, lack of social security and incentives to complete a and Tamil Nadu (44%). trip on time. 53% of the truck drivers earn a meagre income of Rs.10,000-Rs.20,000 per month. 93% of truck drivers The most significant and concerning finding of this do not get any social security benefits such as provident study is that despite having a high rate of crashes and fund, pension, health insurance, life insurance, gratuity, sustaining injuries, none of the respondent truck drivers etc (SaveLIFE Foundation, 2020). Three-fourth of the fleet had applied/benefited from any Government run scheme owners have confirmed that their trucks were involved in for compensation after the road crash. They had neither road crashes and listed “getting insurance claim for vehicle laid claim to or benefited from any Government scheme like 94 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS cashless treatment at hospitals, solatium fund for hit-and- 8.4 AWARENESS REGARDING run cases, or any other ex-gratia schemes at the central or state level. “INSURANCE OF MOTOR VEHICLE AGAINST THIRD PARTY RISKS” AND OTHER RELATED ASPECTS 8.3 PERSONAL INJURY INSURANCE AND COVERAGE AT THE TIME OF According to MVAA 2019, it is compulsory for drivers to have third-party insurance in order to get coverage for their own THE CRASH liability and the damage caused to the third party w.r.t bodily injury/death or vehicle. It is important to note that despite The process of claiming insurance is fraught with challenges the Government bringing in progressive changes in the for vulnerable groups like truck drivers who often hail from MVAA, 19 listed above, about two-third of the respondents LIH and disadvantaged sections of society. Truck drivers were not aware/somewhat aware of third-party liability from Maharashtra stated they had to go through certain insurance, while about one-third stated otherwise (refer to hassles during the claim proceedings and received late Table 5A.19). Only 36% of the truck drivers said they were approval for their claims filed. Overall, more than half the fully aware of the fact that third party insurance had been truck drivers (54.5%) said that they were not covered under made mandatory under the MVAA, 19. any sort of personal injury insurance44, whereas nearly 40% were covered under life insurance and 18% under medical Interestingly, awareness about third-party liability insurance insurance. was directly related to the driving experience of the respondents, i.e., respondents with more driving experience Over 8 out of 10 respondents (87%) in Tamil Nadu had seemed to be more aware of it. Also, those drivers who had filed a claim for insurance for personal injuries while in experienced a crash seemed to be more aware (49%) of the Bihar, such a proportion was as low as 13.5%. It must be clause than those who had not (13%). At the State level, noted that while the coverage of personal injury insurance less than one-fifth of truck drivers were aware of third-party was highest in Bihar, the proportion of claims was lowest, liability insurance except for Maharashtra where nearly 8 whereas for Tamil Nadu it was directly proportional. out of 10 truck drivers were aware of it. 44. Personal accident insurance is a policy that can reimburse medical costs, provide compensation in case of disability or death caused by accidents, depending upon the nature of the disability. Traffic Crash Injuries and Disabilities: The Burden on Indian Society There remains a confusion and misunderstanding among of compensation received is not adequate and the delays truck drivers on the definition of third party insurance and in awarding compensation make the process unfavourable. what it includes. Nearly two-third of the respondents said Government schemes are also not well publicized among that third party insurance covers the other party involved the poor and do not offer immediate relief after a road in the crash, followed by nearly 13% who said that the crash. insured gets compensation as cover while 8% said that the insuree can claim compensation on death, severe injury and damaged vehicle. In terms of the nature and scope of coverage under third party insurance, 7 out of 10 respondents mentioned that it covers for death, injury, and property damage. Similarly, almost 27% stated that it covers only property damage, while 25% stated it included only for injury/disability. Only 4% of the respondents thought that it included only death under its purview. About one-third of the respondents stated that they were ‘not aware’ of the compensation process, including time limitation for filing the case before the Claims Tribunal and deputation of an officer by the insurer for settlement of the claim. Almost, a similar proportion of respondents were not aware of the inclusion of khalasi or attendant under third party insurance coverage under MVAA, 2019. This lack of awareness across respondent categories has emerged as a trend throughout the study. Information asymmetry and poor literacy levels often deter the poor from filing claims. Even if the claims are filed, the proportion 96 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS TABLE 8.4: AWARENESS OF MOTOR THIRD PARTY LIABILITY INSURANCE-RELATED ASPECTS AT STATE Bihar (N=101) CATEGORY NA SA FA The purchase of Motor Third party liability insurance is compulsory and you may be fined 2% 79.2% 18.8% by the Police if vehicle is uninsured If the vehicle UNINSURED, you/ owner may be personally liable to pay for injuries 3% 69.3% 27.7% caused to others if you are at fault for crash Motor Third Party liability insurance provides compensation to other people 2% 71.3% 26.7% for their injuries if the crash is your fault Motor Third Party liability insurance does not provide compensation for 5% 69.3% 25.7% injuries you incur if the crash is your fault If someone else is a fault for an crash & you incur injuries, you may be able 5% 72.3% 22.8% to claim compensation from the insurer the vehicle is insured with The compensation you are eligible to receive may be reduced if you breach a traffic law 5% 66.3% 28.7% Along with driver, truck attendant (khalasi) is also covered for benefits under third party insurance under MVAA, 2019 20.8% 63.4% 15.8% The time limitation for filing of cases for compensation for injuries before the 10.9% 64.4% 24.8% Claims Tribunal is 6 months from the date of the crash In case of road crash, insurance company is liable to designate an officer 11.9% 71.3% 16.8% to help you with the process of settlement of your claim Traffic Crash Injuries and Disabilities: The Burden on Indian Society Maharashtra (N=113) Tamil Nadu (N=100) Uttar Pradesh (N=106) NA SA FA NA SA FA NA SA FA 5.3% 15% 79.6% 53% 53% 31% 33% 40.6% 26.4% 9.7% 31.9% 58.4% 50% 50% 33% 31.1% 31.1% 37.7% 13.3% 19.5% 67.3% 26% 26% 55% 30.2% 34.9% 34.9% 13.3% 27.4% 59.3% 46% 46% 38% 47.2% 34.9% 17.9% 9.7% 35.4% 54.9% 54% 54% 30% 28.3% 43.4% 28.3% 17.7% 26.5% 55.8% 26% 26% 47% 35.8% 40.6% 23.6% 17.7% 31% 51.3% 50% 50% 33% 43.4% 36.8% 19.8% 23% 37.2% 39.8% 55% 55% 28% 45.3% 35.8% 18.9% 27.4% 24.8% 47.8% 45% 45% 38% 55.7% 29.2% 15.1% 98 OUTCOMES OF THE INSURANCE & LEGAL COMPENSATION PROCESS 6- POINT POLICY RECOMMENDATIONS to use of vehicles, details of victims, family members and other aspects are shared with the tribunal as quickly and efficiently as possible. The notification should also direct 1. Comprehensive Implementation of MCTAP the use of Crime and Criminal Tracking Network and Systems (CCTNS) by Police as well as Tribunals as the A Director level official should be appointed by MoRTH formal electronic to share files and information including for ensuring compliance with all Supreme Court & High FIRs and DARs. Court judgments including but not limited to judgment on MCTAP. Further, an advisory should be sent to JS Centre- 3. Mechanism for Interim Compensation State Coordination for implementation of these judgments. The Supreme Court in its judgment dated 05th March The MVAA,2019 also mandates a Motor Vehicle Accident 2019 in the case of M.R. Krishna Murthi vs. The New India Fund to be set up by the Central Government (Section 164B) Assurance Co. Ltd., SLP (C) No 31521-31522 of 2017, noted for giving interim compensation to victims of road crashes that there was no proper implementation of the Claims under Section 164 A. The Central Government can also Tribunal Agreed Procedure by the Claims Tribunals at all establish a Motor Accidents Mediation Authority (MAMA) India level. Even though the Supreme Court directed NALSA in every district to provide fixed interim compensation as to ensure implementation in coordination and cooperation direct credit to Aadhaar linked bank accounts. MAMA can with various High Courts, yet, the implementation has also take over pre-litigation procedures from MACT. been weak. The National Road Safety Board, which will be created under the Motor Vehicles Amendment Act, 2019, The Union Govt must fix an amount that can be transferred can be the main coordinating agency to ensure proper immediately as interim compensation pending adjudication implementation of the MCTAP. of the compensation claim. The recommended range of amount is INR 2-5 lakhs in case of death and INR 50,000 2. Issuance of Notification under MVAA,2019 to for injury. standardise protocol between MACT, Police and Insurance Company 4. Ensuring coordination between MAMA, State Road Safety Council (SRSC), and State Legal Services Authority For effective and efficient implementation of online (SLSA) DAR is important to ensure no delay in compensation being awarded to claimants. The standardization of this An effective institutional mechanism needs to be put process will ensure that all crash documents, vehicular in place to ensure smooth coordination between the records, compliance with statutory provisions in regard relevant agencies. Appointment of a 3-member team at Traffic Crash Injuries and Disabilities: The Burden on Indian Society the State level could include officials from the Health, Law should be incentivised. Government should encourage and Transport departments respectively. MVAA,19 has companies to create low-price, micro- insurance products brought in certain progressive changes in the insurance with LIH in mind. For example, Medical insurance provides and compensation process to make it more victim-friendly. coverage only for hospitalization, pre-specified ailments The Act has simplified the claims process to benefit the and crashes, for a pre-specified amount while health claimants by reducing the litigation period, which currently insurance provides a comprehensive coverage against runs into years. To further increase coordination and hospitalization expenses, pre-hospitalization and post- ensure real-time monitoring of implementation, the Central hospitalization expenses and ambulance charges. An Government should create a policy framework to ensure insurance product designed to ensure pay-out on losing efficient coordination between MAMA, SRSC and SLSA. “one-month of work due to ill-health” would help create an interim-safety net for the entire household. Also IRDA 5. Increasing Awareness about MCTAP and other should ensure that insurance agencies create mechanisms Compensation Schemes for simple claim settlement. This can be achieved through the Government mandating General Insurance Corporation (GIC) to set up a dedicated helpline number for LIH. Other insurance companies can contribute to this and the number can be linked to the hospital database of LIH. Information asymmetry and poor literacy levels often deter the poor from filing claims. Even if the claims are filed, the proportion of compensation received is not adequate and the delays in awarding compensation make the process unfavourable. Government schemes are also not well publicized among the poor and do not offer immediate relief after a road crash. 6. Inserting Technology to ensure Insurance Coverage Inserting technology to increase accessibility and affordability of insurance products to poor households 100 INTERACTIONS WITH INSTITUTIONS CHAPTER 9 According to the WHO, 50% road crashes victims die in the first 15 minutes and the rest can be saved by providing basic life support during the “Golden Hour”. It therefore becomes imperative to provide proper initial care to road crash victims within the first hour of the crash. During the survey, respondents were probed about their interaction with key stakeholders, i.e. Police and health workers. Overall (combining LIH and HIH categories), among the victims that survived, 55 percent were admitted in hospital for more than a day, while 13 percent were discharged within 24 hours. Out of those who did not survive, 15 percent died at the scene, 7 percent died on the way to hospital, 9 percent died within 30 days from the crash. KEY FINDINGS 1. Almost all victims of HIH category (98%) were transferred to hospital while among LIH category 89 percent; 1/3rd of victims transferred in ambulances. 2. 2/3rd of LIH victims and 8 out of 10 HIH victims were admitted to hospital for treatment. Further, the average time any LIH victim stayed in hospital was nearly 20 days whereas it was approximately 10 days for HIH category. 3. Reporting of crashes to police was higher among LIH respondents (54%) compared to HIH category respondents (43%). Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4. Almost half of LIH respondents (48%) filed FIR while 41% LIH and HIH categories), it was found that ambulances of HIH respondents did the same. Compared to survival did not arrive at the crash location within 15 minutes in 55 cases, the proportion of FIR filing was significantly higher percent cases while it took more than half an hour in about (over 2 times) when a road crash victim died. 14 percent cases. However, state-wise, more than half of respondents of Tamil Nadu said that the ambulance arrived at the crash 9.1. INTERACTIONS WITH THE location within 15 minutes. MEDICAL SYSTEM Across states, a higher proportion of victims were taken Majority of the victims were transferred to hospital. Almost to private hospitals compared to government hospitals. all victims of HIH category (98%) were transferred to a On deeper analysis, it was observed that cases where hospital while amongst LIH category 89 percent were victims survived in road crashes, mostly were taken to transferred to a hospital. private hospitals (LIH-67%, HIH-87%); while the cases where victims died (immediately or later on), most were Overall, in the majority of the cases victims were shifted transferred to government hospitals (LIH-55%, HIH-56%). through private vehicles followed by ambulances and An inclination towards private hospitals amongst both public vehicles such as auto/ taxi etc. State-wise, in case of categories could be due to the perception of better Tamil Nadu, highest proportion of victims were transferred emergency facilities, even when private hospitals can be to hospital in ambulances while lowest in Bihar. more expensive, especially for the LIH category. With a mandate to reduce the mortality and morbidity of Overall, compared to the LIH category, a higher proportion trauma patients in Tamil Nadu, the State Government of HIH category victims were admitted to any hospital. launched “Tamil Nadu Accident and Emergency care Among LIH category, nearly two-third of victims were Initiative (TAEI)” programme in 2016 to improve emergency admitted to hospital while among HIH category four out of medical services in trauma cases.45 five victims were admitted. Further, victims that were transferred through ambulance The percentage of victims that were admitted to hospital were asked about the response time. Overall (combining among HIH category was higher than LIH category in both 45. https://www.dropbox.com/sh/mnahgopoj4bcw1g/AACz_FcdzK2VMdIbjv0ewIuFa?dl=0&preview=TAEI+Manual+2018+09+10.pdf 102 INTERACTION WITH INSTITUTIONS urban and rural areas. A significant difference was observed regarding types of discrimination they have faced. The most in LIH (66%) and HIH (84%) category in rural areas. On prevalent form of discrimination/ prejudice by the hospital staff further enquiry, it was found that the average time any LIH among LIH category was not attending victims immediately victim stayed in hospital was nearly 20 days whereas it was by hospital staff on reaching hospital (69.8%) followed by the approximately 10 days for HIH category. cases where victims were even denied admission in hospital (13.2%).While HIH category respondents reported that the Among both the categories (LIH and HIH), almost half of the hospital staff made excuses to treat the victim and asked to respondents reported that the victims were not attended by take them to other hospitals (55.2%). the hospital staff (doctor/ nurse) immediately on reaching the hospital.In Tamil Nadu, 12 percent LIH respondents said that it took more than half an hour for the hospital 9.3. INTERACTIONS WITH POLICE staff to attend to the victim. Similarly, one-fourth of HIH respondents of Bihar mentioned that hospital staff took SYSTEM more than half an hour to attend the victim after reaching the hospital. To understand the victims’ / family members’ experience with the police and legal system, they were explored on aspects such as FIR filing, adherence to road safety laws, assistance by police officials etc. PREVALENCE OF 9. 2. DISCRIMINATORY PRACTICES IN As per the Motor Vehicles Act 1988 and the Motor vehicles THE MEDICAL SYSTEM (Amendment) Act, 2019 wearing a helmet for motorized two-wheeler users and seatbelt for motorized four-wheeler users is compulsory. In order to understand usage of safety Overall, nearly 7 percent of respondents mentioned that they devices while riding/ driving, respondents were asked if the had faced discrimination/ prejudice by the hospital officials/ victims were wearing such protective devices. staff among both LIH and HIH categories. The highest proportion of Bihar respondents from both LIH (13.2%) and Overall, the proportion of victims that wore helmet or seatbelt HIH (21.9%) categories experienced discrimination by the at the time of crash was lower among LIH compared to HIH hospital staff, which was comparatively higher than other category. Among LIH, one-third of victims were wearing states. Further, respondents that have faced discrimination/ helmets while only 5 percent were wearing seatbelts at the prejudice at hospitals were asked an open-ended question Traffic Crash Injuries and Disabilities: The Burden on Indian Society time of crash. In the HIH category about half of the victims possible reasons for the same. 46 percent LIH respondents were wearing helmets while about one-fifth were wearing said they did not feel the need of filing FIR followed by one- seatbelts. Compared to urban areas, it was observed that fourth of respondents that did not want to get into legal seatbelt/ helmet usage was more prevalent in rural areas hassle and 8 percent respondents that were afraid of police which was almost twice the urban areas. harassment. Few others mentioned that they were afraid of police asking for bribes (3.6%) and few mentioned police Respondents were probed on whether they had intimated declining to file the FIR (2.3%). the crash to the police. Overall, case reporting to the police was found higher among LIH respondents compared to Similarly, half of the HIH respondents did not file the FIR HIH respondents. saying they did not want to get into legal hassle followed by one-third that mentioned they did not feel the need for Over half of the respondents from the LIH category (54%) the same. reported the road crash to the police whereas, 43% of HIH respondents reported crashes to the police. Also, overall (both LIH & HIH), more than 8 out of 10 respondents reported the crash to the police where the victim had died while in case of serious injuries about one- “After hitting us, he hit the third of road crashes were reported to the police. pedal. We could barely note the vehicle registration number. Additionally, respondents were asked if FIR of the crash The policeman asked us for the was filed. Overall, close to half of LIH respondents had not vehicle registration number for filed the FIR of the crash while over 50 percent amongst HIH category respondents did not file the FIR.Also, overall, filing the FIR” three-fourth of LIH respondents filed FIR where the victim had died. Similarly, 90% of HIH respondents filed FIR in - Male FGD Participant, Lucknow case of road crash death. Those respondents who admitted to not filing the FIR were asked an open-ended unaided question to know the 104 INTERACTION WITH INSTITUTIONS During FGDs, many respondents mentioned that since the above should be trained and sensitized on the rights of crash was a hit and run case and the vehicle could not bystanders, road crash victims and their family members. be identified or they could not note the vehicle number, The police should not entangle road users in procedural therefore the FIR couldn’t be filed, since the police wanted hassles. Many FGD participants also mentioned police to know the offender. Also, many female respondents reluctance in filing FIRs in Hit and Run cases. Police should admitted to not being aware of the process and the need be trained to support road crash victims and their families. for filing FIR. Since police is one of the key stakeholders in terms of enforcing rules under MVAA, 19, good practices of certain Respondents that filed FIR (N=970) were further asked if States can be standardised across the country and made police officials were helpful/ cooperative during the FIR a norm. For instance, the DGP’s ‘Fortnightly Crime Review process. Overall, about 18.3 percent respondents of LIH Meeting’ should also include a review of Road Crash Cases category stated that police were not helpful/ cooperating in the State. with them while among HIH category it was about 11.7 percent. State-wise, over one-third LIH respondents of 2. Raising Awareness and reducing Information Barriers. Bihar and close to one-fourth LIH respondents of Uttar Pradesh stated that they were not assisted by police during The Government should also raise awareness amongst the FIR process. In the HIH category, one-third respondents poor and uneducated households on their rights as road of Bihar and 18 percent of Maharashtra did not receive user as well as in case of a road crash. In case of an police assistance during the FIR process. crash the State Government should provide advice during the MACT claim process. Insurance agencies and IRDAI should also reach people through BTL activities to reduce 6-POINT POLICY RECOMMENDATIONS information barriers. 3. Additional Support to vulnerable people, including 1. Sensitization and Training of Police on rights of Road women under Proposed Cashless Treatment Scheme Crash Victims and other Road Users. under Section 162 of MVAA,2019 Police Officials at the level of Investigation Officer and Traffic Crash Injuries and Disabilities: The Burden on Indian Society Many respondents in FGDs and IDIs stated that they didn’t be managed by the State Health Services and the helpline receive proper medical care at the hospital. While the number should be publicised at all hospitals. Ministry of Road Transport and Highways (MoRTH) and National Health Agency will operationalize the Cashless 6. Ensuring Coordination between different stakeholders. crash scheme, the State Government should create Grievance Redressal Mechanism to ensure healthcare The proposed National Road Safety Board (NRSB) under service providers in the State don’t deny treatments to Section215(B) of the MVAA, 2019 should be constituted victims. immediately to ensure coordination between different stakeholders. A strong, independent and technically 4. Setting Clear Roles and Responsibilities for District competent NRSB would also serve as primary centre for Road Safety Committees ensuring data analysis and data driven policy changes. NRSB can also supervise and monitor efforts of all State All State Governments have created a District Road Safety Governments to achieve various road safety related Committee under Section 215(3) of the Motor Vehicles indicators as well as create mechanisms to engage with Act, 1988. This was done in 2018 under the instructions road users throughout the country. of the Supreme Court Committee on Road Safety under Writ Petition (Civil) No. 295 of 2012. However, the roles and The Officiating Secretary of the State Road Safety responsibilities of the District Road Safety Committee is Authority/Board should be entrusted with the responsibility not standardized. Their roles and responsibilities should to maintain coordination among all relevant stakeholders. be measurable, reportable and verifiable. The Action Taken The appointment of a specific member from NRSB at the Reports should be submitted digitally to the State and the National level can be done for the same. Central Government. 5. Grievance Redressal Mechanism There should be a grievance redressal helpline number for all cases of medical negligence. The number should 106 WAY FORWARD CHAPTER 10 This report presents a rigorous analysis on the socio- economic impact of RTIs on poor households and disadvantaged sections amongst road users in India. It highlights the significant differences in the short-term and long-term; direct and indirect impacts of crashes on victims and their households by comparing among Low Income and High Income Households. Key findings indicate that children and adolescents are particularly at risk, as are truck drivers due to their long commutes; women bear a greater and disproportionate burden of road crashes. Outcomes are also significantly different for households in Low Capacity States vis-à-vis households in High Capacity States and urban areas. As such, government interventions may need to focus more on LIH from rural areas and Low Capacity States, who are more severely affected It needs to be stated that this is not a longitudinal study. A follow up study would enhance the value of the perspectives offered here and would help in capturing the overall impact of crashes better. Globally, disability has been studied over longer periods of time and it is important to conduct more studies in the future to assess its holistic impact. Favourable signs of Government Action have emerged with the recent enactment of the Motor Vehicles (Amendment) Act, 2019 and the rules being framed under it by MoRTH. If implemented fully and urgently by all states, the proposed changes could pave the way for a positive turnaround of the road safety situation in India. Under relevant MVAA 2019 provisions, this report suggests that government support systems need to be created and social safety nets extended to poor households to mitigate their financial burden and cope with the sudden fallout of a road crash. The legal system needs to be sensitised towards the predicament of Traffic Crash Injuries and Disabilities: The Burden on Indian Society poor victims and their families in the event of a crash and the IV. Create an accessible legal framework for availing rights of road crash victims to commensurate and timely insurance and compensation by road crash victims compensation needs to be institutionalised. In addition, emergency medical care needs to be improvised and V. Address the disproportionate gender impact of RTIs strengthened to ensure greater chances of survival among through participative governance & special schemes VRUs/LIH victims. The gendered impact of road crashes for women needs to be acknowledged: women’s participation in road safety reforms should be increased and special state-run VI. Strengthen post-crash support for children and programmes and schemes need to be implemented at the young adults through state support state level to provide them immediate relief. The report emphasises the need to tailor road safety Improving road safety performance at the national and initiatives according to the socio-economic status of state level calls for a long-term vision, an integrated road users, as RTIs in India especially affect VRUs, framework and sustained efforts from all stakeholders. most of whom are poor. It identifies key areas needing Implementing the six thematic recommendations above in immediate improvements and provides some key policy a sustainable way will require strengthening of institutions, recommendations for the central and state Governments ensuring inter-agency coordination, sanctioning dedicated for alleviating RTI-related suffering of VRUs, adolescents budgets, and building the institutional capacity of states, and women. These policy reforms have been grouped especially low capacity states. under the following six key themes: This report provides a template to assess and inform reforms based on actual ground situation. This template I. Enhance effectiveness of institutional mechanisms could be used by Central and State Governments to embed and awareness building the methodology used in the study to help policy makers evolve customized road safety policies and action plans. II. Institutionalise post-crash emergency care and make Similar or adapted assessmentstudies could be replicated health infrastructure & coverage more accessible & in more states with differential capacities (perhaps under inclusive the proposed MoRTH’s State Support Scheme for Road Safety) to highlight gaps and areas of regulatory reform. III. Provide Social Security nets for crash victims from This can be more effective and beneficial for undertaking LIH targeted efforts and focused interventions. 108 WAY FORWARD Below is a quick snapshot of policy implications/recommendations along six broad themes: THEME ONE: Enhance effectiveness of institutional mechanisms and awareness building 1. DIFFERENTIATED SUPPORT FOR VRUS, ESPECIALLY FROM RURAL LIH The interlinkages between VRUs, LIH and road crash outcomes, indicate the need to invest more in VRU friendly infrastructure that prioritizes their safety especially in rural areas. State Governments should select districts with a high VRU crash rate and prioritize their safety through dedicated Annual Action Plans. The findings of this study reveal that 83% of LIH victims were VRUs. Further, income decline was most severe for LIH rural households (56%) compared to LIH urban (29.5%) and HIH rural (39.5%). 2. MANDATORY PUBLISHING OF ROAD SAFETY TARGETS BY EVERY STATE AND PLANNED, TARGETED SPENDING BY HIGH CAPACITY STATES (HCS)  It should be made mandatory for all States to publish their targets on road safety annually so that their performance can be measured against these targets. Additionally, their  budgets should be reviewed by a relevant authority to maintain transparency and efficiency. Since High Capacity States have higher spending power and more effective institutional mechanisms to implement targets, a multi-level agency should be set up in every State to oversee road safety efforts and guide HCS in drawing out detailed plans.  3. SENSITISATION AMONG THE MEDIA FOR GREATER REPORTING ON CRASH CASES Road safety educational programmes need to be enhanced for the education and sensitisation of targeted sections. For instance, the WHO Media Fellowship offers reporters a curriculum to help make their reporting around road crashes more nuanced. A similar model needs to be replicated at State level to ensure in-depth comprehensive and science-based coverage. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4. SENSITIZATION AND TRAINING OF POLICE ON RIGHTS OF ROAD CRASH VICTIMS AND OTHER ROAD USERS Police Officials at the level of Investigation Officer and above should be trained and sensitized on the rights of bystanders, road crash victims and their family members. Police should be trained to support road crash victims and their families. Since police is one of the key stakeholders in terms of enforcing rules under MVAA, 19, good practices of certain States can be standardised across the country and made a norm. For instance, the DGP led fortnightly crime reviews can be made a routine practice across States to ensure better training of police The police should not entangle road users in procedural hassles. About 18.3% respondents of LIH category and 11.7% from HIH category stated that police were not helpful/cooperating with them. Many FGD participants also mentioned police reluctance in filing FIRs in Hit and Run cases. 5. SETTING CLEAR ROLES AND RESPONSIBILITIES FOR DISTRICT ROAD SAFETY COMMITTEES All State Governments have created a District Road Safety Committee under Section 215(3) of the Motor Vehicles Act, 1988. This was done in 2018 under the instructions of the Supreme Court Committee on Road Safety under Writ Petition (Civil) No. 295 of 2012. However, the roles and responsibilities of the District Road Safety Committee is not standardized. Their roles and responsibilities should be measurabWWle, reportable and verifiable. The Action Taken Reports should be submitted digitally to the State and the Central Government. 6. ENSURING COORDINATION BETWEEN DIFFERENT STAKEHOLDERS The Officiating Secretary of the State Road Safety Authority/Board shall be entrusted with the responsibility to maintain coordination among all relevant stakeholders. The appointment of a specific member from NRSB at the National level can be done for the same.The proposed National Road Safety Board (NRSB) under Section215(B) of the MVAA, 2019 should be constituted to ensure coordination between different stakeholders. A strong, independent and technically competent NRSB would also serve as primary centre for ensuring data analysis and data driven policy changes. NRSB can also supervise and monitor efforts of all State Governments to achieve various road safety related indicators as well as create mechanisms to engage with road users throughout the country. 110 WAY FORWARD 7. RAISING AWARENESS AND REDUCING INFORMATION BARRIERS. The Government should raise awareness amongst poor and uneducated households on their rights as road users as well as planning their next steps in case of a road crash. For instance, State Governments should create awareness of cashless treatment schemes, emergency numbers and other support schemes being run for crash victims. They should also provide advice during the MACT claim process. Insurance agencies and IRDA should also reach people through BTL activities to reduce information barriers. 70% of respondents of LIH and 63% of HIH were not aware of compensation clauses and schemes in the event of a road crash. Traffic Crash Injuries and Disabilities: The Burden on Indian Society THEME TWO: Institutionalize post-crash emergency care and make health infrastructure & coverage more accessible & inclusive 8. URGENT NEED TO LOWER THE OOPE FOR LIH The lack of infrastructure at the primary level, lack of awareness on life-saving protocols among local communities and first responders, low coverage and inadequate compensation, low doctor-patient ratio and inefficient emergency management increases the costs for post-crash care. There is an urgent need to lower the OOPE for LIH by improving health infrastructure, especially in rural areas, investing in better training of manpower, making post-crash emergency care more accessible and efficient, ensuring more efficient penetration and coverage of LIH under health insurance. The risk of catastrophic expenditure is inversely proportional to increasing income per capita, i.e., it is significantly larger for those belonging to lower-income quartiles than for those belonging to the highest income quartile. Out of Pocket Expenses (OOPE) was the most significant direct cost borne by victim families among LIH. The overall OOPE was higher for LIH (62%) than HIH (59%). LIH spent a little more than half (52%) of all their income (Rs.78,824) as OOPE on the victim’s treatment (hospitalisation, medicines, care) compared to HIH that spent 30.5% of their household income, i.e., Rs.60,476 on the victim’s post-crash treatment and recovery. A mere 6.1% of the LIH in rural areas availed medical insurance compensation, whereas 26.3% of the HIH residing in rural areas availed medical insurance compensation. 9. STATES NEED TO URGENTLY IMPLEMENT THE SCHEME FOR CASHLESS TREATMENT OF ROAD CRASH VICTIMS AND PUBLICIZE THE GOOD SAMARITAN LAW  In order to save more lives during the critical golden hour. Currently, the Centre has floated such a scheme for cashless treatment of road crash victims under Section 162 of the Motor Vehicles (Amendment), Act, 2019. The proposed scheme suggests a cap of Rs 2.5 lakh for the victim’s treatment per crash and designates the National Health Authority as the nodal agency to implement the scheme under Pradhan Mantri Jan Arogya Yojana.  None of the truck drivers surveyed said that they had applied/benefited from cashless treatment at the hospital, or ex-gratia schemes. Across states, a higher proportion of victims were taken to private hospitals compared to government hospitals which can prove to be more expensive, especially for LIH. 112 WAY FORWARD 10. ADDITIONAL SUPPORT TO VULNERABLE PEOPLE, INCLUDING WOMEN UNDER PROPOSED CASHLESS TREATMENT SCHEME UNDER SECTION 162 OF MVAA,2019 Many respondents in FGDs and IDIs stated that they didn’t receive proper medical care at the hospital. While the Ministry of Road Transport and Highways (MoRTH) and National Health Agency will operationalize the Cashless crash scheme, the State Government should create Grievance Redressal Mechanism to ensure healthcare service providers in the State don’t deny treatments to victims. During the FGD, women participants mentioned the need for cashless treatment of road crash victims in all government and private hospitals, especially for poor families. 11. ENSURING QUALITY OF CARE AT THE HOSPITAL Many respondents spoke about authorities with mistrust. A few participants suggested that there should be a mechanism to ensure quality of care at hospitals and awareness on these rights should be raised amongst the general public. The quality of care can be ensured for every patient by observing scientific protocols and safe best practices, reducing waiting time and unnecessary delays, being responsive to patient needs, avoiding waste and following equitable and non-discriminatory standards.Hospitals should establish measurable benchmarks to monitor outcomes and follow up on these standards and practices. Since most of the women who either die or are injured in road crashes are in rural areas, Accredited Social Health Activists (ASHAs) can be entrusted with the task of spreading awareness on the rights of patients, information about government run health schemes and ensuring that victims get proper rehabilitation and after-care post an crash. 12. MAKE INSURANCE POLICIES MORE INCLUSIVE BY COVERING FOR REHABILITATION AND RECOVERY OF ROAD CRASH VICTIMS. ADDITIONALLY, INSURANCE SCHEMES SHOULD ALSO ACCOUNT FOR THE MENTAL HEALTH IMPACT OF ROAD CRASHES ON VICTIMS AND DESIGN MORE PROGRESSIVE POLICIES. ESTABLISH A NEURO-SPINAL REHAB CENTRE AT THE DISTRICT LEVEL FOR ALL STATES. Merely increasing insurance coverage is not enough as not all those who are enrolled know about the scheme or its benefits, not all the poor are covered, and not everyone has access to healthcare. Health insurance coverage in India remains poor because the private health insurance industry is still at a nascent stage, the pool of people who are able and willing to pay for insurance is low, and insurance premiums are high. Further because LIH, especially in rural India, have limited access to healthcare services such as doctors and hospitals, they are less likely to buy health insurance. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 13. MENTAL HEALTH SUPPORT Motor vehicle crashes can result in ‘significant post-traumatic psychiatric morbidity’. The psychological impact of road crashes is an understudied area and the data on the subject is extremely fragmented or non-existent. Academic and other institutions should analyse the trends for psychological distress due to road crashes in India.The Ministry of Health and Family Welfare should also update the National Mental Health Policy (NMHP) notified in 2014. NMHP acknowledges the linkage between poverty and mental health however it does not categorise crash victims as “Vulnerable Population”. The state government should also ensure implementation of NMHP right from Primary Health Care level. State Governments should also conduct awareness drives on already existing schemes like – ‘KIRAN 24x7 Mental Health Rehabilitation Helpline. Most importantly, mental health of road crash victims should be covered under health insurance.  The police should not entangle road users in procedural hassles. About 18.3% respondents of LIH category and 11.7% from HIH category stated that police were not helpful/cooperating with them. Many FGD participants also mentioned police reluctance in filing FIRs in Hit and Run cases. 14. IMPROVING ACCESS TO EMERGENCY MEDICAL CARE. THERE IS A NEED TO PUBLICIZE EMERGENCY NUMBERS AND CREATE MORE AWARENESS AROUND IT. 112 HAS BEEN DECLARED A PAN-INDIA EMERGENCY HELP LINE NUMBER for immediate assistance services for police, fire, health and women.  People in rural areas have poor access to medical facilities. Primary Care and Secondary Care infrastructure and resources in rural areas are inadequate to provide proper care to victims of road crashes. The Central and State Governments should ensure placement of adequate numbers of Basic Life Support (BLS) and (ALS) ambulances with life support equipment, and a trained paramedic. Each district should be equipped with a secondary trauma care facility with infrastructure and resources for initial evaluation, resuscitation, stabilization and initiation of transfer to a higher-level trauma care facility. 15. GRIEVANCE REDRESSAL MECHANISM: There should be a grievance redressal helpline number at all hospitals to be published and managed by the State Health Services for aggrieved victims and their families to complaint and be heard. This will ensure hospitals act with responsibility. Nearly 7% of the respondents mentioned that they had faced discrimination/ prejudice by the hospital officials/staff among both LIH and HIH categories.The types of discrimination included victims being denied admission and not attending to the victims immendiately on arrival at the hospital. 114 WAY FORWARD THEME THREE: Provide a social security net for crash victims from LIH through state support 16. INTEGRATING ROAD CRASH VICTIMS AS A SPECIAL CATEGORY IN SOCIAL SECURITY SCHEMES Policymakers need to acknowledge the interplay between road crashes and various social hierarchies of class, gender, location that intersect to render certain disadvantaged groups more vulnerable to the shocks of crashes. The spatial context and lived experiences of poor households makes it harder for them to respond to the harsh impact of road crashes, pushing them into a vicious cycle of debt and suffering. Therefore, all existing social security schemes should recognize victims of road crashes as a special category that needs Government support as various levels. 17. COMPREHENSIVE REHABILITATION SUPPORT. A REHAB FACILITY SHOULD BE SET UP IN EVERY DISTRICT.  Injury caused by crashes is the 3rd largest cause of Disability. According to a report by NIMHANS, ‘nearly 100% of the severely injured, 50% of the moderately injured and 10-20% of the mildly injured will have lifelong disabilities’. In India, there are multiple structural, social and economic barriers to accessing Rehabilitation. The Central and State Ministers of Social Welfare and Empowerment should  create comprehensive programmes for rehabilitation of crash victims. Similarly, District Road Safety Committees should also maintain a database of people in each district who should receive such care and support them through community based programmes. Among those who survived the road crash, about three out of ten (29.5%) respondents from poor families (LIH) reported undergoing disability. Further, about 6 out of 10 respondents in LIH (64%) and HIH (62%) category required on-going mobility assistance. In terms of time taken to resume work after an crash, the result was more severe for HIH than LIH. Among the LIH, the average time taken to rejoin the previous occupation was about 92 days (about 3 months) whereas it was 43 days (about 1.5 months) amongst HIH category. Overall, LIH category victims took about 107 days to find a new job from the day of the crash whereas it was about 65 days in case of HIH victims. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 18. ACCESS TO UPSKILLING AND JOBS. The National Skill Development Corporation (NSDC) can undertake a special programme to upskill crash victims from rural areas. The programme can set up specific targets of skilling 1 million people for the next 5 years and so on. The NSDC can tie up with other NGOs for this purpose.  Most rural poor are injured in road crashes, this is also validated by the 2011 census data as 71% of India’s 26.8 million Persons with Disability (PwD) live in rural India. Out of the total population of PwD, about 15 million are male and 11.8 million, female. Poor households have a lesser ability to respond to road crashes and find it difficult to mitigate their financial burden in the event of an unforeseen emergency. Since the impact is more severe on LIH than HIH, the Ministry of Social Welfare and Empowerment, Ministry of Small and Medium Enterprises, Ministry of Skill Development and Ministry of Agriculture  should create priority programs for upskilling of PwD  in rural areas and also create specific programs for female PwD in rural areas.  19. SUPPORT TO CONTINUE EDUCATION. Throughout FGDs and IDIs many respondents stated the impact of  crashes on Education with many male respondents having to leave education to support the household financially.The Ministry of Education should create specific schemes to ensure children from households that have been impacted due to road crashes can continue their education.  Indian Industrial Institutes (ITIs) impart skills in various vocational trades to meet the skilled manpower requirements in the country. An automatic enrolment policy should be created at the district level for road crash victims or their family members who had to drop out of schools or forsake education owing to a road crash.  As high as one in five (20%) respondents of LIH category have mentioned that someone in their household had to give up education due to the crash. Such a proportion of respondents among the HIH category was only 5 percent. 116 WAY FORWARD THEME FOUR: Create an accessible legal framework for road crash victims to avail insurance and compensation 20. COMPREHENSIVE IMPLEMENTATION OF MCTAP A Director level official should be appointed by MoRTH for ensuring compliance with all Supreme Court & High Court judgments including but not limited to judgment on MCTAP. Further, an advisory should be sent to JS Centre-State Coordination for implementation of these judgments. The Supreme Court in its judgment dated 05th March 2019 in the case of M.R. Krishna Murthi vs. The New India Assurance Co. Ltd., SLP (C) No 31521-31522 of 2017, noted that there was no proper implementation of the Claims Tribunal Agreed Procedure by the Claims Tribunals at all India level. Even though the Supreme Court directed NALSA to ensure implementation in coordination and cooperation with various High Courts, yet, the implementation has been weak. The National Road Safety Board, which will be created under the Motor Vehicles Amendment Act, 2019, can be the main coordinating agency to ensure proper implementation of the MCTAP. 21. ISSUANCE OF NOTIFICATION UNDER SECTION 164C OF THE MVAA, 2019 TO STANDARDIZE PROTOCOLS BETWEEN MACT, POLICE AND INSURANCE COMPANY  For effective and efficient implementation of online DAR is important to ensure no delay in compensation being awarded to claimants. The standardization of this process will ensure that all crash documents, vehicular records, compliance with statutory provisions in regard to use of vehicles, details of victims, family members and other aspects are shared with the tribunal as quickly and efficiently as possible. The notification should also direct the use of Crime and Criminal Tracking Network and Systems (CCTNS) by Police as well as Tribunals as the formal electronic to share files and information including FIRs and DARs 22. ISSUANCE OF NOTIFICATION UNDER SECTION 164C OF THE MVAA, 2019 TO STANDARDIZE PROTOCOLS BETWEEN MACT, POLICE AND INSURANCE COMPANY  For effective and efficient implementation of online DAR is important to ensure no delay in compensation being awarded to claimants. The standardization of this process will ensure that all crash documents, vehicular records, compliance with statutory provisions in regard to use of vehicles, details of victims, family members and other aspects are shared with the tribunal as quickly and efficiently as possible. The notification should also direct the use of Crime and Criminal Tracking Network and Systems (CCTNS) by Police as well as Tribunals as the formal electronic to share files and information including FIRs and DARs Traffic Crash Injuries and Disabilities: The Burden on Indian Society 23. MECHANISM FOR INTERIM COMPENSATION Interim compensation becomes crucial for the survival of poor households in the event of an crash. The MVAA,2019  mandates a Motor Vehicle Accident Fund to be set up by the Central Government (Section 164B) for giving immediate relief to victims of road  crashes under Section 164 A. The Central Government can also establish a Motor Accidents Mediation Authority (MAMA) in every district to provide fixed interim compensation as direct credit to Aadhaar linked bank accounts. MAMA can also take over pre-litigation procedures from MACT. The Union Govt must fix an amount that can be transferred immediately as interim compensation pending adjudication of the compensation claim. The recommended range of amount is INR 2-5 lakhs in case of death and INR 50,000 for injury. 23% of the victims/nominees had to attend court for claiming compensation. 13% of the respondents said they faced hurdles/difficulties in accessing the money. 25% of the respondents surveyed took more than 6 months to receive any financial help/relief. Additionally, the time taken for receiving compensation from motor vehicle, medical, and life insurance was higher for urban areas than for rural areas for both LIH & HIH. 24. INCREASING AWARENESS ABOUT MCTAP AND OTHER COMPENSATION SCHEMES Information asymmetry and poor literacy levels often deter the poor from filing claims. Even if the claims are filed, the proportion of compensation received is not adequate and the delays in awarding compensation make the process unfavourable. Government schemes are also not well publicized among the poor and do not offer immediate relief after a road crash. This can be achieved through the Government mandating General Insurance Corporation (GIC) to set up a dedicated helpline num- ber for LIH. Other insurance companies can contribute to this and the number can be linked to the hospital database of LIH. 70% of respondents of LIH and 63% of HIH were not aware of compensation clauses and schemes in the event of a road crash. 118 WAY FORWARD 25. INSERTING TECHNOLOGY TO ENSURE INSURANCE COVERAGE: Inserting technology to increase accessibility and affordability of insurance products to poor households should be incentivised. Government should  encourage companies to create low-price, micro- insurance products  with LIH in mind. For example, Medical insurance provides coverage only for hospitalization, pre-specified ailments and crashes, for a pre-specified amount while health insurance provides a comprehensive coverage against hospitalization expenses, pre-hospitalization and post-hospitalization expenses and ambulance charges. An insurance product designed to ensure pay-out on losing “one-month of work due to ill-health” would help create an interim-safety net for the entire household. Also IRDA should ensure that insurance agencies create mechanisms for simple claim settlement. Overall, the insurance coverage of HIHs (in terms of the motor vehicle, medical, life insurance) was higher compared to LIHs at the time of the crash. Traffic Crash Injuries and Disabilities: The Burden on Indian Society THEME FIVE: Address the disproportionate gender impact of RTIs through participative governance & special schemes for women 26. BETTER GENDER DISAGGREGATED DATA Gender responsive reporting and monitoring is essential to evaluate the impact of road crashes on women.46 WHO also recommends that “Gender differences in the social and economic consequences of temporary and/or permanent disability resulting from injury have to be taken into account when planning rehabilitation services” (WHO, 2002). To ensure rehabilitation services as well as adequate support to either women road crash victims or families which are left to deal with loss of male breadwinner, gender disaggregated data at state and district level would be imperative to create gender responsive post-road crash safety nets. The risk of catastrophic expenditure is inversely proportional to increasing income per capita, i.e., it is significantly larger for those belonging to lower-income quartiles than for those belonging to the highest income quartile. Out of Pocket Expenses (OOPE) was the most significant direct cost borne by victim families among LIH. The overall OOPE was higher for LIH (62%) than HIH (59%). LIH spent a little more than half (52%) of all their income (Rs.78,824) as OOPE on the victim’s treatment (hospitalisation, medicines, care) compared to HIH that spent 30.5% of their household income, i.e., Rs.60,476 on the victim’s post-crash treatment and recovery. A mere 6.1% of the LIH in rural areas availed medical insurance compensation, whereas 26.3% of the HIH residing in rural areas availed medical insurance compensation. 27. EMERGENCY CASH TRANSFERS TO VULNERABLE FEMALE HEADED HOUSEHOLDS As part of PM Garib Kalyan Yojana the Government has already implemented the “Unconditional Emergency Cash Transfer” (UECT) to women during the current COVID-19 crisis. (IWWAGE, 2020) The state governments can use a similar framework of UECT to give Aadhar linked DBT to recently turned FHHs.  More vulnerable FHHs should be prioritised. The time frame of the emergency cash transfer should be standardised. Across household categories, the proportion of male Chief Wage Earners (CWE) was higher than female CWE; the number being higher among LIH. 50% of the women from LIH and 55% from HIH were CWE of the household before the crash whereas 81% of the men from LIH and 74% men from HIH were CWE before the crash. 31% of the female members in LIH were severely affected by the decline in household income after the crash compared to 53.5% of the male members. 46. Findings from a 2011 Gallup Poll surveying 143 countries showed that there is a worldwide gap between the sense of safety felt by men and by women, and that this gap was more pronounced in high and middle-income countries where physical safety has increased with economic and social development. Similarly, a 2014 study in the United States found that many people changed their behaviour as a result of harassment: 47% of women and 32% of men started constantly assessing their surroundings, and 31% of women opted to go out in a group or with another person instead of alone. 120 WAY FORWARD 28. MONETARY SCHEMES FOR LOW INTEREST LOANS: During the FGD, many participants suggested schemes for low interest or no interest loans to support regular household expenses. The women suggested that the low interest loan should be easily accessible without much paperwork. 29. SCHEMES TO INCENTIVIZE WORK FROM HOME SMALL BUSINESS. WOMEN WHO HAVE LOST THE BREADWINNER OF THEIR FAMILY IN A ROAD CRASH SHOULD BE ENROLLED INTO THE EMPLOYMENT DATABASE TO MAKE THEIR JOB SEARCH EASIER. State Governments can float schemes to support these women in running small home businesses. Niti Aayog also recommended this strategy to mitigate the declining female labour force participation rates in India. It has proposed to increase women’s employment by encouraging entrepreneurship among women. (Niti Aayog, 2019). Women participants also reiterated this. They suggested simple business models like packaging, baking, pickle making as something that would help them monetarily without leaving the house. Women also preferred a model where they could earn daily or weekly income instead of monthly payments. Besides caregiving, LIH respondents stated that in the absence of any steady primary source of income (especially in the case of death of a breadwinner), the women of the household often had to step up and take additional jobs to mitigate the financial burden. Across households, 40% of the women participants reported a change in their working patterns while around 11% said they took up extra work after the crash. 30. WOMEN’S PARTICIPATION IN LOCAL ROAD SAFETY GOVERNANCE FRAMEWORKS. Women’s participation in planning and decision making at local road safety governance frameworks including State Road Safety Council and District Road Safety Committee should be ensured. Adequate female representation shall not only ensure Gender responsive monitoring, reporting and budgeting, but will also create opportunities for women to be trained for various roles including as paramedics, backend operators for electronic enforcement architecture and other systems which will be created to ensure road safety. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 31. STANDARDISATION OF COMPENSATION FOR NON-WORKING WOMEN The MACT has often taken a very conservative view on compensation for “house-wives”. In Sher Singh vs. Raghubir Singh (2004), the Tribunal assessed the dependency of the family on the housewife at as low as Rs. 600 per month. The Tribunal concluded that the ‘services rendered by the deceased woman could be replaced by hiring a servant at the salary of Rs. 600/- per month.’ This logic is highly fallacious. The unpaid work done by women in households cannot be quantified by comparing it to the work done by a domestic help. This approach to compute the compensation by relying upon the minimum wages payable to a skilled worker has also been criticised by various members of Judiciary. In Arun Kumar Agarwal vs. National Insurance Company (2006), the Supreme Court also stated, “It is not possible to quantify any amount in lieu of the services rendered by the wife/mother to the family…  the term `services’ is required to be given a broad meaning and must be construed by taking into account the loss of personal care and attention given by the deceased to her children as a mother and to her husband as a wife. The Bombay High Court in the case of Rambhau & Ors Vs The Oriental Insurance Co & Ors (2007),  in its judgment dated 17th September 2020 directed Oriental Insurance to pay Rs. 8,22,000/- along with interest at the rate of 6% per annum as compensation for the woman’s death. The Court while computing the amount considered various factors such as loss of love and affection, funeral expenses, household work and other such factors. Therefore in light of the subjective interpretation, it is of utmost importance that the Central Government issues guidelines to set a definite criteria for determination of compensation payable to the dependents of a non-earning housewife/mother to remove subjectivities and ensure that family members or the disabled women (in case of serious injuries) receive appropriate compensation. 122 WAY FORWARD THEME SIX: Strengthen post-crash support for children and young adults through state support 32. ENACTMENT AND IMPLEMENTATION OF CHILD ROAD SAFETY PROVISIONS IN MVAA, 2019 MVAA, 2019 has provisions for mandating the use of Child Helmets, Child Restraints and also penalizes juvenile driving. These sections should be notified by the Central Government under the Central Motor Vehicle Rules and the State Governments should ensure that effective implementation. The Enforcement agencies should also ensure enforcement of child safety provisions. 33. EDUCATIONAL INSTITUTE BASED SUPPORT SYSTEM. CHILDREN AND ADOLESCENTS WHO ARE IMPACTED BY A ROAD CRASH DIRECTLY OR INDIRECTLY SHOULD BE PROVIDED SUPPORT FROM THE STATE. Since the main institution of interaction for them are schools, the education department can ensure access to qualified child therapists. Since road crashes impact nutritional intake of household members, the State Government can also create a better mechanism to monitor their calorie intake and ensure they get adequate nutrition through the School Mid-Day Meal Scheme. 34. SUPPORT FOR PAYMENT OF SCHOOL FEES FOR CHILDREN FROM VULNERABLE FAMILIES. In the IDIs, adolescents mentioned that financial constraints due to road crashes led to either late admission or dropping out of school completely to support their family financially. This was stressed more by male adolescent participants. The State Government should ensure this by enacting a moratorium on payment of school fees for at least 3 months so that the children from vulnerable families don’t have to leave school due to financial constraints. Since almost 80% of adolescents who die in road crashes are male, the Government should ensure that this policy is gender neutral. Traffic Crash Injuries and Disabilities: The Burden on Indian Society 35. ENSURING SAFE SCHOOL ZONES Considering around 9% of all road crashes in India are reported near schools and colleges it’s im- perative to ensure that all road owning agencies ensure that children and adolescents are safe while commuting on roads. Urban Local Bodies (ULB) and Rural Local Bodies (RLB) in villages should cre- ate safe school zones by slowing down vehicles by design and improving infrastructure by providing walkable pavements, safe crossings etc. The Union Government should also prescribe standards for this under Section 198A of MVAA, 2019. 36. ENACTING RULES ON SAFE TRANSPORT TO SCHOOL Governments should address safety issue faced by children while commuting to school by making rules regarding school buses, vans, auto rickshaws and other means of transport, for safe transportation of school children. In 2018, over 4500 children died in road crash deaths in the 4 surveyed states out of which over half the deaths happened in UP. Rules around school transport should be formulated by State Governments to help safeguard children. Standardization of rules for all school transport including personally organized transport will ensure that children coming from poor families don’t have to be in overcrowded personally organized transport to cut costs. This is important since parents around 70% of parent respondents from Mumbai, Chennai and Lucknow admitted that their children travel in overcrowded personally organized vehicles. (SaveLIFE, 2019) 37. ISSUANCE OF CHILD ROAD SAFETY POLICY State Governments as part of their State Road Safety Policy, Annual Action Plan and Road Safety Fund should prioritize road safety for children and adolescents. The State Government should stan- dardize rules for safety of children by issuing a child road safety policy. They should highlight informa- tion for parents and guardians in local languages. Concrete measures should be budgeted and made part of the State Road Safety Annual Action Plan.. 124 ANNEXURE & APPENDIX & APPENDIX ANNEXURE 3A ANNEXURE Traffic Crash Injuries and Disabilities: The Burden on Indian Society 3A.1: TABLE INDICATING A SNAPSHOT OF DESCRIPTIVE STATISTICS ABOUT THE PARTICIPANTS. Particulars Bihar Maharashtra Tamil Nadu Uttar Pradesh Total Participants (#, %) in HIH "115, (26.6)" "113, (26.2)" "103, (23.8)" "101, (23.4)" "432, (100)" Average monthly household income for HIH (INR) 2,99,130 2,01,106 2,04,612 2,32,673 2,35,417 Participants (#, %) in LIH "412, (25.0)" "415, (25.2)" "407, (24.7)" "413, (25.1)" "1647, (100)" Average monthly household income for LIH (INR) 15,637 17,422 32,125 15,224 20,058 Participants (#, %) as truck drivers "101, (24.0)" "113, (26.9)" "100, (23.8)" "106, (25.2)" "420, (100)" Average monthly income from driving profession for 20,743 17,013 27,850 15,991 20,232 truck drivers (INR) % of female victims 13.9 16.5 22.7 8.4 15.3 % of victims below 18 years 5.3 1.9 0.2 3.9 2.8 % of victims over 60 years 4.2 6.4 2.4 4.3 4.3 #, % with major crash injury "(342), 64.9" "(392), 74.2" "(408), 80.0" "(288), 56.0" "(1430), 68.8" #, % crash deaths "(185), 35.1" "(136), 25.8" "(102), 20.0" "(226), 44.0" "(649), 31.2" #, % fully recovered after injury "(218), 63.7" "(296), 75.5" "(311), 76.2" "(203), 70.5" "(1028), 71.9" #, % recovered with some disability "(118), 34.5" "(94), 24.0" "(51), 12.5" "(76), 26.4" "(339), 23.7" #, % have long term mobility disability "(76), 64.4" "(56), 59.6" "(39), 76.5" "(44), 57.9" "(215), 63.4" % of victims residing in urban areas 39.3 42.4 40.2 39.3 40.3 % of victims who were chief wage earner "138, (26.2)" "107, (20.3)" "179, (35.1)" "161, (31.3)" "585, (28.1)" % of victims as pedestrians/cyclists 22.6 10 10.6 18.9 15.5 % of victims as riding a motorcycle 55.2 81.1 62.4 61.7 65.1 % of victims in a passenger car 9.9 5.7 24.5 10.7 12.6 % of victims in other modes (autos, buses, trucks) 12.3 3.2 2.5 8.8 6.7 % of victims where crash happened on (Expressway & 21.4 14.5 12.6 24.9 17.8 NH) % of victims where crash happened on 66.8 77.1 85.8 59.6 73.5 (SH, City/ district/ municipality roads) % of victims where crash happened on rural roads 11.8 8.4 1.6 15.6 8.6 (Village roads) % of victims who died at scene 19.5 16.3 4.3 21.4 15.4 % of victims where crash FIR was filed 40 41.3 60.6 45.1 46.7 % of victims who received medical treatment / 83.5 93.8 96.9 89.5 90.9 transferred to hospital Average estimated medical cost (INR) 58,023 1,01,081 61,976 78,584 75,011 % of victims who received any financial compensation/ 67.4 83.3 90 48.1 75.4 relief within 6 months 126 ANNEXURE 3A 3A.2: TABLE INDICATING INCOME LEVELS FOR (LIH) AND (HIH) IN INDIA AND GLOBALLY S.N. Country Pre-tax income of INR 13,500 per adult per month Pre-tax income of INR 50,000 per adult per month 1 India Bottom 40% Top 10% 2 World Bottom 19% Top 42% [United Nations Sustainable Development Goals 10.1; World Inequality Database] 3A.3: FIGURE INDICATING AN OVERVIEW OF THE RESEARCH METHODOLOGY RESEARCH METHODOLOGY Exploratory Research Descriptive Research Desk Research Preparation Of Survey Quantitative Survey Qualitative Survey - Fgds Instruments - Interviews Among & Idis Among Victims Or Victims Or Victim’s Victim’s Family Member Family Discussion With Piloting & [Test Sample] Men & women groups World Bank Pre-Testing Bottom 40% Poor [Control Sample] Adolescents Top 10% Rich Finalization Of Instruments Truck Drivers Traffic Crash Injuries and Disabilities: The Burden on Indian Society 3A.4: TABLE INDICATING THE STATE- WISE LIST OF SAMPLE SIZE No. of road crashes in Appropriate Sample Achieved State-wise S.N. States Districts India (2005-2018) Size (Calculated) Sample Size 1 Bihar Begusarai, Gaya, Muzaffarpur, Patna 1,24,176 383 527 "Mumbai, 2 Maharashtra 8,74,647 384 528 Nagpur, Pune, Solapur" Chennai, Coimbatore, Madurai, 3 Tamil Nadu 8,90,640 384 516 Tiruchirappalli 4 Uttar Pradesh Agra, Lucknow, Meerut, Varanasi 4,11,791 384 514 3A.5: TABLE INDICATING THE SAMPLE SIZE FOR QUANTITATIVE SURVEY Sample Size for Quantitative Survey Victim/ Victim’s Family Victim/ Victim’s Family S.N. State members (HIH Control Truck Drivers Grand Total members (LIH Test Sample) Sample) 1 Bihar 412 115 101 628 2 Maharashtra 415 113 113 641 3 Tamil Nadu 407 103 100 610 4 Uttar Pradesh 413 101 106 620 Total 1647 432 420 2499 128 ANNEXURE 4A 4A.1: TABLE INDICATING THE CHANGE IN THE MONTHLY INCOME OF VICTIMS ON RESUMING WORK AFTER THE CRASH Rs. 5,001 Rs. 10,001 Rs 20,001 Rs. 30,001 Category (pre-crash, Not Up to More than N to to to to post crash, current) earning Rs. 5,000 Rs.50,000 Rs. 10,000 Rs. 20,000 Rs.30,000 Rs.50,000 Change Pre-crash 1052 18.20% 8.70% 24.20% 21.40% 8.30% 9.00% 10.20% in LIH victim’s income On resuming work 1052 27.40% 8.90% 22.20% 17.30% 6.10% 8.20% 9.90% after crash Current (as on 31 1052 22.40% 7.70% 20.10% 22.40% 13.20% 10.00% 4.20% Jan 2020) Rs.1 Lakh Rs.2 Lakh Category (pre-crash, Not Up to Rs.50,000 to More than N to Rs.2 to Rs.4 post crash, current) earning Rs.50,000 Rs.1 Lakh Rs. 4 Lakh Lakh Lakh Change Pre-crash 378 14.00% 30.20% 37.30% 16.10% 1.90% 0.50% in HIH victim’s On resuming work income 378 11.10% 36.80% 34.70% 14.60% 2.40% 0.60% after crash Current (as on 31 378 9.00% 24.90% 41.80% 20.60% 3.20% 0.60% Jan 2020) 4A.2: TABLE INDICATING HABITATION- WISE, AND GENDER-WISE DETAILS ON THE DECLINE IN THE VICTIM’S HOUSEHOLD INCOME LIH HIH Category (Habitation, gender) N Severe Moderate None N Severe Moderate None Habitation Type 1647 50.40% 25.40% 24.20% 432 24.80% 34.30% 41.00% Urban 482 37.10% 29.50% x33.40% x 21.60% 35.40% 43.00% Rural 1165 55.90% 23.70% 20.40% 76 39.50% 28.90% 31.60% Victim Gender 1647 50.40% 25.40% 24.20% 432 24.80% 34.30% 41.00% Male 1420 53.50% 24.90% 21.60% 340 26.50% 35.90% 37.60% Female 227 31.30% 28.20% 40.50% 92 18.50% 28.30% 53.30% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4A.3: TABLE INDICATING THE STATE- WISE, HABITATION- WISE AND GENDER- WISE SPLIT OF EARNING STATUS OF VICTIMS (BEFORE CRASH) Category (State, LIH HIH habitation, gender) N Yes No N Yes No Overall 1647 82.10% 17.90% 432 85.90% 14.10% Bihar 412 76.70% 23.30% 115 87.80% 12.20% Maharashtra 415 81.70% 18.30% 113 75.20% 24.80% Tamil Nadu 407 91.90% 8.10% 103 96.10% 3.90% Uttar Pradesh 413 78.50% 21.50% 101 85.10% 14.90% Habitation Type 1647 82.10% 17.90% 432 85.90% 14.10% Urban 482 78.60% 21.40% 356 85.10% 14.90% Rural 1165 83.60% 16.40% 76 89.50% 10.50% Victim Gender 1647 82.10% 17.90% 432 85.90% 14.10% Male 1420 85.60% 14.40% 340 90.30% 9.70% Female 227 60.80% 39.20% 92 69.60% 30.40% 4A.4: TABLE INDICATING THE IMPACT OF THE VICTIM’S DISABILITY ON SALARY / WAGE LIH HIH Disability Yes, almost No, lower Yes, almost No, lower N NA N NA the same than previous the same than previous Overall 1052 51.90% 31.90% 16.20% 378 73.00% 22.00% 5.00% Underwent disability 310 27.10% 40.30% 32.60% 29 48.30% 44.80% 6.90% No disability 692 61.60% 28.80% 9.70% 336 75.00% 19.90% 5.10% DK/CS 50 72.00% 24.00% 4.00% 13 76.90% 23.10% 0.00% 130 ANNEXURE 4A 4A.5: TABLE INDICATING THE AVERAGE LOSSES DUE TO ROAD CRASH AS WELL AS THE PROPORTION RECOVERED THROUGH INSURANCE LIH [N=1647] HIH [N=432] Losses incurred due % recovered/ to to road crash Avg. loss of income/ Avg. loss of income/ % recovered/ to be be recovered from expenditure expenditure recovered from insurances insurances Total expenditure Rs.1,52,339 12.60% Rs.1,98,037 23.70% Loss of income (victim & Rs. 37,572 Rs.75,391 family members) during 19.70% 28.40% period of treatment 24.70% 38.10% Loss of property/ vehicle etc. Rs. 12,752 Rs.28,845 9.90% 25.20% due to road crash 8.40% 14.60% Out of pocket expenses on Rs. 78,824 Rs.60,476 15.50% 30.60% treatment of victim 51.70% 30.50% Legal/ administrative/ Rs. 6,627 Rs.5,629 compensation expenses 5.30% 6.60% including police, lawyer, etc. 4.30% 2.80% Compensation cost to other Rs. 2,509 Rs.6,321) vehicle/ person involved 2.40% 6.00% in crash 1.60% 3.20% Rs. 14,054 Rs.21,375 Others 22.80% 45.50% 9.20% 10.80% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4A.6: TABLE INDICATING THE STATE- WISE DETAILS THE PROPORTION OF LOSSES THAT HAVE BEEN RECOVERED/ARE DUE TO BE RECOVERED FROM INSURANCE Proportion Recovered Type of losses incurred LIH HIH due to road crash Uttar Uttar Bihar Maharashtra Tamil Nadu Bihar Maharashtra Tamil Nadu Pradesh Pradesh N 412 415 407 413 115 113 103 101 Overall recovery 11.00% 8.00% 22.30% 8.10% 25.40% 15.30% 27.90% 14.80% Loss of income (victim & family members) during 13.10% 10.40% 47.20% 8.40% 29.40% 18.50% 52.00% 14.10% period of treatment Loss of property/ vehicle etc. 7.80% 4.90% 20.20% 6.80% 20.40% 22.80% 30.20% 28.30% due to road crash Out of pocket expenses on 10.70% 8.80% 34.90% 8.00% 21.80% 32.40% 45.70% 23.30% treatment of victim Legal/ administrative/ compensation expenses 5.60% 2.60% 6.10% 6.90% 10.20% 1.10% 7.10% 8.10% including police, lawyer, etc. Compensation cost to other vehicle/ person 4.10% 0.90% 3.10% 1.50% 14.20% 2.10% 4.30% 2.50% involved in crash Others 24.90% 20.70% -- 16.70% 56.50% -- -- 12.50% 132 ANNEXURE 4A 4A.7: TABLE INDICATING THE STATE- WISE DETAILS ON THE AVERAGE EXPENSES INCURRED ON THE FUNERAL OF THE CRASH VICTIM LIH HIH State N Avg. N Avg. Overall 595 Rs.22,242 54 Rs.51,498 Bihar 178 Rs.28,490 7 Rs.89,071 Maharashtra 125 Rs.16,244 11 Rs.71,182 Tamil Nadu 84 Rs.42,010 18 Rs.61,722 Uttar Pradesh 208 Rs.12,517 18 Rs.14,633 4A.8: TABLE INDICATING THE CORRELATION BETWEEN THE EARNING STATUS OF THE VICTIM AND THE DECLINE IN STANDARD OF LIVING OF THE HOUSEHOLD Living standard LIH HIH has decreased N Yes No DK/CS N Yes No DK/CS Impact of crash 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Survived 1052 58.60% 40.30% 1.10% 378 28.60% 69.00% 2.40% Died 595 72.30% 26.20% 1.50% 54 35.20% 64.80% 0.00% Earning status 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% of Victim Earning member 1353 66.90% 32.00% 1.10% 371 32.90% 65.20% 1.90% Non-earning member 294 48.00% 50.00% 2.00% 61 8.20% 88.50% 3.30% 4A.9: TABLE INDICATING STATE- WISE RESPONSES ON WHETHER THE LIVING STANDARD OF THE HOUSEHOLD DETERIORATED AFTER THE CRASH LIH HIH State Total Yes No DK/CS Total Yes No DK/CS Overall 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Bihar 412 73.30% 25.70% 1.00% 115 40.00% 53.00% 7.00% Maharashtra 415 49.40% 50.60% -- 113 24.80% 75.20% -- Tamil Nadu 407 59.00% 39.60% 1.50% 103 35.00% 65.00% -- Uttar Pradesh 413 72.40% 24.90% 2.70% 101 16.80% 82.20% 1.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4A.10: TABLE INDICATING THE HABITATION, GENDER, AND STATE PROFILE OF VICTIMS WHO WERE CHIEF WAGE EARNERS Category LIH HIH (Habitation, gender) N Yes No N Yes No Habitation Type 1353 77.80% 22.20% 371 70.60% 29.40% Urban 379 75.20% 24.80% 303 70.60% 29.40% Rural 974 78.90% 21.10% 68 70.60% 29.40% Victim Gender 1353 77.80% 22.20% 371 70.60% 29.40% Male 1215 81.00% 19.00% 307 73.90% 26.10% Female 138 50.00% 50.00% 64 54.70% 45.30% Overall 1353 77.80% 22.20% 371 70.60% 29.40% Bihar 316 74.10% 25.90% 101 66.30% 33.70% Maharashtra 339 79.40% 20.60% 85 77.60% 22.40% Tamil Nadu 374 77.50% 22.50% 99 71.70% 28.30% Uttar Pradesh 324 80.20% 19.80% 86 67.40% 32.60% 4A.11: TABLE INDICATING THE HABITATION- WISE AND GENDER- WISE SPLIT FOR AVERAGE MONTHLY CONTRIBUTION OF THE DECEASED VICTIMS TO THE TOTAL HOUSEHOLD INCOME Category Up to Rs. 5,001 to Rs. 10,001 to Rs. 20,001 to More than N Not earning (habitation, gender) Rs. 5,000 Rs. 10,000 Rs. 20,000 Rs. 30,000 Rs.30,000 Habitation Type 595 17.30% 22.70% 27.70% 20.80% 5.70% 5.70% Urban 64 28.10% 10.90% 17.20% 20.30% 15.60% 7.80% LIH Rural 531 16.00% 24.10% 29.00% 20.90% 4.50% 5.50% Victim Gender 595 17.30% 22.70% 27.70% 20.80% 5.70% 5.70% Male 536 13.60% 22.80% 29.90% 21.80% 6.20% 5.80% Female 59 50.80% 22.00% 8.50% 11.90% 1.70% 5.10% Category Up to Rs.50,000 to More than N Not earning (habitation, gender) Rs.50,000 Rs.1 Lakh Rs.1 Lakh Habitation Type 54 14.80% 59.30% 16.70% 9.30% Urban 33 21.20% 51.50% 15.20% 12.20% HIH Rural 21 4.80% 71.40% 19.00% 4.80% Victim Gender 54 14.80% 59.30% 16.70% 9.30% Male 47 6.40% 63.80% 19.10% 10.70% Female 7 71.40% 28.60% -- -- 134 ANNEXURE 4A 4A.12: TABLE INDICATING THE GENDER- WISE DETAILS ON THE CHANGE IN MONTHLY CONTRIBUTION TO HOUSEHOLD INCOME POST CRASH Category Rs. 5,001 Rs. 10,001 Rs. 20,001 Rs. 30,001 Not Up to More than (pre- crash, N to to to to earning Rs. 5,000 Rs.50,000 post-crash, current) Rs. 10,000 Rs. 20,000 Rs. 30,000 Rs. 50,000 Pre-crash_ 1052 18.20% 8.70% 24.20% 21.40% 8.30% 9.00% 10.20% Victim Gender Male 884 14.90% 8.40% 26.70% 23.90% 8.80% 8.00% 9.30% Female 168 35.10% 10.70% 11.30% 8.30% 5.40% 14.30% 14.90% LIH On resuming work after 1052 27.40% 8.90% 22.20% 17.30% 6.10% 8.20% 9.90% crash_Victim Gender Male 884 24.30% 9.40% 24.50% 19.20% 6.30% 7.40% 8.80% Female 168 43.50% 6.50% 10.10% 7.10% 4.80% 12.50% 15.50% Current (as on 31 Jan 2020) 1052 22.40% 7.70% 20.10% 22.40% 13.20% 10.00% 4.20% _Victim Gender Male 884 19.30% 8.00% 22.10% 24.50% 12.30% 9.30% 4.40% Female 168 38.70% 6.00% 9.50% 11.30% 17.90% 13.70% 3.00% Category Rs.50,000 Rs.1 Lakh Rs.2 Lakh Not Up to More than (pre- crash, post- crash, N to to to earning Rs.50,000 Rs. 4 Lakh current) Rs.1 Lakh Rs.2 Lakh Rs.4 Lakh Pre-crash 378 14.00% 30.20% 37.30% 16.10% 1.90% 0.50% Male 293 10.20% 30.70% 39.90% 16.00% 2.40% 0.70% Female 85 27.10% 28.20% 28.20% 16.50% 0.00% 0.00% HIH On resuming work 378 11.10% 36.80% 34.70% 14.60% 2.40% 0.60% after crash Male 293 6.10% 38.20% 37.50% 14.30% 3.10% 0.60% Female 85 28.20% 31.80% 24.70% 15.30% 0.00% 0.00% Current (as on 31 Jan 2020) 378 9.00% 24.90% 41.80% 20.60% 3.20% 0.60% Male 293 4.40% 24.90% 44.00% 21.80% 4.10% 0.60% Female 85 24.70% 24.70% 34.10% 16.50% 0.00% 0.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4A.13: TABLE INDICATING STATE-WISE RESPONSES ON THE MAJOR INVESTMENT ON VICTIMS THAT COULD NOT BE RECOVERED DUE TO THE ROAD CRASH LIH HIH State N Yes Avg. Investment N Yes Avg. Investment Overall 1647 5.90% Rs.43,036 432 6.70% Rs.80,172 Bihar 412 10.00% Rs.32,488 115 10.40% Rs.27,083 Maharashtra 415 3.90% Rs.52,156 113 1.80% Rs.1,55,000 Tamil Nadu 407 3.70% Rs.37,800 103 3.90% Rs.2,58,750 Uttar Pradesh 413 6.10% Rs.57,640 101 10.90% Rs.59,545 4A.14: TABLE INDICATING A SUMMARY OF DEMOGRAPHIC AND POVERTY PROFILE OF STATES High Capacity States Low Capacity States Particular Maharashtra Tamil Nadu Bihar Uttar Pradesh Population - 2011 Total population (in crore) 11.2 7.2 10.4 20 Urban share 45% 48% 11% 22% Share of adults ( age 15+) 75% 76% 63% 63% Education – 2011 Literacy rate 83% 80% 64% 70% Poverty and inequality – 2012 Poor (in crores) 2 0.9 3.6 6 All 17% 12% 34% 29% Poverty rate Rural 24% 16% 34% 30% (BPL) Urban 9% 7% 31% 26% Income and growth – 2018 Net State Domestic Product at Current Prices (in INR crore) 21,39,378 13,15,577 4,45,942 12,24,672 Per Capita Net State Domestic Product at Current Prices (in 1,76,102 1,71,583 38,631 55,456 INR) (Mean = 1,73,842) (Mean = 47,043) Jobs - 2012 Labour force participation rate 58% 60% 45% 53% Self-employed 47% 32% 53% 64% Workers by Salaried 27% 26% 6% 11% wage-type Casual wage 27% 43% 42% 25% Health workforce - 2012 Qualified health workers per 10,000 population 16.8 12.5 1.5 7.8 [Source: Census of India, World Bank and WHO] 136 ANNEXURE 6A 6A.1: TABLE INDICATING WHETHER THE VICTIM/ HOUSEHOLD MEMBERS SUFFERED FROM DEPRESSION DUE TO THE ROAD CRASH Category (Habitation, gender, state, crash LIH HIH outcome on victim, earning status of victim) N Yes No DK/CS N Yes No DK/CS Habitation Type 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Urban 394 40.10% 57.60% 2.30% 274 23.70% 74.80% 1.50% Rural 287 59.90% 36.60% 3.50% 31 48.40% 51.60% 0.00% Victim Gender 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Male 573 51.10% 45.90% 3.00% 244 27.50% 71.30% 1.20% Female 108 34.30% 63.90% 1.90% 61 21.30% 77.00% 1.60% Overall 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Bihar 146 52.70% 45.20% 2.10% 83 33.70% 61.40% 4.80% Maharashtra 127 40.20% 59.10% 0.80% 87 3.40% 96.60% -- Tamil Nadu 245 40.80% 58.40% 0.80% 73 50.70% 49.30% -- Uttar Pradesh 163 62.60% 29.40% 8.00% 62 19.40% 80.60% -- Overall 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Survived 569 43.20% 53.60% 3.20% 269 23.00% 75.50% 1.50% Died 112 75.00% 24.10% 0.90% 36 50.00% 50.00% 0.00% Overall 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Earning member 551 50.30% 46.80% 2.90% 263 30.00% 68.80% 1.10% Non-earning member 130 40.80% 56.90% 2.30% 42 2.40% 95.20% 2.40% 6A.2: TABLE INDICATING THE SEVERITY OF DEPRESSION BETWEEN LIH AND HIH LIH HIH Outcome of crash on victim N Yes No DK/CS N Yes No DK/CS Overall 681 48.50% 48.80% 2.80% 305 26.20% 72.50% 1.30% Survived 569 43.20% 53.60% 3.20% 269 23.00% 75.50% 1.50% Died 112 75.00% 24.10% 0.90% 36 50.00% 50.00% 0.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 6A.3: TABLE INDICATING HABITATION- WISE, GENDER- WISE AND STATE- WISE DATA ON WHETHER THE VICTIM/ HOUSEHOLD MEMBER WITH MENTAL AILMENT REQUIRED FORMAL MEDICAL CONSULTATION Category LIH HIH (Habitation gender, state) N Yes No DK/CS N Yes No DK/CS Habitation Type 256 70.70% 27.30% 2.00% 65 78.50% 21.50% -- Urban 129 68.20% 28.70% 3.10% 53 73.60% 26.40% -- Rural 127 73.20% 26.00% 0.80% 12 100.00% -- -- Victim Gender 256 70.70% 27.30% 2.00% 65 78.50% 21.50% -- Male 222 72.50% 26.10% 1.40% 52 82.70% 17.30% -- Female 34 58.80% 35.30% 5.90% 13 61.50% 38.50% -- Overall 256 70.70% 27.30% 2.00% 65 78.50% 21.50% -- Bihar 54 64.80% 33.30% 1.90% 14 42.90% 57.10% -- Maharashtra 28 85.70% 10.70% 3.60% 21 100.00% -- -- Tamil Nadu 84 70.20% 28.60% 1.20% 26 76.90% 23.10% -- Uttar Pradesh 90 70.00% 27.80% 2.20% 4 100.00% -- -- 6A.4: TABLE INDICATING THE STATE- WISE, HABITATION- WISE AND GENDER- WISE RESPONSES ON WHETHER THERE IS A CHANGE IN THE SLEEPING PATTERN OF HOUSEHOLD MEMBERS LIH HIH Category Yes, Sometimes, No, Yes, Sometimes, No, (State, habitation, gender) N difficulty in difficulty in sleep N difficulty in difficulty in sleep sleeping sleeping well sleeping sleeping well Overall 681 34.50% 38.30% 27.20% 305 16.70% 43.90% 39.30% Bihar 146 30.10% 43.20% 26.70% 83 18.10% 66.30% 15.70% Maharashtra 127 24.40% 36.20% 39.40% 87 6.90% 44.80% 48.30% Tamil Nadu 245 32.70% 42.40% 24.90% 73 38.40% 35.60% 26.00% Uttar Pradesh 163 49.10% 29.40% 21.50% 62 3.20% 22.60% 74.20% Habitation Type 681 34.50% 38.30% 27.20% 305 16.70% 43.90% 39.30% Urban 394 35.50% 32.50% 32.00% 274 15.70% 43.80% 40.50% Rural 287 33.10% 46.30% 20.60% 31 25.80% 45.20% 29.00% Victim Gender 681 34.50% 38.30% 27.20% 305 16.70% 43.90% 39.30% Male 573 35.60% 37.70% 26.70% 244 16.40% 44.70% 38.90% Female 108 28.70% 41.70% 29.60% 61 18.00% 41.00% 41.00% 138 ANNEXURE 6A 6A.5: TABLE INDICATING THE RESPONSES ON WHETHER THE LIVING STANDARD OF HOUSEHOLD DECREASED DUE TO THE CRASH Category (crash impact on LIH HIH victim, earning status of victim, state, habitation, gender) N Yes No DK/CS N Yes No DK/CS Impact of crash 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Survived 1052 58.60% 40.30% 1.10% 378 28.60% 69.00% 2.40% Died 595 72.30% 26.20% 1.50% 54 35.20% 64.80% 0.00% Earning status of Victim 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Earning member 1353 66.90% 32.00% 1.10% 371 32.90% 65.20% 1.90% Non-earning member 294 48.00% 50.00% 2.00% 61 8.20% 88.50% 3.30% Overall 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Bihar 412 73.30% 25.70% 1.00% 115 40.00% 53.00% 7.00% Maharashtra 415 49.40% 50.60% -- 113 24.80% 75.20% -- Tamil Nadu 407 59.00% 39.60% 1.50% 103 35.00% 65.00% -- Uttar Pradesh 413 72.40% 24.90% 2.70% 101 16.80% 82.20% 1.00% Habitation Type 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Urban 482 50.40% 46.90% 2.70% 356 28.70% 69.10% 2.20% Rural 1165 68.90% 30.40% 0.70% 76 32.90% 65.80% 1.30% Victim Gender 1647 63.50% 35.20% 1.30% 432 29.40% 68.50% 2.10% Male 1420 64.60% 34.00% 1.30% 340 31.20% 66.50% 2.40% Female 227 56.40% 42.70% 0.90% 92 22.80% 76.10% 1.10% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 6A.6: TABLE INDICATING THE HABITATION- WISE, GENDER- WISE, AND STATE- WISE RESPONSES ON WHETHER VICTIMS REQUIRED MOBILITY ASSISTANCE LIH HIH Victims required mobility assistance N Yes N Yes Habitation Type 310 63.50% 29 62.10% Urban 62 82.30% 20 55.00% Rural 248 58.90% 9 77.80% Victim Gender 310 63.50% 29 62.10% Male 280 63.90% 25 68.00% Female 30 60.00% 4 25.00% Overall 310 63.50% 29 62.10% Bihar 99 62.60% 19 73.70% Maharashtra 88 61.40% 6 33.30% Tamil Nadu 47 78.70% 4 50.00% Uttar Pradesh 76 57.90% -- -- 6A.7: TABLE INDICATING THE HABITATION- WISE, GENDER- WISE, AND STATE- WISE RESPONSES ON THE TYPE OF PERMANENT DISABILITY LIH HIH Category (Habitation, gender, Para/ Acquired Amputation Severe Acquired Amputation state) N Other N Quadriplegia Brain Injury of a limb burns Brain Injury of a limb Habitation Type 121 8.30% 22.30% 65.30% 2.50% 1.70% 6 50.00% 50.00% Urban 21 14.30% 28.60% 47.60% 9.50% 0.00% 5 60.00% 40.00% Rural 100 7.00% 21.00% 69.00% 1.00% 2.00% 1 0.00% 100.00% Victim Gender 121 8.30% 22.30% 65.30% 2.50% 1.70% 6 50.00% 50.00% Male 113 8.00% 21.20% 66.40% 2.70% 1.80% 5 60.00% 40.00% Female 8 12.50% 37.50% 50.00% 0.00% 0.00% 1 0.00% 100.00% Overall 121 8.30% 22.30% 65.30% 2.50% 1.70% 6 50.00% 50.00% Bihar 45 8.90% 11.10% 71.10% 6.70% 2.20% 4 25.00% 75.00% Maharashtra 37 5.40% 21.60% 73.00% -- -- 2 100.00% -- Tamil Nadu 14 21.40% 57.10% 21.40% -- -- -- -- -- Uttar Pradesh 25 4.00% 24.00% 68.00% -- 4.00% -- -- -- 140 ANNEXURE 6A 6A.8: TABLE INDICATING HABITATION- WISE, GENDER- WISE, AND STATE- WISE RESPONSES ON WHETHER THE VICTIM RETURNED TO PREVIOUS OCCUPATION/SCHOOL AFTER THE CRASH LIH HIH Category (Habitation, gender, state) N Yes No N Yes No Habitation Type 1052 75.70% 24.30% 378 91.50% 8.50% Urban 418 84.90% 15.10% 323 91.30% 8.70% Rural 634 69.60% 30.40% 55 92.70% 7.30% Victim Gender 1052 75.70% 24.30% 378 91.50% 8.50% Male 884 76.50% 23.50% 293 93.20% 6.80% Female 168 71.40% 28.60% 85 85.90% 14.10% Overall 1052 75.70% 24.30% 378 91.50% 8.50% Bihar 234 67.10% 32.90% 108 89.80% 10.20% Maharashtra 290 66.90% 33.10% 102 85.30% 14.70% Tamil Nadu 323 92.00% 8.00% 85 97.60% 2.40% Uttar Pradesh 205 72.20% 27.80% 83 95.20% 4.80% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 6A.9: TABLE INDICATING STATE- WISE, HABITATION- WISE, AND GENDER- WISE RESPONSES ON AVERAGE NUMBER OF DAYS THAT THE VICTIM TOOK TO RETURN TO PREVIOUS OCCUPATION/SCHOOL LIH HIH Category (State, habitation, gender) N Avg. days N Avg. days Overall 796 92 346 43 Bihar 157 134 97 46 Maharashtra 194 122 87 45 Tamil Nadu 297 33 83 25 Uttar Pradesh 148 129 79 56 Habitation Type 796 92 346 43 Urban 355 58 295 43 Rural 441 121 51 45 Victim Gender 796 92 346 43 Male 676 101 273 45 Female 120 45 73 36 142 ANNEXURE 6A 6A.10: TABLE INDICATING HABITATION- WISE, GENDER- WISE, AND STATE- WISE RESPONSES ON AVERAGE NUMBER OF DAYS THAT THE VICTIM TOOK TO FIND A NEW JOB FROM THE DAY OF CRASH LIH HIH Category (Habitation, gender, state) N Avg. days N Avg. days Habitation Type 91 107 13 65 Urban 36 63 11 69 Rural 55 135 2 43 Victim Gender 91 107 13 65 Male 75 119 10 79 Female 16 47 3 18 Overall 91 107 13 65 Bihar 28 40 4 29 Maharashtra 20 189 8 84 Tamil Nadu 21 120 1 60 Uttar Pradesh 22 105 -- -- Traffic Crash Injuries and Disabilities: The Burden on Indian Society 6A.11: TABLE INDICATING STATE- WISE, HABITATION- WISE, AND GENDER- WISE RESPONSES ON THE SEVERITY OF DISABILITY LIH HIH Category (State, habitation, gender) Serious Partial Temporary Serious Partial Temporary N N disability disability disability disability disability disability Overall 310 39.00% 39.70% 21.30% 29 20.70% 58.60% 20.70% Bihar 99 45.50% 29.30% 25.30% 19 21.10% 63.20% 15.80% Maharashtra 88 42.00% 55.70% 2.30% 6 33.30% 50.00% 16.70% Tamil Nadu 47 29.80% 19.10% 51.10% 4 -- 50.00% 50.00% Uttar Pradesh 76 32.90% 47.40% 19.70% -- -- -- -- Habitation Type 310 39.00% 39.70% 21.30% 29 20.70% 58.60% 20.70% Urban 62 33.90% 43.50% 22.60% 20 25.00% 60.00% 15.00% Rural 248 40.30% 38.70% 21.00% 9 11.10% 55.60% 33.30% Victim Gender 310 39.00% 39.70% 21.30% 29 20.70% 58.60% 20.70% Male 280 40.40% 38.60% 21.10% 25 20.00% 64.00% 16.00% Female 30 26.70% 50.00% 23.30% 4 25.00% 25.00% 50.00% 144 6A.12: TABLE INDICATING THE CHANGE IN THE OCCUPATION OF VICTIMS FOR LIH Laborer/ skilled Salaried Change in the occupation Agriculture Petty trader/ Businessmen/ N Unemployed Housewife worker/ employee Student Retired of victim (LIH) Laborer/ Farmer shop owner self-employed unskilled worker (Pvt/ Govt) Pre crash- Habitation split 1052 6.70% 3.60% 11.50% 20.40% 9.10% 7.30% 33.50% 7.30% 0.60% Urban 418 8.40% 4.30% 1.90% 17.00% 10.30% 10.30% 39.50% 7.70% 0.70% Rural 634 5.50% 3.20% 17.80% 22.70% 8.40% 5.40% 29.50% 7.10% 0.50% ANNEXURE 6A Pre crash- Victim Gender 1052 6.70% 3.60% 11.50% 20.40% 9.10% 7.30% 33.50% 7.30% 0.60% Male 884 7.00% 0.00% 12.50% 21.80% 9.80% 7.70% 33.60% 7.20% 0.50% Female 168 4.80% 22.60% 6.60% 13.70% 5.40% 5.40% 32.70% 7.70% 1.20% On resuming work after 1052 17.80% 3.70% 10.30% 17.40% 8.70% 8.20% 28.30% 5.10% 0.70% crash Traffic Crash Injuries and Disabilities: The Burden on Indian Society Urban 418 11.70% 4.30% 1.40% 17.40% 10.50% 11.50% 35.90% 6.20% 1.00% Rural 634 21.80% 3.30% 16.10% 17.30% 7.40% 6.00% 23.30% 4.40% 0.50% On resuming work after 1052 17.80% 3.70% 10.30% 17.40% 8.70% 8.20% 28.30% 5.10% 0.70% crash-Victim Gender Male 884 18.80% 0.00% 11.20% 18.80% 9.20% 8.30% 28.50% 4.80% 0.60% Female 168 12.50% 23.20% 5.40% 9.50% 6.00% 7.70% 27.40% 7.10% 1.20% Current (as on 31 Jan 1052 14.40% 3.50% 11.30% 16.60% 9.10% 7.90% 33.00% 3.40% 0.80% 2020)- Habitation Urban 418 8.10% 3.80% 1.90% 16.80% 9.80% 11.00% 43.50% 3.80% 1.20% Rural 634 18.50% 3.30% 17.50% 16.60% 8.70% 5.80% 26.00% 3.20% 0.50% Current (as on 31 Jan 1052 14.40% 3.50% 11.30% 16.60% 9.10% 7.90% 33.00% 3.40% 0.80% 2020)- Victim Gender Male 884 14.90% 0.00% 12.40% 17.90% 9.70% 8.10% 33.00% 3.20% 0.70% Female 168 11.30% 22.00% 5.40% 10.10% 6.00% 6.50% 32.70% 4.80% 1.20% 6A.13: TABLE INDICATING THE CHANGE IN THE OCCUPATION OF VICTIMS FOR HIH Change in occupation of victim Businessmen / Salaried employee N Unemployed Housewife Farmer Student Others (Pre crash) self-employed (Pvt/ Govt) Pre crash-Habitation 378 4.20% 2.90% 1.30% 42.30% 41.50% 6.60% 1.10% Urban 323 4.60% 2.50% 1.20% 44.30% 39.60% 6.80% 0.90% Rural 55 1.80% 5.50% 1.80% 30.90% 52.70% 5.50% 1.80% Pre crash-Victim Gender 378 4.20% 2.90% 1.30% 42.30% 41.50% 6.60% 1.10% Male 293 4.10% 0.00% 1.70% 48.10% 39.20% 5.80% 1.00% Female 85 4.70% 12.90% 0.00% 22.40% 49.40% 9.40% 1.20% On resuming work after crash- 378 3.40% 3.20% 1.10% 45.00% 42.10% 4.00% 1.40% Habitation Urban 323 2.80% 2.80% 1.20% 47.10% 41.20% 4.00% 0.90% Rural 55 7.30% 5.50% 0.00% 32.70% 47.30% 3.60% 3.60% On resuming work after crash- 378 3.40% 3.20% 1.10% 45.00% 42.10% 4.00% 1.40% Victim Gender Male 293 3.40% 0.00% 1.40% 51.50% 40.30% 2.40% 1.00% Female 85 3.50% 14.10% 0.00% 22.40% 48.20% 9.40% 2.40% Current (as on 31 Jan 2020)- 378 2.60% 2.90% 1.30% 46.60% 42.30% 2.90% 1.40% Habitation Urban 323 2.20% 2.80% 0.90% 48.90% 40.90% 3.10% 1.20% Rural 55 5.50% 3.60% 3.60% 32.70% 50.90% 1.80% 1.80% Current (as on 31 Jan 2020)-Victim 378 2.60% 2.90% 1.30% 46.60% 42.30% 2.90% 1.40% Gender Male 293 2.00% 0.00% 1.40% 53.20% 39.90% 2.00% 1.40% Female 85 4.70% 12.90% 1.20% 23.50% 50.60% 5.90% 1.20% 146 ANNEXURE 6A 6A.14: TABLE INDICATING THE STATE- WISE, HABITATION- WISE, AND GENDER- WISE DETAILS OF THE OCCUPATIONAL IMPACT ON HOUSEHOLDS DUE TO THE CRASH Category Change in working pattern Someone in household had to take Someone in household had to (state, habitation, gender) of household members up additional jobs/shifts give up study LIH HIH LIH HIH LIH HIH [N=1647] [N=432] [N=1647] [N=432] [N=1647] [N=432] Overall 43.90% 26.60% 14.20% 3.90% 20.00% 4.90% Bihar 43.40% 33.00% 16.50% 8.70% 30.60% 11.30% Maharashtra 42.70% 23.00% 12.30% 0.90% 9.90% -- Tamil Nadu 43.20% 35.00% 19.40% 4.90% 13.30% 3.90% Uttar Pradesh 46.20% 14.90% 8.70% 1.00% 26.40% 4.00% Habitation Type 43.90% 26.60% 14.20% 3.90% 20.00% 4.90% Urban 36.90% 25.00% 11.20% 0.80% 11.60% 2.20% Rural 46.80% 34.20% 15.50% 18.40% 23.50% 17.10% Victim Gender 43.90% 26.60% 14.20% 3.90% 20.00% 4.90% Male 44.40% 25.90% 15.40% 4.10% 20.80% 5.90% Female 40.50% 29.30% 6.60% 3.30% 15.00% 1.10% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 148 ANNEXURE 8A 8A.1: TABLE INDICATING THE TYPE OF VEHICLE USED BY THE VICTIM, WHICH WAS INVOLVED IN CRASH State N M2W Car Bicycle 3W Pedestrian Others LIH Overall 1647 64.90% 7.40% 6.20% 3.70% 12.20% 5.60% Bihar 412 51.90% 3.20% 10.20% 8.00% 18.20% 8.50% Maharashtra 415 79.50% 4.30% 2.90% 1.20% 9.20% 2.90% Tamil Nadu 407 66.10% 17.20% 3.40% 1.20% 8.40% 3.70% Uttar Pradesh 413 62.00% 5.10% 8.20% 4.40% 13.10% 7.30% HIH Overall 432 66.00% 25.90% 0.90% 2.10% 3.70% 1.30% Bihar 115 67.00% 23.50% 1.70% 4.30% -- 3.50% Maharashtra 113 86.70% 9.70% 0.90% 0.90% 1.80% -- Tamil Nadu 103 47.60% 44.70% -- 1.00% 5.80% 1.00% Uttar Pradesh 101 60.40% 27.70% 1.00% 2.00% 7.90% 1.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 8A.2: TABLE INDICATING THE STATE- WISE AND HABITATION-WISE DETAILS ON LIFE INSURANCE COVERAGE OF THE VICTIM LIH HIH Category (state,habitation, gender) N Yes No DK/CS N Yes No DK/CS Total 681 17.50% 76.70% 5.90% 305 77.40% 22.30% 0.30% Bihar 146 38.40% 54.80% 6.80% 83 85.50% 14.50% -- Maharashtra 127 18.10% 77.20% 4.70% 87 87.40% 12.60% -- Tamil Nadu 245 8.20% 90.60% 1.20% 73 50.70% 49.30% -- Uttar Pradesh 163 12.30% 74.80% 12.90% 62 83.90% 14.50% 1.60% Habitation Type 681 17.50% 76.70% 5.90% 305 77.40% 22.30% 0.30% Urban 394 19.50% 74.10% 6.30% 274 81.40% 18.20% 0.40% Rural 287 14.60% 80.10% 5.20% 31 41.90% 58.10% -- Victim Gender 681 17.50% 76.70% 5.90% 305 77.40% 22.30% 0.30% Male 573 19.20% 74.50% 6.30% 244 79.10% 20.50% 0.40% Female 108 8.30% 88.00% 3.70% 61 70.50% 29.50% -- 150 ANNEXURE 8A 8A.3: TABLE INDICATING THE STATE- WISE AND HABITATION-WISE DETAILS ON MEDICAL INSURANCE COVERAGE OF THE VICTIM Category (State, LIH HIH habitation, gender) N Yes No DK/CS N Yes No DK/CS Overall 681 20.90% 69.90% 9.30% 305 33.80% 61.60% 4.60% Bihar 146 28.80% 54.10% 17.10% 83 22.90% 68.70% 8.40% Maharashtra 127 7.90% 85.80% 6.30% 87 49.40% 50.60% -- Tamil Nadu 245 32.20% 66.90% 0.80% 73 30.10% 67.10% 2.70% Uttar Pradesh 163 6.70% 76.10% 17.20% 62 30.60% 61.30% 8.10% Habitation Type 681 20.90% 69.90% 9.30% 305 33.80% 61.60% 4.60% Urban 394 21.60% 69.00% 9.40% 274 33.60% 63.10% 3.30% Rural 287 19.90% 71.10% 9.10% 31 35.50% 48.40% 16.10% Victim Gender 681 20.90% 69.90% 9.30% 305 33.80% 61.60% 4.60% Male 573 21.80% 68.60% 9.60% 244 36.10% 59.40% 4.50% Female 108 15.70% 76.90% 7.40% 61 24.60% 70.50% 4.90% 8A.4: TABLE INDICATING THE STATE- WISE AND HABITATION- WISE DETAILS ON VEHICLE INSURANCE COVERAGE OF THE VICTIM’S VEHICLE Category LIH HIH (State, habitation) N Yes No DK/CS NA N Yes No DK/CS NA Overall 681 42.90% 33.80% 12.30% 11.00% 305 64.90% 23.60% 7.90% 3.60% Bihar 146 63.00% 18.50% 6.20% 12.30% 83 61.40% 16.90% 20.50% 1.20% Maharashtra 127 48.00% 38.60% 5.50% 7.90% 87 81.60% 16.10% 1.10% 1.10% Tamil Nadu 245 40.00% 44.50% 6.50% 9.00% 73 47.90% 43.80% 4.10% 4.10% Uttar Pradesh 163 25.20% 27.60% 31.90% 15.30% 62 66.10% 19.40% 4.80% 9.70% Habitation Type 681 42.90% 33.80% 12.30% 11.00% 305 64.90% 23.60% 7.90% 3.60% Urban 394 48.20% 31.00% 11.70% 9.10% 274 67.90% 21.20% 7.70% 3.30% Rural 287 35.50% 37.60% 13.20% 13.60% 31 38.70% 45.20% 9.70% 6.50% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 8A.5: TABLE INDICATING STATE- WISE DETAILS ON THE TYPE OF MOTOR VEHICLE INSURANCE FOR VICTIM’S VEHICLE LIH HIH State Third party Third party Comprehensive Comprehensive N insurance DK/CS N insurance DK/CS insurance insurance (Liability) (Liability) Overall 292 57.90% 28.40% 13.70% 198 49.00% 39.40% 11.60% Bihar 92 54.30% 39.10% 6.50% 51 23.50% 58.80% 17.60% Maharashtra 61 60.70% 14.80% 24.60% 71 69.00% 26.80% 4.20% Tamil Nadu 98 64.30% 33.70% 2.00% 35 37.10% 57.10% 5.70% Uttar Pradesh 41 46.30% 12.20% 41.50% 41 56.10% 22.00% 22.00% 8A.6: TABLE INDICATING HABITATION- WISE, GENDER, WISE AND STATE- WISE RESPONSES ON WHETHER THE VICTIM/NOMINEE HAD TO ATTEND COURT FOR COMPENSATION Visited court for LIH HIH compensation N Yes No NA DK/CS N Yes No NA DK/CS Habitation Type 1647 24.70% 56.90% 13.60% 4.80% 432 17.80% 62.70% 14.40% 5.10% Urban 482 17.00% 60.40% 16.80% 5.80% 356 15.20% 64.00% 15.70% 5.10% Rural 1165 27.90% 55.50% 12.30% 4.40% 76 30.30% 56.60% 7.90% 5.30% Victim Gender 1647 24.70% 56.90% 13.60% 4.80% 432 17.80% 62.70% 14.40% 5.10% Male 1420 25.80% 56.30% 13.30% 4.60% 340 19.40% 60.00% 15.00% 5.60% Female 227 18.10% 60.80% 15.40% 5.70% 92 12.00% 72.80% 12.00% 3.30% Overall 1647 24.70% 56.90% 13.60% 4.80% 432 17.80% 62.70% 14.40% 5.10% Bihar 412 21.40% 54.60% 17.20% 6.80% 115 14.80% 56.50% 12.20% 16.50% Maharashtra 415 24.10% 56.10% 17.80% 1.90% 113 15.00% 57.50% 26.50% 0.90% Tamil Nadu 407 20.90% 66.10% 11.50% 1.50% 103 15.50% 76.70% 6.80% 1.00% Uttar Pradesh 413 32.40% 50.80% 7.70% 9.00% 101 26.70% 61.40% 10.90% 1.00% 152 ANNEXURE 8A 8A.7: TABLE INDICATING THE RESPONSES ON WHETHER THE VICTIM/ HOUSEHOLD MEMBERS FILED CASES IN MACT Impact of crash LIH HIH on victim N Yes No DK/CS N Yes No DK/CS 1647 24.50% 56.40% 19.10% 432 20.40% 56.00% 23.60% Survived 1052 13.50% 67.20% 19.30% 348 17.70% 60.80% 21.40% Died 595 44.00% 37.30% 18.70% 54 38.90% 22.20% 38.90% 8A.8: TABLE INDICATING THE STATE- WISE RESPONSES ON THE STATUS OF THE CASE IN MACT LIH HIH State N On-going N On-going Overall 404 50.20% 88 35.20% Bihar 98 59.20% 20 45.00% Maharashtra 103 45.60% 23 13.00% Tamil Nadu 72 47.20% 20 45.00% Uttar Pradesh 131 48.90% 25 40.00% 8A.9: TABLE INDICATING THE STATE- WISE RESPONSES ON WHETHER VICTIM/HOUSEHOLD MEMBERS VISITED MACT FOR HEARING LIH HIH State N Yes N Yes Overall 404 79.20% 88 71.60% Bihar 98 71.40% 20 55.00% Maharashtra 103 74.80% 23 60.90% Tamil Nadu 72 79.20% 20 70.00% Uttar Pradesh 131 88.50% 25 96.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 8A.10: TABLE INDICATING THE STATE- WISE RESPONSES ON WHETHER VICTIM/FAMILY MEMBERS SPENT ON LITIGATION LIH HIH State N Yes N Yes Overall 99 55.60% 50 64.00% Bihar 36 63.90% 11 63.60% Maharashtra 16 68.80% 13 15.40% Tamil Nadu 31 29.00% 10 80.00% Uttar Pradesh 16 75.00% 16 93.80% 8A.11: TABLE INDICATING THE VEHICLE SIZE, EDUCATION LEVELS, AND STATE-WISE DETAILS OF TRUCK DRIVERS WHO FILED AN FIR Size of vehicle N Yes No DK/CS Overall 244 32.80% 66.40% 0.80% Medium Motor Vehicle (B/w 7.5-12 tons) 117 29.10% 70.10% 0.90% Heavy Motor Vehicle (Exceed 12 tons) 112 32.10% 67.00% 0.90% Trailer 15 66.70% 33.30% Education level N Yes No DK/CS Overall 244 32.80% 66.40% 0.80% Illiterate or Educated till 5th Class 34 50.00% 50.00% Middle school (up to Class 8th) 74 33.80% 63.50% 2.70% Secondary school (up to Class 10th) 83 31.30% 68.70% Senior secondary school (up to Class 12th) & above 53 22.60% 77.40% State N Yes No DK/CS Overall 244 32.80% 66.40% 0.80% Bihar 40 2.50% 95.00% 2.50% Maharashtra 108 41.70% 58.30% -- Tamil Nadu 48 43.80% 56.30% -- Uttar Pradesh 48 27.10% 70.80% 2.10% 154 ANNEXURE 8A 8A.12: TABLE INDICATING THE EDUCATIONAL LEVELS OF TRUCK DRIVERS WHO FILED AN INSURANCE CLAIM Education vs. filed claim for insurance N Yes No Overall 221 45.20% 54.80% Illiterate 5 40.00% 60.00% Did not complete primary education 3 100.00% Primary school (up to Class 5th) 23 52.20% 47.80% Middle school (up to Class 8th) 64 51.60% 48.40% Secondary school (up to Class 10th) 76 44.70% 55.30% Senior secondary school (up to Class 12th) 33 24.20% 75.80% Diploma 4 75.00% 25.00% Graduate/college and above 13 61.50% 38.50% 8A.13: TABLE INDICATING THE STATE- WISE INSURANCE AMOUNT RECEIVED BY TRUCK DRIVERS/ FLEET OWNERS State Claim amount Overall (N=63) Rs.66,524 Tamil Nadu Rs.97,069 Bihar Rs.50,000 Maharashtra Rs.40,182 Uttar Pradesh -- 8A.14: TABLE INDICATING THE STATE- WISE PERSONAL INJURY INSURANCE COVERAGE OF TRUCK DRIVER AT THE TIME OF THE CRASH [Multiple Responses] State N None Life Insurance Medical Insurance Overall 244 54.50% 40.20% 18.00% Bihar 40 27.50% 70.00% 22.50% Maharashtra 108 51.90% 40.70% 20.40% Tamil Nadu 48 68.80% 25.00% 25.00% Uttar Pradesh 48 68.80% 29.20% 2.10% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 8A.15: FIGURE INDICATING TYPE OF INSURANCE COVERAGE AMONG TRUCK DRIVERS COMPREHENSIVE INSURANCE THIRD PARTY INSURANCE (LABILITY) DK/CS OVERALL (N = 221) 46.6% 24.9% 28.5% BIHAR (N = 37) 8.1% 59.5% 32.4% MAHARASHTRA (N = 94) 59.6% 14.9% 25.5% TAMIL NADU (N = 45) 77.8% 17.8% 4.4% UTTAR PRADESH (N = 45) 20.0% 24.4% 55.6% 8A.16: TABLE INDICATING THE IMPACT OF THE MVAA ON COMPLIANCE WITH VEHICLE INSURANCE REQUIREMENTS AT STATE LEVEL [Figures in percent] State N Yes, Definitely Yes, to some extent Not at all Overall 420 36.40% 56.40% 7.10% Bihar 101 15.80% 80.20% 4.00% Maharashtra 113 38.10% 49.60% 12.40% Tamil Nadu 100 57.00% 41.00% 2.00% Uttar Pradesh 106 34.90% 55.70% 9.40% 8A.17: TABLE INDICATING THE AWARENESS LEVELS ON THIRD PARTY LIABILITY INSURANCE WITH RESPECT TO CRASH EXPERIENCE AND DRIVING EXPERIENCE Crash experience vs. awareness of Third party liability insurance N Yes No DK/ CS Overall 420 34.00% 40.70% 25.20% Yes 244 49.20% 31.60% 19.30% No 176 13.10% 53.40% 33.50% Driving experience vs. awareness of Third party liability insurance N Yes No DK/CS Overall 420 34.00% 40.70% 25.20% More than 10 yrs. 136 49.30% 30.90% 19.90% 6-10 yrs. 144 46.50% 33.30% 20.10% 2-5 yrs. 134 11.90% 56.70% 31.30% Less than 2 yrs. 6 0.00% 83.30% 16.70% 156 ANNEXURE 8A 8A.18: TABLE INDICATING THE TRUCK DRIVER’S AWARENESS LEVELS ABOUT COVERAGE UNDER THIRD PARTY INSURANCE State N All of these Only Property Damage Only Injury/ Disability Only Death Overall 143 69.90% 27.30% 25.20% 4.20% Bihar 20 95.00% 5.00% 5.00% 5.00% Maharashtra 88 56.80% 39.80% 38.60% 5.70% Tamil Nadu 17 94.10% -- 5.90% -- Uttar Pradesh 18 83.30% 16.70% -- -- 8A.19: TABLE INDICATING THE AWARENESS ON MOTOR THIRD PARTY LIABILITY INSURANCE OF TRUCK DRIVERS ON VARIOUS ASPECTS [N=420, All figures in percent] Not Somewhat Fully Aspect related to third party insurance Aware Aware Aware The purchase of Motor Third-party liability insurance is compulsory, 22.90% 40.70% 36.40% and you may be fined by the Police if the vehicle is uninsured If the vehicle you are driving is UNINSURED, you (or the owner) may be 23.10% 41.00% 36.00% personally liable to pay for injuries caused to others if you are at fault Motor Third Party liability insurance provides compensation to other 17.90% 44.30% 37.90% people for their injuries if the crash is your fault Motor Third Party liability insurance does not provide compensation 27.60% 41.90% 30.50% for injuries you incur if the crash is your fault If someone else is at fault for an crash and you incur injuries, you may be able to 23.80% 45.00% 31.20% claim compensation from the insurer the vehicle is insured with The compensation you are eligible to receive may be 21.20% 44.50% 34.30% reduced if you breach a traffic law Along with driver, truck attendant (khalasi) is also covered for 32.60% 40.70% 26.70% benefits under third party insurance under MVAA, 2019 The time limitation for filing of cases for compensation for injuries before the 33.30% 41.20% 25.50% Claims Tribunal is 6 months from the date of the crash In case of road crash, insurance company is liable to designate an officer to help 35.00% 40.20% 24.80% you with the process of settlement of your claim Traffic Crash Injuries and Disabilities: The Burden on Indian Society 8A.20: TABLE INDICATING THE STATE- WISE AND GENDER-WISE RESPONSES ON WHETHER VICTIMS OR THE FAMILIES HAVE RECEIVED ELIGIBLE COMPENSATION FROM GOVERNMENT / LOCAL AUTHORITIES LIH HIH Category Received eligible Avg. time Received eligible Avg. time (State, gender) N Availed compensation taken (months) N Availed compensation taken (months) (N=183) (N=95) (N=36) (N=9) Overall 1647 11.10% 51.90% 13.7 432 8.30% 25.00% 20.1 Bihar 412 14.60% 50.00% 9 115 18.30% 33.30% 22.6 Maharashtra 415 6.00% 52.00% 11.2 113 2.70% 33.30% 12 Tamil Nadu 407 10.10% 39.00% 9.4 103 7.80% -- -- Uttar Pradesh 413 13.80% 63.20% 20.4 101 4.00% 25.00% 11 Victim Gender 1647 11.10% 51.90% 13.7 432 8.30% 25.00% 20.1 Male 1420 11.60% 52.10% 14 340 8.80% 26.70% 21.4 Female 227 7.90% 50.00% 11 92 6.50% 16.70% 10 8A.21: TABLE INDICATING THE STATE- WISE AWARENESS LEVELS OF COMPENSATION CLAUSES AND SCHEMES IN THE EVENT OF AN CRASH LIH HIH State N Yes No DK/CS N Yes No DK/CS Overall 681 22.90% 70.00% 7.00% 305 25.20% 63.30% 11.50% Bihar 146 32.20% 54.80% 13.00% 83 16.90% 61.40% 21.70% Maharashtra 127 17.30% 81.10% 1.60% 87 20.70% 74.70% 4.60% Tamil Nadu 245 31.40% 66.10% 2.40% 73 28.80% 69.90% 1.40% Uttar Pradesh 163 6.10% 81.00% 12.90% 62 38.70% 41.90% 19.40% 158 ANNEXURE 9A 9A.1: TABLE INDICATING STATE- WISE DETAILS ON THE MODE OF TRANSPORT USED TO TRANSFER THE VICTIM TO THE HOSPITAL Not transferred State N Ambulance Police vehicle Private vehicle Public vehicle DK/CS to hospital LIH Overall 1647 30.60% 6.60% 31.10% 20.70% 7.80% 3.20% Bihar 412 15.30% 5.30% 32.30% 26.70% 18.90% 1.50% Maharashtra 415 24.10% 3.90% 48.90% 16.40% 1.70% 5.10% Tamil Nadu 407 62.20% 2.00% 6.10% 25.80% 3.90% -- Uttar Pradesh 413 21.30% 15.30% 36.60% 14.30% 6.50% 6.10% HIH Overall 432 33.30% 3.20% 36.10% 25.50% 1.60% 0.20% Bihar 115 8.70% 7.80% 58.30% 24.30% 0.90% -- Maharashtra 113 23.90% 0.90% 34.50% 36.30% 3.50% 0.90% Tamil Nadu 103 79.60% -- 3.90% 16.50% -- -- Uttar Pradesh 101 24.80% 4.00% 45.50% 23.80% 2.00% -- 9A.2: TABLE INDICATING STATE- WISE DETAILS OF THE REACTION TIME OF THE AMBULANCE TO ARRIVE AT CRASH LOCATION State N Within 15 minutes 16-30 mins 31-45 mins Beyond 45 mins DK/CS LIH Overall 504 44.80% 31.30% 9.10% 5.40% 9.30% Bihar 63 44.40% 19.00% 6.30% 15.90% 14.30% Maharashtra 100 32.00% 27.00% 7.00% 10.00% 24.00% Tamil Nadu 253 54.90% 37.20% 7.90% -- -- Uttar Pradesh 88 30.70% 28.40% 17.00% 8.00% 15.90% HIH Overall 144 45.80% 36.80% 9.00% 4.90% 3.50% Bihar 10 40.00% 30.00% -- 20.00% 10.00% Maharashtra 27 22.20% 48.10% 18.50% 7.40% 3.70% Tamil Nadu 82 56.10% 32.90% 9.80% 1.20% -- Uttar Pradesh 25 40.00% 40.00% -- 8.00% 12.00% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 9A.3: TABLE INDICATING STATE- WISE DETAILS ON THE TYPE OF HOSPITAL THAT THE VICTIM WAS ADMITTED TO LIH HIH State N Govt Pvt N Govt Pvt Overall 681 36.60% 63.40% 305 18.40% 81.60% Bihar 146 34.20% 65.80% 83 14.50% 85.50% Maharashtra 127 34.60% 65.40% 87 6.90% 93.10% Tamil Nadu 245 36.70% 63.30% 73 27.40% 72.60% Uttar Pradesh 163 39.90% 60.10% 62 29.00% 71.00% 9A.4: TABLE INDICATING THE STATE- WISE, HABITATION- WISE, AND GENDER- WISE PROPORTION OF VICTIMS ADMITTED TO HOSPITALS LIH HIH Category (State, habitation, gender) N Yes N Yes Overall 1519 68.10% 425 81.60% Bihar 334 68.30% 114 78.10% Maharashtra 408 75.70% 109 89.00% Tamil Nadu 391 68.50% 103 71.80% Uttar Pradesh 386 59.30% 99 87.90% Habitation Type 1519 68.10% 425 81.60% Urban 472 73.30% 350 81.10% Rural 1047 65.70% 75 84.00% Victim Gender 1519 68.10% 425 81.60% Male 1306 68.40% 334 82.90% Female 213 66.20% 91 76.90% 160 ANNEXURE 9A 9A.5: TABLE INDICATING STATE-WISE, HABITATION-WISE, AND GENDER-WISE DETAILS ON CRASHES REPORTED TO POLICE LIH HIH Category (State, habitation, gender) N Yes No DK/CS N Yes No DK/CS Overall 1647 54.30% 43.20% 2.60% 432 43.10% 53.20% 3.70% Bihar 412 47.80% 48.10% 4.10% 115 28.70% 60.00% 11.30% Maharashtra 415 48.40% 50.40% 1.20% 113 23.90% 76.10% -- Tamil Nadu 407 72.00% 27.00% 1.00% 103 70.90% 28.20% 1.00% Uttar Pradesh 413 49.20% 47.00% 3.90% 101 52.50% 45.50% 2.00% Habitation Type 1647 54.30% 43.20% 2.60% 432 43.10% 53.20% 3.70% Urban 482 42.50% 54.80% 2.70% 356 39.00% 57.30% 3.70% Rural 1165 59.10% 38.40% 2.50% 76 61.80% 34.20% 3.90% Victim Gender 1647 54.30% 43.20% 2.60% 432 43.10% 53.20% 3.70% Male 1420 55.10% 42.30% 2.70% 340 43.80% 51.80% 4.40% Female 227 49.30% 48.90% 1.80% 92 40.20% 58.70% 1.10% 9A.6: TABLE INDICATING STATE- WISE, HABITATION- WISE, AND GENDER- WISE DETAILS ON WHETHER AN FIR WAS FILED AFTER THE CRASH LIH HIH Category (State, habitation, gender) N Yes No DK/CS N Yes No DK/CS Overall 1647 48.00% 47.70% 4.30% 432 41.40% 50.70% 7.90% Bihar 412 43.00% 51.50% 5.60% 115 29.60% 58.30% 12.20% Maharashtra 415 45.80% 52.50% 1.70% 113 24.80% 75.20% -- Tamil Nadu 407 59.20% 35.90% 4.90% 103 66.00% 15.50% 18.40% Uttar Pradesh 413 44.30% 50.60% 5.10% 101 48.50% 50.50% 1.00% Habitation Type 1647 48.00% 47.70% 4.30% 432 41.40% 50.70% 7.90% Urban 482 37.10% 57.70% 5.20% 356 36.80% 54.80% 8.40% Rural 1165 52.50% 43.50% 3.90% 76 63.20% 31.60% 5.30% Victim Gender 1647 48.00% 47.70% 4.30% 432 41.40% 50.70% 7.90% Male 1420 49.20% 46.50% 4.30% 340 42.10% 50.30% 7.60% Female 227 41.00% 54.60% 4.40% 92 39.10% 52.20% 8.70% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 9A.7: TABLE INDICATING STATE- WISE, HABITATION - WISE, AND GENDER- WISE DETAILS ON WHETHER THE VICTIMS/ HOUSEHOLD MEMBERS RECEIVED ASSISTANCE BY POLICE DURING THE FIR PROCESS Assistance of police during LIH HIH the FIR process N Yes No DK/CS N Yes No DK/CS Overall 791 78.10% 18.30% 3.50% 179 84.40% 11.70% 3.90% Bihar 177 56.50% 35.60% 7.90% 34 58.80% 32.40% 8.80% Maharashtra 190 83.20% 12.10% 4.70% 28 78.60% 17.90% 3.60% Tamil Nadu 241 92.50% 7.10% 0.40% 68 97.10% 2.90% -- Uttar Pradesh 183 74.90% 23.00% 2.20% 49 87.80% 6.10% 6.10% Habitation Type 791 78.10% 18.30% 3.50% 179 84.40% 11.70% 3.90% Urban 179 92.70% 6.10% 1.10% 131 80.90% 13.70% 5.30% Rural 612 73.90% 21.90% 4.20% 48 93.80% 6.30% -- Victim Gender 791 78.10% 18.30% 3.50% 179 84.40% 11.70% 3.90% Male 698 78.40% 18.20% 3.40% 143 84.60% 11.90% 3.50% Female 93 76.30% 19.40% 4.30% 36 83.30% 11.10% 5.60% 9A.8: TABLE INDICATING THE STATE- WISE TRENDS IN THE TIME TAKEN TO ATTEND TO THE VICTIM AT HOSPITAL Immediately on Within 10-30 State N 31-60 mins Beyond 60 mins DK/ CS reaching hospital mins LIH Overall 1519 50.00% 32.00% 4.90% 2.00% 11.10% Bihar 334 58.70% 25.70% 3.90% 4.20% 7.50% Maharashtra 408 60.30% 27.70% 1.20% 0.70% 10.00% Tamil Nadu 391 38.10% 48.60% 12.00% 0.50% 0.80% Uttar Pradesh 386 43.50% 25.10% 2.60% 3.10% 25.60% HIH Overall 425 53.60% 34.60% 4.90% 3.80% 3.10% Bihar 114 32.50% 40.40% 11.40% 13.20% 2.60% Maharashtra 109 59.60% 30.30% 3.70% 0.90% 5.50% Tamil Nadu 103 50.50% 47.60% 1.00% -- 1.00% Uttar Pradesh 99 74.70% 19.20% 3.00% -- 3.00% 162 ANNEXURE 9A 9A.9: TABLE INDICATING STATE- WISE TRENDS ON WHETHER ANY DISCRIMINATION/PREJUDICE WAS FACED BY THE HOSPITAL STAFF LIH HIH State N Yes No DK/CS N Yes No DK/CS Overall 1519 7.00% 83.50% 9.50% 425 6.80% 87.50% 5.60% Bihar 334 13.20% 75.40% 11.40% 114 21.90% 64.90% 13.20% Maharashtra 408 1.50% 92.90% 5.60% 109 0.90% 97.20% 1.80% Tamil Nadu 391 11.00% 81.80% 7.20% 103 1.00% 97.10% 1.90% Uttar Pradesh 386 3.40% 82.10% 14.50% 99 2.00% 92.90% 5.10% 9A.10: TABLE INDICATING STATE- WISE RESPONSES ON WHETHER SOMEONE KNOWN WAS WORKING AS FIRST AID STAFF AT MEDICAL FACILITY/ HOSPITAL LIH HIH State N Yes N Yes Overall 660 28.60% 299 20.70% Bihar 134 24.60% 83 25.30% Maharashtra 126 9.50% 83 3.60% Tamil Nadu 240 55.00% 73 47.90% Uttar Pradesh 160 7.50% 60 5.00% 9A.11: TABLE INDICATING STATE- WISE RESPONSES ON WHETHER THE VICTIM/ HOUSEHOLD MEMBER WAS HELPED BY SOMEONE KNOWN DURING THE TREATMENT OF THE VICTIM LIH HIH State N Yes N Yes Overall 188 92.60% 62 79.00% Bihar 33 87.90% 21 47.60% Maharashtra 12 83.30% 3 100.00% Tamil Nadu 131 95.40% 35 100.00% Uttar Pradesh 12 83.30% 3 33.30% Traffic Crash Injuries and Disabilities: The Burden on Indian Society 9A.12: TABLE INDICATING STATE-WISE RESPONSES ON WHETHER ROAD SAFETY PRECAUTIONS WERE TAKEN BY VICTIM DURING THE ROAD CRASH LIH HIH State Wearing Wearing Not wearing Wearing Wearing Not wearing N NA N NA helmet seatbelt helmet/ seatbelt helmet seatbelt helmet/ seatbelt Overall 1647 36.80% 5.00% 36.10% 22.10% 432 49.10% 20.40% 23.80% 6.70% Bihar 412 35.20% 3.40% 25.00% 36.40% 115 53.90% 22.60% 17.40% 6.10% Maharashtra 415 36.10% 2.90% 47.70% 13.30% 113 73.50% 7.10% 15.90% 3.50% Tamil Nadu 407 32.70% 9.30% 45.00% 13.00% 103 17.50% 27.20% 48.50% 6.80% Uttar Pradesh 413 43.10% 4.60% 26.60% 25.70% 101 48.50% 25.70% 14.90% 10.90% 164 9A.13: TABLE INDICATING STATE- WISE, HABITATION- WISE, AND GENDER- WISE INFORMATION ON IMPACT OF THE CRASH LIH HIH Category (State, habitation, N N 24 hrs 24 hrs Died at Died at gender) hospital the scene the scene to hospital from crash from crash ANNEXURE 9A Died while being transported Died in hospital within 30 days Died in hospital within 30 days Died while being transported to Discharged from hospital within Discharged from hospital within Hospitalized for more than 1 day Hospitalized for more than 1 day Died after 30 days from the crash Died after 30 days from the crash Overall 1647 18.40% 8.00% 13.40% 50.50% 8.90% 0.90% 432 4.20% 2.80% 13.40% 74.10% 5.10% 0.50% Bihar 412 24.30% 7.80% 12.90% 43.90% 10.40% 0.70% 115 2.60% 1.70% 10.40% 83.50% 1.70% -- Traffic Crash Injuries and Disabilities: The Burden on Indian Society Maharashtra 415 19.30% 3.40% 2.90% 67.00% 6.30% 1.20% 113 5.30% 3.50% 5.30% 85.00% 0.90% -- Tamil Nadu 407 5.40% 5.70% 33.70% 45.70% 8.80% 0.70% 103 -- 3.90% 35.00% 47.60% 13.60% -- Uttar 413 24.50% 15.30% 4.60% 45.00% 9.90% 0.70% 101 8.90% 2.00% 4.00% 78.20% 5.00% 2.00% Pradesh Habitation 1647 18.40% 8.00% 13.40% 50.50% 8.90% 0.90% 432 4.20% 2.80% 13.40% 74.10% 5.10% 0.50% Type Urban 482 5.60% 3.70% 22.20% 64.50% 3.70% 0.20% 356 4.80% 2.00% 13.50% 77.20% 2.00% 0.60% Rural 1165 23.70% 9.80% 9.80% 44.60% 11.00% 1.10% 76 1.30% 6.60% 13.20% 59.20% 19.70% -- Victim 1647 18.40% 8.00% 13.40% 50.50% 8.90% 0.90% 432 4.20% 2.80% 13.40% 74.10% 5.10% 0.50% Gender Male 1420 19.20% 8.20% 11.50% 50.70% 9.50% 0.80% 340 4.40% 2.60% 11.50% 74.70% 6.20% 0.60% Female 227 13.70% 6.60% 25.10% 48.90% 4.80% 0.90% 92 3.30% 3.30% 20.70% 71.70% 1.10% -- 166 APPENDIX 1: PROPOSED DEFINITION FOR LIH (BOTTOM 40) AND BPL As per United Nations SDG 10.1 goals, bottom 40 percent METHODOLOGY NOTE: of the country’s population in terms of income is being monitored. The World Inequality Database (WID.world) aims to provide open and convenient access to the most extensive As per the World Inequality Database (https://wid.world/ available database on the historical evolution of the world country/india/), using the income distribution simulator distribution of income and wealth, both within countries (see fig 1 below) it was estimated that pre-tax annual and between countries. income of INR 1,61,400 Per Adult is the threshold income of bottom 40% of the population of India. This translates to The estimates are based on a combination of sources INR 13,450 per month per adult. used at the national level (including tax receipts, household surveys and national accounts), fiscal data coming from Hence for this survey, this income to be taken as the taxes on income, inheritance and wealth data and wealth threshold per capita income for the test sample (to be rankings. The calculations are based on national income termed as “bottom-40” henceforth). (NI), i.e. GDP minus consumption of fixed capital (capital depreciation) plus net foreign income. [https://wid.world/ All households with per capita (adult) monthly income methodology/#library-others] (pre-tax) up to INR 13,450 would be considered as target respondents. POVERTY BASED ON DR. C. RANGARAJAN RE- PORT: Similarly, using the same simulator (see fig 2 below) it was estimated that any adult with annual pre-tax income of As per Dr. Rangarajan report the new poverty line is when INR 6,00,000/- or above would be considered among the monthly per capita consumption expenditure of Rs.972 in top-10 % of the population in India. This converts to INR rural areas and Rs.1,407 in urban areas in 2011-12 (i.e. Rs. 50,000/- per month. 47 per day for urban areas). Hence for survey among control sample, households The inflation rate in India between March 2012 and March having per capita pre-tax monthly income of INR 50,000/- 2019 was 53.73%, which translates into a total increase of or above would be selected (to be termed as “top-10” Rs.756. This means that Rs.1,407 rupees in March 2012 henceforth). are equivalent to Rs.2,163 in March 2019. The average monthly inflation rate between these periods was 0.51% In All the enumerators would be provided a table wherein they consideration of this study, households under poverty line can convert the household income based on number of would be determined based on monthly household income adults in the household to decide whether the household and number of members in household. can be interviewed or not. Traffic Crash Injuries and Disabilities: The Burden on Indian Society FIG 1: THRESHOLD MONTHLY INCOME OF BOTTOM-40% OF POPULATION FIG 2: THRESHOLD MONTHLY INCOME OF TOP-10% OF POPULATION 168 APPENDIX 2: ROAD CRASH VICTIM PROFILE The impact of road crash on victims varies depending on various 4.1 GENDER OF VICTIMS factors such as victim’s demographic and socio-economic profile (age, gender, educational qualification, household income, Gender wise, travel habits and road usage of males differ from etc.). This chapter presents summary of the demographic, females to a large extent. Males being prime users of the roads professional and economic profile of victims. The road crash in the form of drivers, pedestrians, cyclists, passengers, etc. more victims were segregated into two key categories i.e. LIH (from likely to get killed or seriously injured in crashes than women. poor families) and HIH (from rich families). During survey about 86 percent of road crash victims of LIH category were males while among the HIH category such proportion was about 79 percent. TABLE 4.1: GENDER OF ROAD CRASH VICTIMS [All figures in %] LIH HIH Road crash victim gender N Male Female N Male Female Overall 1647 86.2 13.8 432 78.7 21.3 Bihar 412 87.1 12.9 115 82.6 17.4 Maharashtra 415 85.5 14.5 113 76.1 23.9 Tamil Nadu 407 79.4 20.6 103 68.9 31.1 Uttar Pradesh 413 92.7 7.3 101 87.1 12.9 4.2 AGE-GROUP OF VICTIMS AT victims, overall maximum number (53.6%) of victims were in the age-group of 26-45 years. Similarly, among HIH category, THE TIME OF ROAD CRASH overall highest proportion of victims (64%) were from the age-group of 26-45 years. The probable reason is that most A majority of the victims covered in the survey were from commuting/ travel happens due to work/ occupation and 26- young and middle working age groups. Among LIH category 45 age-groups are more prone to crashes. TABLE 4.2: AGE-GROUP OF ROAD CRASH VICTIMS AT THE TIME OF CRASH [All figures in %] Age-group of the road crash victim N 14-18 yrs. 18-25 yrs. 26-35 yrs. 36-45 yrs. 46-60 yrs. More than 60 yrs. LIH Overall 1647 4.9 20.5 29.3 24.3 16.7 4.3 Bihar 412 8.0 25.7 26.9 21.6 12.9 4.9 Maharashtra 415 3.4 18.8 28.9 24.1 18.3 6.5 Tamil Nadu 407 0.7 10.6 29.7 31.2 25.3 2.5 Uttar Pradesh 413 7.5 26.9 31.5 20.3 10.4 3.4 HIH Overall 432 0.7 16.4 39.6 24.1 14.8 4.4 Bihar 115 1.7 27.8 55.7 9.6 3.5 1.7 Maharashtra 113 -- 10.6 27.4 37.2 18.6 6.2 Tamil Nadu 103 -- 9.7 37.9 32.0 18.4 1.9 Uttar Pradesh 101 1.0 16.8 36.6 17.8 19.8 7.9 Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.3 EDUCATIONAL QUALIFICATION time of crash. Almost, similar trend was observed across states where highest proportion of HIH victims was either OF VICTIMS AT THE TIME OF graduate or post graduate at the time of crash. ROAD CRASH On the other hand, only one-fourth (24.8%) of victims from LIH category were graduate or above at the time of crash. In terms of education, about two-third (66.2%) of the HIH category victims were graduate or post graduate at the TABLE 4.3: EDUCATIONAL QUALIFICATION OF ROAD CRASH VICTIMS [All figures in %] Highest education of Up to 5th Up to 8th Up to 10th Up to 12th victim at the time of road N Diploma Graduate Postgraduate Class Class Class Class crash LIH Overall 1647 21.0 13.1 17.9 15.2 8.1 21.3 3.5 Bihar 412 31.1 15.0 16.0 16.7 4.6 16.3 0.2 Maharashtra 415 18.0 12.5 23.9 16.1 7.2 17.8 4.3 Tamil Nadu 407 7.3 7.4 12.0 12.0 17.9 37.6 5.7 Uttar Pradesh 413 27.1 17.4 19.4 16.0 2.7 13.6 3.9 HIH Overall 432 3.0 3.9 4.6 10.4 11.8 52.5 13.7 Bihar 115  -- 1.7 5.2 12.2 13.9 62.6 4.3 Maharashtra 113 6.2 6.2 7.1 9.7 10.6 38.1 22.1 Tamil Nadu 103  -- 3.9 4.9 10.7 18.4 45.6 16.5 Uttar Pradesh 101 6.0 4.0 1.0 8.9 4.0 64.4 11.9 170 APPENDIX 2: ROAD CRASH VICTIM PROFILE 4.4 OCCUPATION OF VICTIMS AT (30.7%) at the time of crash followed by victims that were laborer/ skilled or unskilled workers (21.1%), agriculture THE TIME OF CRASH laborer/ farmer (14.3%), etc. Occupation profile wise, among LIH category, the highest proportion of victims covered was salaried employees TABLE 4.4: VICTIMS OCCUPATION AT THE TIME OF CRASH – LIH [N=1647, All figures in %] Laborer/ LIH victims Petty Agriculture skilled Salaried occupation trader/ Businessmen/ Unemployed Housewife Laborer/ worker/ employee Retired Student at the time of shop self-employed Farmer unskilled (Pvt/ Govt) crash owner worker Overall 6.3 3.6 14.3 21.1 8.4 7.5 30.7 0.8 7.2 Bihar 9.0 4.4 12.6 20.4 10.9 5.6 26.5 1.0 9.7 Maharashtra 4.1 3.6 26.5 15.2 7.2 6.0 27.7 0.5 9.2 Tamil Nadu 3.4 2.9 4.7 18.7 9.3 12.8 46.2 1.2 0.7 Uttar Pradesh 8.5 3.6 13.3 30.0 6.3 5.8 22.8 0.5 9.2 Among HIH category, most victims (42%) were businessmen/ self-employed at the time of crash and almost similar proportion of victims (41%) were salaried employees (Pvt/ govt.). TABLE 4.5: VICTIMS OCCUPATION AT THE TIME OF CRASH – HIH [N=432, All figures in %] Salaried HIH victims occupation Businessmen/ Unemployed Housewife Farmer employee Student Others at the time of crash self-employed (Pvt/ Govt) Overall 4.6 3.5 1.6 42.1 41.0 5.8 1.4 Bihar 7.8 0.9 1.7 54.8 30.4 3.5 0.9 Maharashtra 8.8 8.0 0.9 34.5 39.8 7.1 0.9 Tamil Nadu 0.0 1.9 0.0 19.4 75.7 1.9 1.0 Uttar Pradesh 1.0 3.0 4.0 59.4 18.8 10.9 3.0 Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.5 INCOME OF VICTIMS AT THE were earning between Rs.10,001 to Rs.20,000. About 18 percent of victims from LIH households were not earning TIME OF CRASH at all. In terms of monthly income at the time of crash, most of the State wise, except Tamil Nadu, highest proportion of victims from LIH households (25%) were earning between victims were earning between Rs.5,000 to Rs.10,000 at the Rs.5,000 to Rs.10,000 followed by victims that time of crash. TABLE 4.6: VICTIMS INCOME AT THE TIME OF CRASH – LIH [N=1647, All figures in %] LIH victims Rs. 10,001 Rs. 20,001 Rs. 30,001 Rs. 50,001 Rs. 75,001 Not Up to Rs. 5,001 to monthly income at to to to to to earning Rs. 5,000 Rs. 10,000 the time of crash Rs. 20,000 Rs. 30,000 Rs. 50,000 Rs. 75,000 Rs. 1,00,000 Overall 17.9 13.8 25.5 21.2 7.3 7.7 4.8 1.8 Bihar 23.3 20.4 28.2 20.1 5.8 1.7 -- 0.5 Maharashtra 18.3 17.8 30.8 21.4 5.8 3.1 2.7 -- Tamil Nadu 8.1 1.5 10.3 17.4 14.0 25.1 16.7 6.9 Uttar Pradesh 21.5 15.3 32.4 25.7 3.9 1.2 -- -- Compared to LIH household victims, lesser proportion were earning between Rs.50,000 to Rs.1 Lakh per month of HIH household victims were not earning at the time of and almost similar proportion of HIH household victims crash. Among HIH household victims, one-third of victims was earning up to Rs.50,000 per month. TABLE 4.7: VICTIMS INCOME AT THE TIME OF CRASH – HIH [N=432, All figures in %] HIH victims monthly income at Up to Rs.50,000 to Rs.1 Lakh to Rs.2 Lakh to Rs.4 Lakh to Not earning the time of crash Rs.50,000 Rs.1 Lakh Rs.2 Lakh Rs.4 Lakh Rs.6 Lakh Overall 14.1 33.8 34.7 14.6 2.3 0.5 Bihar 12.2 42.6 37.4 4.3 1.7 1.7 Maharashtra 24.8 37.2 29.2 8.8  -- --  Tamil Nadu 3.9 33.0 30.1 32.0 1.0 --  Uttar Pradesh 14.9 20.8 42.6 14.9 6.9 --  172 APPENDIX 2: ROAD CRASH VICTIM PROFILE 4.6 MARITAL STATUS OF VICTIM AT THE TIME OF ROAD CRASH Overall, about 7 out of 10 victims from both LIH and HIH category were married and rest were single. TABLE 4.8: MARITAL STATUS OF THE VICTIM AT THE TIME OF ROAD CRASH [All figures in %] LIH HIH Marital status of the victim N Married Single N Married Single Overall 1647 69.7 30.3 432 74.1 25.9 Bihar 412 66.0 34.0 115 65.2 34.8 Maharashtra 415 63.6 36.4 113 72.6 27.4 Tamil Nadu 407 85.7 14.3 103 90.3 9.7 Uttar Pradesh 413 63.7 36.3 101 69.3 30.7 Traffic Crash Injuries and Disabilities: The Burden on Indian Society 4.7 AVERAGE HOUSEHOLD SIZE The median values of number of adult members was 3, number of members below 18 years was 2 and total members in household was 5. The average household size of respondents in LIH segment was 5.6 which consisted of 3.8 adult members (above 18 years of age) and 1.8 members below 18 years of age. TABLE 4.9: AVERAGE HOUSEHOLD SIZE (MEAN VALUE) Average household size No. of adult members No. of members below 18 N Total members (Mean value) above 18 yrs. of age yrs. of age LIH Overall 1647 3.8 1.8 5.6 Bihar 412 4.2 2.3 6.4 Maharashtra 415 3.8 1.3 5.1 Tamil Nadu 407 3.1 1.1 4.2 Uttar Pradesh 413 4.2 2.4 6.6 HIH Overall 432 3.4 1.4 4.8 Bihar 115 3.6 2.0 5.6 Maharashtra 113 3.1 1.0 4.1 Tamil Nadu 103 3.1 1.1 4.2 Uttar Pradesh 101 3.7 1.4 5.1 174 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A1 PROFILE OF ROAD CRASH A1.1 YEAR OF ROAD CRASH VICTIM Overall, higher proportion of the respondents was covered where crashes happened during 2015-19. Among LIH, During the survey, victims or their family members were seven out of ten crashes happened in 2015-19 while in explored about the various details of the road crash. the case of HIH eight out of ten crashes happened during Demographic and professional profile or victim, details of 2015-19. the crash such as time date, type of vehicles involved etc. were collected. The road crash victims were segregated Almost similar trend was seen across all states where into two key categories i.e. LIH (from poor families) and HIH the maximum number of respondents/ family members (from rich families). experienced crashes during 2015-19. TABLE A1: YEAR OF ROAD CRASH [All figures in %] LIH HIH Year of crash N 2005-09 2010-14 2015-19 N 2005-09 2010-14 2015-19 Overall 1647 9.4 20.4 70.2 432 3.7 17.1 79.2 Bihar 412 8.5 24.5 67.0 115 6.1 13.0 80.9 Maharashtra 415 13.3 19.5 67.2 113 6.2 12.4 81.4 Tamil Nadu 407 6.6 15.0 78.4 103 1.0 16.5 82.5 Uttar Pradesh 413 9.0 22.5 68.5 101 1.0 27.7 71.3 Traffic Crash Injuries and Disabilities: The Burden on Indian Society A1.2 GENDER OF VICTIMS victims of road crashes while among the HIH category it was about 78 percent. Overall, higher proportion of males were victims of road Almost similar trend was seen across all states where the crashes. In the LIH category, over 8 out of 10 were male maximum number of road crash victims were males. TABLE A2: GENDER OF ROAD CRASH VICTIMS [All figures in %] LIH HIH Road crash victim gender N Male Female N Male Female Overall 1647 86.2 13.8 432 78.7 21.3 Bihar 412 87.1 12.9 115 82.6 17.4 Maharashtra 415 85.5 14.5 113 76.1 23.9 Tamil Nadu 407 79.4 20.6 103 68.9 31.1 Uttar Pradesh 413 92.7 7.3 101 87.1 12.9 176 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A1.3 AGE-GROUP OF VICTIMS AT THE Thus, more than half of respondents (53.6%) were in the age-group of 26-45 years. TIME OF ROAD CRASH Similarly, among the HIH category, overall, highest Considering the age-group of the respondents from the LIH proportion of victims (40%) was from the age-group of group, overall maximum number of victims (29%) were in 26-35 years followed by 36-45 yrs. (24%). Thus about two- the age-group of 26-35 years followed by 36-45 yrs. (24%). third (64%) of victims were in the age-group of 26-45 years. TABLE A3: AGE-GROUP OF ROAD CRASH VICTIMS [All figures in %] Age-group of the road crash 46-60 More than 60 N 14-18 yrs. 18-25 yrs. 26-35 yrs. 36-45 yrs. victim yrs. yrs. LIH Overall 4.9 20.5 29.3 24.3 16.7 4.3 1647 Bihar 8.0 25.7 26.9 21.6 12.9 4.9 412 Maharashtra 3.4 18.8 28.9 24.1 18.3 6.5 415 Tamil Nadu 0.7 10.6 29.7 31.2 25.3 2.5 407 Uttar Pradesh 7.5 26.9 31.5 20.3 10.4 3.4 413 HIH Overall 0.7 16.4 39.6 24.1 14.8 4.4 432 Bihar 1.7 27.8 55.7 9.6 3.5 1.7 115 Maharashtra 10.6 27.4 37.2 18.6 6.2 113 Tamil Nadu 9.7 37.9 32.0 18.4 1.9 103 Uttar Pradesh 1.0 16.8 36.6 17.8 19.8 7.9 101 Traffic Crash Injuries and Disabilities: The Burden on Indian Society A1.4 EDUCATIONAL QUALIFICATION victims were educated up to 5th class followed by victims educated till 10th standard (18%). OF VICTIMS AT THE TIME OF ROAD CRASH Among the HIH category, more than half of the victims were graduate followed by post-graduate (14%). In terms of education of LIH category victims, around 21 percent were graduate and almost similar proportion of TABLE A4: EDUCATIONAL QUALIFICATION OF ROAD CRASH VICTIMS [All figures in %] Education of victim at Up to 5th Up to 8th Up to 10th Up to 12th N Diploma Graduate Postgraduate the time of road crash Class Class Class Class LIH Overall 1647 21.0 13.1 17.9 15.2 8.1 21.3 3.5 Bihar 412 31.1 15.0 16.0 16.7 4.6 16.3 0.2 Maharashtra 415 18.0 12.5 23.9 16.1 7.2 17.8 4.3 Tamil Nadu 407 7.3 7.4 12.0 12.0 17.9 37.6 5.7 Uttar Pradesh 413 27.1 17.4 19.4 16.0 2.7 13.6 3.9 HIH Overall 432 3.0 3.9 4.6 10.4 11.8 52.5 13.7 Bihar 115  -- 1.7 5.2 12.2 13.9 62.6 4.3 Maharashtra 113 6.2 6.2 7.1 9.7 10.6 38.1 22.1 Tamil Nadu 103  -- 3.9 4.9 10.7 18.4 45.6 16.5 Uttar Pradesh 101 6.0 4.0 1.0 8.9 4.0 64.4 11.9 178 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A1.5 MARITAL STATUS OF highest victims of Tamil Nadu were married while lowest were from Uttar Pradesh. VICTIMS AT THE TIME OF ROAD CRASH Overall, about 7 out of 10 victims from both LIH and HIH category were married and rest were single. State-wise, TABLE A5: MARITAL STATUS OF THE VICTIM AT THE TIME OF ROAD CRASH [All figures in %] LIH HIH Marital status of the victim N Married Single N Married Single Overall 1647 69.7 30.3 432 74.1 25.9 Bihar 412 66.0 34.0 115 65.2 34.8 Maharashtra 415 63.6 36.4 113 72.6 27.4 Tamil Nadu 407 85.7 14.3 103 90.3 9.7 Uttar Pradesh 413 63.7 36.3 101 69.3 30.7 A2 ROAD CRASH DETAILS A2.1 ROAD TYPE WHERE CRASH percent crashes among HIH category occurred on city/ district/municipal roads. HAPPENED Based on crashes reported, the proportion of death cases Road type wise, the maximum number of crashes occurred was higher on national highways/ state highways, while on city/ district/ municipality roads followed by national survival cases were higher on city/ district/ municipality highways/ expressways roads, probably because of the speed of the vehicles. Category wise, 56 percent crashes among LIH and 64 Traffic Crash Injuries and Disabilities: The Burden on Indian Society TABLE A6: ROAD TYPE WHERE CRASH HAPPENED [All figures in %] Type of road on which crash National Highway/ State City/ District/ N Village road happened Expressway Highway Municipality roads LIH Overall 1647 18.1 15.4 55.9 10.6 Bihar 412 25.3 17.8 41.1 15.8 Maharashtra 415 11.0 18.1 62.2 8.7 Tamil Nadu 407 13.5 13.9 70.6 2.0 Uttar Pradesh 413 24.0 13.5 42.3 20.2 HIH Overall 432 17.4 14.4 63.9 4.3 Bihar 115 14.5 32.5 48.2 4.8 Maharashtra 113 19.5 3.4 69.0 8.0 Tamil Nadu 103 9.6 8.2 82.2  -- Uttar Pradesh 101 27.4 12.9 56.5 3.2 180 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A2.2 VEHICLES INVOLVED IN THE The higher proportion of LIH victims that were involved in the crash were using roads/highways as pedestrians CRASH (12.2%), followed by those who were using cars (7.4%) and bicycles (6.2%) With respect to the type of vehicle involved in the crash, overall, about 6 out of 10 crashes happened while victims Among HIH category victims, after M2Ws one-fourth of were riding motorized two-wheelers. crashes occurred when victims were using cars. TABLE A7: TYPE OF VEHICLE INVOLVED IN CRASH – VICTIM VEHICLE [All figures in %] Victim vehicle type involved N M2W Car Bicycle 3W Pedestrian Others in crash LIH Overall 1647 64.9 7.4 6.2 3.7 12.2 5.6 Bihar 412 51.9 3.2 10.2 8.0 18.2 8.5 Maharashtra 415 79.5 4.3 2.9 1.2 9.2 2.9 Tamil Nadu 407 66.1 17.2 3.4 1.2 8.4 3.7 Uttar Pradesh 413 62.0 5.1 8.2 4.4 13.1 7.3 HIH Overall 432 66.0 25.9 0.9 2.1 3.7 1.3 Bihar 115 67.0 23.5 1.7 4.3 -- 3.5 Maharashtra 113 86.7 9.7 0.9 0.9 1.8 0.0 Tamil Nadu 103 47.6 44.7 -- 1.0 5.8 1.0 Uttar Pradesh 101 60.4 27.7 1.0 2.0 7.9 1.0 Traffic Crash Injuries and Disabilities: The Burden on Indian Society Also, impact of the crash (survived) was measured based – Bicycle (55%) and when they were using three-wheelers on type of vehicle victims were using at the time of crashes. (47%). It was found that about 8 out of 10 victims survived when they were travelling in cars (79.5%) followed by motorized Across LIH and HIH categories, lowest proportion of road two wheelers users (75.3%). victims survived while they was using road as pedestrian. Comparatively, the proportion of survived victims was low while they were traveling through non-motorized transport TABLE A8: TYPE OF VICTIM VEHICLE WISE IMPACT OF CRASH (SURVIVED) [All figures in %] Victim vehicle type wise impact of crash (survived) Overall LIH Survived HIH Survived N 2079 1647 432 Overall 68.8 63.9 87.5 Car 79.5 73.0 86.6 M2W (Motorcycle/ Scooter/ Scooty) 75.3 71.1 90.9 Bicycle 54.7 53.9 75.0 3W/ Cycle or Battery Rickshaw 47.1 41.0 88.9 Pedestrian 42.9 43.3 37.5 Others 41.8 39.1 83.3 Further, in terms of other offending vehicles involved in the Among HIH category respondents, about 32 percent were crash, overall, slightly over one-fourth of victims from the using M2Ws, followed by Cars (29.4%), trucks/ lorries/ LIH category were riding M2Ws, followed by truck/lorry/ tractors (12%). Car as another offending vehicle during the tractor and then car. crash was mentioned by highest proportion of respondents in Bihar (24.3%), Tamil Nadu (28.2%), and Uttar Pradesh A higher proportion of trucks /lorries /tractors was involved (37.6%), and M2W in Maharashtra (55.8%). in crashes in Bihar (28.9%) and Uttar Pradesh (27.8%), while M2Ws in Maharashtra (37.8%) and Cars in Tamil Nadu (29%). 182 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH TABLE A9: TYPE OF VEHICLE INVOLVED IN THE CRASH – OTHER OFFENDING VEHICLE [All figures in %] Other offending Truck/ Bus/ vehicle involved in N M2W lorry/ Car None 3W Taxi Others Minibus crash Tractor LIH Overall 1647 25.8 22.0 20.9 6.9 4.6 6.7 5.8 7.5 Bihar 412 20.6 28.9 11.2 9.2 10.4 3.9 5.3 10.4 Maharashtra 415 37.8 16.1 21.2 8.4 2.4 4.8 2.2 7.0 Tamil Nadu 407 21.4 15.0 29.0 4.9 3.7 11.1 14.7 0.2 Uttar Pradesh 413 23.2 27.8 22.5 4.8 1.7 7.0 1.2 11.6 HIH Overall 432 31.7 12.0 29.4 1.9 10.4 5.1 7.6 1.9 Bihar 115 24.3 7.0 24.3 0.9 23.5 7.0 10.4 2.6 Maharashtra 113 55.8 6.2 28.3 4.4 1.8 0.9 0.9 1.8 Tamil Nadu 103 17.5 17.5 28.2 1.0 5.8 10.7 18.4 1.0 Uttar Pradesh 101 27.7 18.8 37.6 1.0 9.9 2.0 1.0 2.0 Traffic Crash Injuries and Disabilities: The Burden on Indian Society A2.3 WAYS IN WHICH VEHICLE/ ROAD areas higher proportion of victims were using the roads as passenger/ pillion rider or pedestrian. USED BY THE VICTIM AT THE TIME OF CRASH Overall, from the LIH category, over two-third of victims were either driving/ riding the vehicle, one-fifth were using as passengers/ pillion riders, and about 12 percent as a Respondents were asked about the way in which victims pedestrian. were using vehicle/ road at the time of crash. Overall, higher proportion of victims were using roads while driving/ riding Similarly, among the HIH category, 8 out of 10 victims were vehicle. using the road as driver/ rider while about one-sixth were using as passenger/ pillion riders. In terms of habitation, higher proportion of victims in urban areas were driving/ riding vehicles, while in the case of rural TABLE A10: WAYS IN WHICH ROAD/ VEHICLE USED BY THE VICTIM [All figures in %] LIH HIH Road/ vehicle usage as Driver/ Passenger/ Driver/ Passenger/ N Pedestrian N Pedestrian Rider Pillion Rider Pillion Overall 1647 67.2 20.6 12.2 432 80.8 15.5 3.7 Bihar 412 52.2 29.6 18.2 115 75.7 24.3  -- Maharashtra 415 68.2 22.7 9.2 113 85.0 13.3 1.8 Tamil Nadu 407 83.8 7.9 8.4 103 84.5 9.7 5.8 Uttar Pradesh 413 64.9 22.0 13.1 101 78.2 13.9 7.9 184 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A3. RESPONDENT PROFILE A3.1 RESPONDENTS POSITION IN HOUSEHOLD Out of all the respondents, about 42 percent were victims themselves while in 58 percent cases close family members Among both the categories, most of the respondents were were interviewed. either head of the households or chief wage earners. 28 percent LIH and 31 percent HIH respondents were other most affected members of the household. TABLE A11: RESPONDENTS POSITION IN HOUSEHOLD [All figures in %] LIH HIH Position in household N HoH CWE Other* N HoH CWE Other* Overall 1647 45.7 26.3 28.1 432 33.6 35.2 31.3 Bihar 412 45.1 23.8 31.1 115 15.7 34.8 49.6 Maharashtra 415 48.7 20.0 31.3 113 54.0 21.2 24.8 Tamil Nadu 407 47.7 33.7 18.7 103 45.6 40.8 13.6 Uttar Pradesh 413 41.2 27.8 31.0 101 18.8 45.5 35.6 A3.2 GENDER WISE Gender wise, one-fourth of respondents in LIH category were females while and one-third in HIH category were females. Highest proportion of females was covered in Tamil Nadu. Traffic Crash Injuries and Disabilities: The Burden on Indian Society TABLE A12: GENDER OF RESPONDENTS [All figures in %] LIH HIH Gender of respondent N Male Female N Male Female Overall 1647 74.5 25.5 432 66.9 33.1 Bihar 412 76.0 24.0 115 69.6 30.4 Maharashtra 415 78.6 21.4 113 73.5 26.5 Tamil Nadu 407 63.4 36.6 103 51.5 48.5 Uttar Pradesh 413 79.9 20.1 101 72.3 27.7 A3.3 AGE GROUP WISE Age-group wise, most of the respondents were from the age-group of 26-35 years followed by 36-45 years across both the categories. TABLE A13: AGE-GROUP OF RESPONDENTS [All figures in %] Age group N 18-25 yrs. 26-35 yrs. 36-45 yrs. 46-60 yrs. More than 60 yrs. LIH Overall 1647 18.5 36.0 25.5 17.0 3.0 Bihar 412 26.2 34.2 21.4 14.3 3.9 Maharashtra 415 21.4 34.7 25.1 15.4 3.4 Tamil Nadu 407 4.7 37.1 35.1 22.9 0.2 Uttar Pradesh 413 21.5 38.0 20.6 15.5 4.4 HIH Overall 432 15.5 44.9 28.2 10.6 0.7 Bihar 115 27.8 57.4 12.2 2.6 --  Maharashtra 113 13.3 31.9 38.9 13.3 2.7 Tamil Nadu 103 5.8 41.7 39.8 12.6  -- Uttar Pradesh 101 13.9 48.5 22.8 14.9  -- 186 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A3.4 EDUCATION WISE Education wise, about 18 percent LIH respondents were educated till primary level followed by senior secondary level (17%) and secondary level (16%). While in case of HIH category, about two-third of respondents were graduate or above. TABLE A14: EDUCATION OF RESPONDENTS [All figures in %] Up to Senior Graduate/ Post- Highest Education Middle Secondary N Primary secondary Diploma college and graduate/ of Respondent school school Class school above University LIH Overall 1647 18.1 12.0 15.8 16.8 7.7 25.0 4.7 Bihar 412 26.9 12.6 15.5 19.4 5.1 20.1 0.2 Maharashtra 415 12.3 11.8 21 22.4 6.7 20.5 5.3 Tamil Nadu 407 4.2 7.1 9.1 9.8 16.5 45.2 8.1 Uttar Pradesh 413 28.8 16.2 17.7 15.3 2.4 14.5 5.1 HIH Overall 432 0.7 2.5 3.9 10.4 11.3 56.0 15.0 Bihar 115 --  --  6.1 11.3 15.7 63.5 3.5 Maharashtra 113 0.9 3.5 4.4 15.9 10.6 42.5 22.1 Tamil Nadu 103  -- 1.0 1.9 7.8 14.6 52.4 22.3 Uttar Pradesh 101 2.0 5.9 3.0 5.9 4.0 66.3 12.9 Traffic Crash Injuries and Disabilities: The Burden on Indian Society A3.5 OCCUPATION WISE Among HIH category, about 8 out of 10 respondents were either business/ self-employed or salaried employees (Pvt. Govt.). Occupation wise most of LIH respondents were labour (skilled/ unskilled)/ shop owners (27.5%) followed by salaried employees (Pvt./ Govt.) (27%), farmers/ agriculture laborer (20%). TABLE A15: OCCUPATION OF RESPONDENTS [All figures in %] Unskilled/ Farmer/ Salaried Occupation of skilled Businessmen/ Retired/ N Unemployed Housewife Agri employee respondent worker/ shop self-employed Student laborer (Pvt/ Govt) owner LIH Overall 1647 5.9 9.7 20.4 27.5 7.3 27.0 2.2 Bihar 412 8.7 9.0 18.0 29.4 6.3 25.7 2.9 Maharashtra 415 7.0 6.0 35.5 18.8 5.1 24.6 3.2 Tamil Nadu 407 1.2 14.3 3.6 26.2 11.8 42.5 0.2 Uttar Pradesh 413 6.5 9.7 24.2 35.6 6.3 15.3 2.4 HIH Overall 432 3.0 10.9 1.2 -- 42.1 40.7 2.1 Bihar 115 6.1 5.2 1.7 -- 44.3 42.6 -- Maharashtra 113 3.5 8.0 -- -- 41.6 40.7 6.2 Tamil Nadu 103 -- 11.7 -- -- 26.2 62.1 -- Uttar Pradesh 101 2.0 19.8 3.0 -- 56.4 16.8 2.0 188 APPENDIX 3: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – LIH & HIH A3.6 BPL STATUS OF HOUSEHOLD number of members in household. Households having per capita income below Rs.2,163 were considered as BPL. The BPL status of the household was recorded based on Based on above, during survey a little higher than half of the reporting of the respondents. However, cases where respondents (53.1%) were covered from BPL households respondents were not aware of the same, BPL status was while remaining were from non-BPL. determined based on monthly household income and TABLE A16: BPL STATUS OF LIH HOUSEHOLDS [All figures in %] BPL status of victim household N Yes No Overall 1647 53.1 46.9 Bihar 412 65.3 34.7 Maharashtra 415 40.2 59.8 Tamil Nadu 407 51.1 48.9 Uttar Pradesh 413 55.7 44.3 Traffic Crash Injuries and Disabilities: The Burden on Indian Society A3.7 AVERAGE HOUSEHOLD SIZE The median values of no. of adult members was 3, number of members below 18 years was 2 and total members in household was 5. The average household size of respondents in LIH segment was 5.6 which consisted 3.8 adult members (above 18 years of age) and 1.8 members below 18 years of age. TABLE A17: AVERAGE HOUSEHOLD SIZE (MEAN VALUE) Average household size No. of adult members No. of members below 18 N Total members (Mean value) above 18 yrs. of age yrs. of age LIH Overall 1647 3.8 1.8 5.6 Bihar 412 4.2 2.3 6.4 Maharashtra 415 3.8 1.3 5.1 Tamil Nadu 407 3.1 1.1 4.2 Uttar Pradesh 413 4.2 2.4 6.6 HIH Overall 432 3.4 1.4 4.8 Bihar 115 3.6 2.0 5.6 Maharashtra 113 3.1 1.0 4.1 Tamil Nadu 103 3.1 1.1 4.2 Uttar Pradesh 101 3.7 1.4 5.1 190 APPENDIX 4: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – TRUCK DRIVERS The truck drivers were interviewed across Bihar, B1. DEMOGRAPHIC PROFILE OF Maharashtra, Tamil Nadu and Uttar Pradesh to understand their awareness about MVAA and Motor third party liability TRUCK DRIVERS insurance, compensation and experience of road crashes. The respondents selected for the interview were truck A total sample of 420 truck drivers was covered in 4 states: drivers of Medium Motor Vehicles, Heavy Motor Vehicles each state containing about one-fourth of respondents. and Trailers. This section contains demographic and professional profile of truck drivers. TABLE B1: SAMPLE COVERAGE Sample coverage N Percentage Overall 420 -- Bihar 101 24% Maharashtra 113 27% Tamil Nadu 100 24% Uttar Pradesh 106 25% B1.1 AGE-GROUP WISE Age group-wise, overall, 46 percent drivers were in the age group of 26-40 years, while close to 3 out of 10 drivers were in the age group of 36-45 years. TABLE B2: AGE-GROUP OF TRUCK DRIVERS [All figures in %] Age Group N 18-25 yrs. 26-35 yrs. 36-45 yrs. 46-60 yrs. > 60 yrs. Overall 420 8.6 45.5 31.9 13.3 0.7 Bihar 101 9.9 69.3 19.8 1.0 -- Maharashtra 113 6.2 46.9 31.0 15.0 0.9 Tamil Nadu 100 -- 30.0 49.0 21.0 -- Uttar Pradesh 106 17.9 35.8 28.3 16.0 1.9 Traffic Crash Injuries and Disabilities: The Burden on Indian Society B1.2 EDUCATIONAL QUALIFICATION WISE Educational qualification wise, overall 36 percent of truck drivers were educated up to secondary level followed by middle level (29%), senior secondary level (15%). Very few were educated above senior secondary level. More than 43 percent of truck drivers have not passed class 10th. TABLE B3: EDUCATIONAL QUALIFICATION OF TRUCK DRIVERS [All figures in %] Up to Up to Education Not completed Up to Up to Graduate & N Illiterate Class Class Diploma qualification primary Class 5th Class 8th above 10th 12th Overall 420 3.1 1.0 9.8 29.3 36.2 14.8 1.4 4.5 Bihar 101 0.0 0.0 4.0 25.7 51.5 13.9 0.0 5.0 Maharashtra 113 1.8 1.8 15.0 32.7 33.6 12.4 1.8 0.9 Tamil Nadu 100 0.0 0.0 3.0 38.0 34.0 13.0 3.0 9.0 Uttar Pradesh 106 10.4 1.9 16.0 20.8 26.4 19.8 0.9 3.8 192 APPENDIX 4: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – TRUCK DRIVERS B2 PROFESSIONAL EXPERIENCE OF experience (32%) and having more than 15 yrs. experience (18%). TRUCK DRIVERS State wise, nearly 54 percent truck drivers in Bihar had 2-5 B2.1 DRIVING EXPERIENCE WISE years of driving experience and in rest of the states majorly between 6-10 years. Overall, one-third of truck drivers had driving experience of 6-10 years followed by those who were having 2-5 yrs. TABLE B4: DRIVING EXPERIENCE OF TRUCK DRIVERS [All figures in %] Less than 2  Driving experience N 2-5 yrs. 6-10 yrs. 11-15 yrs. More than 15 yrs. yrs. Overall 420 1.4 31.9 34.3 14.0 18.3 Bihar 101  -- 53.5 27.7 10.9 7.9 Maharashtra 113  -- 15.9 31.9 24.8 27.4 Tamil Nadu 100 3.0 37.0 47.0 6.0 7.0 Uttar Pradesh 106 2.8 23.6 31.1 13.2 29.2 B2.2 WORKING SECTOR WISE Overall, 9 out of 10 truck drivers were working in private sector while only 2 percent in government. TABLE B5: WORKING SECTOR OF TRUCK DRIVERS [All figures in %] Working sector N Private Government Overall 420 98.3 1.7 Bihar 101 100.0  -- Maharashtra 113 100.0  -- Tamil Nadu 100 95.0 5.0 Uttar Pradesh 106 98.1 1.9 Traffic Crash Injuries and Disabilities: The Burden on Indian Society B2.3 VEHICLE OWNERSHIP TYPE State wise, majorly trucks were owned by fleet owners except Tamil Nadu where about one-fourth truck drivers have their own trucks. Overall, 8 out of 10 trucks were owned by fleet owners/ company while about 12 percent were self-owned trucks. TABLE B6: VEHICLE OWNERSHIP WISE [All figures in %]  Vehicle ownership N Self-Owned Owned by fleet owner/ company Overall 420 12.4 87.6 Bihar 101 3.0 97.0 Maharashtra 113 16.8 83.2 Tamil Nadu 100 26.0 74.0 Uttar Pradesh 106 3.8 96.2 B2.4 INCOME FROM TRUCK DRIVING Rs.20,000 to Rs.30,000. PROFESSION State wise, major proportion of truck drivers’ income was in between Rs. 10,000 to Rs. 20,000. Overall, nearly 47 percent truck drivers had an income of Rs.10,000- Rs. 20,000, followed by 29 percent having from TABLE B7: INCOME FROM TRUCK DRIVING PROFESSION [All figures in %] Income from truck driving Rs. 5,001 to Rs. 10,001 to Rs. 20,001 to Rs. 30,001 to Rs. 50,001 to N profession 10,000 20,000 30,000 50,000 75,000 Overall 420 12.9 47.1 29.3 8.1 2.6 Bihar 101 2.0 46.5 46.5 5.0 --  Maharashtra 113 25.7 46.9 22.1 3.5 1.8 Tamil Nadu 100 3.0 33.0 33.0 22.0 9.0 Uttar Pradesh 106 18.9 61.3 17.0 2.8  -- 194 APPENDIX 4: RESPONDENT PROFILE (DEMOGRAPHIC & PROFESSIONAL) – TRUCK DRIVERS B2.5 STRUCTURE OF MONTHLY Across states, over half the truck drivers were paid on monthly basis, except Tamil Nadu where 54 percent truck BENEFITS drivers were paid trip wise and 24 percent based on driving hours. Overall, 6 out of 10 truck drivers were paid on monthly basis and rest 31 percent on trip basis. Only 8 percent truck drivers were paid on the basis of driving hours. TABLE B8: STRUCTURE OF MONTHLY BENEFITS OF TRUCK DRIVERS [All figures in %]  Structure of monthly benefits N Monthly Salary Trip wise Number of Driving Hours Overall 420 61.2 30.7 8.1 Bihar 101 87.1 7.9 5.0 Maharashtra 113 76.1 23.0 0.9 Tamil Nadu 100 22.0 54.0 24.0 Uttar Pradesh 106 57.5 38.7 3.8 B2.6 SETTLEMENT OF PENALTIES themselves and 11 percent drivers shared by both driver and owner. Overall, more than three-fourth truck drivers confirmed State wise, majority of truck drivers mentioned that the that the settlement of penalties was done by the owner or settlement of penalties was done by their owner/ company. company, 13 percent truck drivers settled penalties by TABLE B9: SETTLEMENT OF PENALTIES [All figures in %] Owner/ Company Settled by the driver from his Shared by both driver and Settlement of penalties N pays for it salary owner Overall 420 76.7 12.9 10.5 Bihar 101 74.3 9.9 15.8 Maharashtra 113 57.5 27.4 15.0 Tamil Nadu 100 91.0 5.0 4.0 Uttar Pradesh 106 85.8 7.5 6.6 Traffic Crash Injuries and Disabilities: The Burden on Indian Society B2.7 DRIVING SCHEDULE (PER DAY In terms of driving per month, Maharashtra truck drivers drive about 24 days a month followed by Uttar Pradesh. AND PER MONTH) Least driving schedule (per day and per month) was recorded for truck drivers of Tamil Nadu. Overall, truck drivers drive 9.9 hours per day and 22.1 days a month. State wise, truck drivers in Uttar Pradesh drive maximum 11 hours a day followed by Bihar. TABLE B10: VEHICLE OWNERSHIP [N=420, All figures in mean]  Driving schedule Avg. hours’ drive/ day Avg. days’ work/ month Overall 9.9 22.1 Bihar 10.0 21.8 Maharashtra 9.4 24.1 Tamil Nadu 9.1 20.0 Uttar Pradesh 11.0 22.3 B2.8 TYPE OF TRUCK WISE tons) while about 45 percent were driving medium motor/ good vehicles (between 7.5-12 tons). Truck type wise, overall, about half of the truck drivers Across states, at-least half of the truck drivers were driving covered were driving heavy motor vehicles (exceed 12 heavy motor vehicle expect Bihar where such proportion was about 42.6 percent. TABLE B11: TYPE OF TRUCK CATEGORY [All figures in mean] Medium Motor Vehicle (B/w Heavy Motor Vehicle Type of truck category N Trailer 7.5-12 tons) (Exceed 12 tons) Overall 420 45.7 50.2 4.0 Bihar 101 56.4 42.6 1.0 Maharashtra 113 40.7 50.4 8.8 Tamil Nadu 100 43.0 57.0 -- Uttar Pradesh 106 43.4 50.9 5.7 196 APPENDIX 5: QUESTIONNAIRES QUESTIONNAIRE – TEST SAMPLE (B-40) City of Interview Serial No Place of Interview PREAMBLE and it is up to you to decide whether to participate. The interview will take about 25-30 minutes. You can decide Good ………….................…: I am from MDRA (Marketing & not to answer any question and can stop the interview at Development Research Associates), a leading market and any time. Everything that you report during the interview social research agency in India. We are currently conducting will be kept strictly confidential. Your responses would be a survey to assess the impact of road deaths on victims in combined with responses given by other respondents and terms of poverty and social status for SaveLIFE Foundation would not be identified separately. (SLF) in collaboration with the World Bank. [Please note that no payment/ money/ fee to be paid to I want to ask for your permission to include you in our study anyone in any manner for participating in this survey] SECTION A: QUALIFYING CRITERIA S.N. Question Response Has anyone in your household died or suffered (1) Yes, death due to a road crash serious injury from a road crash in the last 15 years? (2) Yes, serious injuries A1 (3) Yes, minor injuries [TERMINATE] [Serious/ severe injuries mean cases where victims attended hospital for treatment] (4) No [TERMINATE] (1) 1 member (2) More than 1 member How many members of your household were [In case of more than 1 member, victim that contributed the most to A2 involved in that road crash? the monthly household expenses before crash would be selected/ information about such victim would be asked. In case where victims contributed equally or not contributed at all, take details about the oldest victim at the time of crash.] Traffic Crash Injuries and Disabilities: The Burden on Indian Society Did road crash victim (as selected in A2) involve (1) Yes A3 in more than 1 crash in last 15 years where (2) No serious/ severe injuries were sustained. [If Yes, information about the latest crash would be taken] (1) Died at the scene (2) Died while being transported to hospital What was the impact of the road crash on the (3) Taken to hospital & discharged within 24 hrs. A4 victim? (4) Had to be admitted in the hospital for more than 1 day (5) Died in hospital within 30 days from the crash (6) Died after 30 days from the crash (1) Before Jan 2005 [TERMINATE] A5 When did the road crash happen? (2) Between Jan 2005 - July 2019 [CONTINUE] (3) After July 2019 [TERMINATE] (1) Self [GO TO A8] (2) Parent/ Grand parent (3) Son/ Daughter (4) Uncle/ Aunt (5) Nephew/ Niece A6 Crash victim’s relation with respondent (6) Spouse (7) Sibling (8) Father/ Mother-in-law (9) Brother/ Sister-in-law (10) Son/ Daughter-in law (11) Others (specify): _____________________ Did you use to live with the victim when the (1) Yes [CONTINUE] A7 road crash happened? (2) No [TERMINATE] (1) Head of the Household How do you term yourself in your household? [HoH is the person (either male or female) that takes key decision in the household] [A group of people staying together under the same roof and sharing food from a common (2) Chief Wage Earner A8 kitchen is called a Household. Persons [Chief wage earner is the person (either male or female) who living in hostels or messes and taking food contributes the most to the household expenses] from a common kitchen do not constitute a (3) Other most affected member of the household household.] [Member of the household that was most impacted due to crash after HoH and CWE] 198 APPENDIX 5: QUESTIONNAIRES (1) Less than 14 yrs. [TERMINATE] What was your age when the road crash A9 happened? (2) More than 14 yrs. [CONTINUE] Please provide following information about your A10 Number household members (as on 31 Jan 2020). 1 Number of adult members above 18 yrs. of age 2 Number of members below 18 yrs. of age 3 Total household members (1) Up to Rs. 5,000 (2) Rs. 5,001 to Rs. 10,000 Income: Please look at this card and tell me which income group best indicates Total (3) Rs. 10,001 to Rs. 20,000 Monthly Household Income. [SHOW CARD] (as on 31 Jan 2020). (4) Rs. 20,001 to Rs. 30,000 A11 [Please include all the income/ receipts of every (5) Rs. 30,001 to Rs. 50,000 member of the household from all sources such as job, profession, wages, rent, pension, (6) Rs. 50,001 to Rs. 75,000 gratuity, etc.] (7) Rs. 75,001 to Rs. 1,00,000 (8) More than Rs. 1,00,000 Based on the table provided in the annexure, is respondent eligible for the survey? (1) Yes [CONTINUE] A12 [Use the table provided at the end to check the (2) No [TERMINATE] eligibility of the respondent for the survey] Is your household a BPL household? (1) Yes A13 [Use the table provided at the end to check and (2) No validate the BPL status of household] Traffic Crash Injuries and Disabilities: The Burden on Indian Society SECTION B: RESPONDENT PROFILE S.N. Question Response B1 Respondent Name B2 Phone Number B3 Address B4 City (1) Bihar (2) Maharashtra B5 State (3) Tamil Nadu (4) Uttar Pradesh (1) Urban B6 Location of habitation (2) Rural (1) Male B7 Gender (2) Female B8 What was your age on last birthday? Mention age: _____________ years. (1) Illiterate (2) Literate with no formal education (3) Did not complete primary education (4) Primary school (up to Class 5th) (5) Middle school (up to Class 8th) B9 Highest Education of Respondent (6) Secondary school (up to Class 10th) (7) Senior secondary school (up to Class 12th) (8) Diploma (9) Graduate/college and above (10) Postgraduate/ University (11) Other (Specify): ____________________ B10 Occupation of respondent (1) Unemployed (2) Housewife (3) Agricultural Laborer (4) Other Laborer (5) Farmer (6) Unskilled worker (7) Petty trader/ shop owner (8) Skilled worker (9) Businessmen/ self-employed (10) Salaried employee (Pvt/ Govt) (11) Retired (12) Other (Specify): ________________ 200 APPENDIX 5: QUESTIONNAIRES SECTION C: ROAD CRASH DETAILS S.N. Question Response When did road crash happen? (Mention date, C1 ___________________ [DD/MM/YYYY] month and year) C2 Where did the road crash happen? City/ location Name: _________________ Type of city/ location where road crash (1) Within the city of victim residence C3 happened (2) Other city (1) Expressway (2) National Highway (3) State Highway C4 Type of road on which crash happened (4) City/ District/ Municipality roads (5) Village road (6) Other (specify): _____________________ Type of vehicles involved in the road crash [MENTION CODE] [POST CODES] Personal vehicles (1) M2W - Motorcycle/ Scooter/ Scooty (2) Car (3) Bicycle (1) Victim vehicle: _____________________ Commercial vehicles C5 (4) Taxi (2) Other offending vehicle: ______________ (5) Three-wheeler/ Cycle-Rickshaw/ Battery Rickshaw (6) Bus/ Minibus (7) Truck/ lorry/ Tractor Others (8) Pedestrian (9) None (10) DK/ CS (11) Others (specify): _______________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society C6 In which way victim was using vehicle/ road at (1) Driver/ Rider the time of crash. (2) Passenger/ Pillion (3) Pedestrian (4) Others: __________________ (1) Victim’s vehicle /vehicle in which victim was travelling Which vehicle was at fault at the time of the C7 (2) Other vehicle road crash? (3) DK/CS C8 Was the victim wearing helmet or seatbelt (1) Yes, wearing helmet [2 wheeler users] during the road crash? (2) Yes, wearing seatbelt [4 wheeler users] (3) Not wearing helmet/ seatbelt (4) Not applicable (1) Ambulance (2) Police vehicle (3) Private vehicle How was the victim transferred to the C9 (4) Public vehicle (auto/ taxi/ etc.) hospital? (5) Not transferred to hospital [GO TO C19] (6) DK/CS (7) Others (specify): _________________ C10 [IF RESPONSE IS 1] Approx. time from crash (1) Within 15 minutes ambulance took to arrive at crash location? (2) 16-30 mins (3) 31-45 mins (4) Beyond 45 mins (4) DK/CS (1) Govt. C11 Which hospital was the victim taken to? (2) Private (3) Others (specify): ____________ C12 Was the victim admitted to the hospital? (1) Yes (2) No (3) DK/CS [IF YES] How long did victim had to stay in C13 _______________________________days hospital? 202 APPENDIX 5: QUESTIONNAIRES (1) Immediately on reaching hospital (2) Within 10-30 mins On reaching hospital, how long it took before a C14 (3) 31-60 mins doctor/ nurse attended to the injury? (4) Beyond 60 mins (5) DK/ CS (1) Yes Did the victim face any discrimination or C15 (2) No prejudice by hospital officials/ staff? (3) DK/CS [IF YES], What kind of harassment/ prejudice did the victim/ attendant/ family face? [RECORD VERBATIM] ______________________________________________________________________________________________ ______________________________________________________________________________________________ POSTCODES (1) Victim was not attended immediately at hospital C16 (2) Asked to wait for police before attending victim (3) Made excuses and asked to take the victim to other hospital (4) Denied admission of victim to the hospital (5) Asked for money for treatment (6) Others (specify): ___________________________________ Among your acquaintances/ friends/ relatives, does anybody work as a medical/ (1) Yes C17 first aid staff at a medical facility or (2) No [GO TO C19] hospital? Were they of any help during the treatment of (1) Yes C18 the victim? (2) No (1) Yes C19 Was this road crash reported to the police? (2) No (3) DK/CS (1) Yes C20 Was a FIR filed after the road crash? (2) No (3) DK/CS (1) Yes [IF YES TO C20] Were the police officials C21 (2) No helpful/ cooperative during the process? (3) DK/CS Traffic Crash Injuries and Disabilities: The Burden on Indian Society [IF NO TO C20] What were the reasons for not filing FIR? [RECORD VERBATIM] ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ POSTCODES C22 (1) Was afraid of police harassment (2) Did not want to get into legal hassles (3) Fear of being asked to pay bribe (4) Did not feel need of filing FIR (5) Police official declined to file FIR (6) Others (specify): ___________________________________ Did you/ your family or offending vehicle (1) Yes user file any case under Motor Accident C23 (2) No [GO TO C27] Claims Tribunal (MACT) after the road crash? (3) DK/CS [GO TO NEXT SECTION D] (1) Yes, Mention how many times: _________ Did you/ your family members have to visit C24 (2) No court for hearings? (3) DK/CS (1) Yes C25 Did you spend any money on litigation? (2) No (3) DK/CS (1) Yes C26 Is the case still ongoing in the courts? (2) No [IF NO TO C23], what were the reasons for not filing case? [RECORD VERBATIM] ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ (1) Out of court settlement was done (2) Unable to hire/ afford lawyer/ fee (3) Did not want to get into legal hassles (4) Did not feel need of filing case (5) To avoid work/ study loss due to court hearings (6) Others (specify): ___________________________________ 204 APPENDIX 5: QUESTIONNAIRES SECTION D: ROAD CRASH VICTIM PROFILE S.N. Question Response ASK D1-D3 IF RESPONDENT IS OTHER THAN ROAD CRASH VICTIM (1) Male D1 Gender of the road crash victim (2) Female D2 Age of victim at the time of road crash Mention age: _____________ years. (1) Illiterate (2) Literate with no formal education (3) Did not complete primary education (4) Primary school (up to Class 5th) (5) Middle school (up to Class 8th) D3 Highest Education of victim at the time of road crash (6) Secondary school (up to Class 10th) (7) Senior secondary school (up to Class 12th) (8) Diploma (9) Graduate/college and above (10) Postgraduate/ University (11) Other (Specify): ____________________ (1) Married D4 Marital status of the victim at the time of road crash (2) Single (Unmarried/ separated/ divorced/ wid- owed) (1) Yes D5 Was the victim earning member of the household before road crash? (2) No [GO TO D7] Was the victim chief wage-earning member [the person who contrib- (1) Yes D6 uted maximum to the household monthly expenses] of the household (2) No before road crash? (1) Yes survived [GO TO D11] D7 Did the victim survive after road crash? (2) No, died due to road crash [GO TO D8] (1) Not earning (2) Up to Rs. 5,000 (3) Rs. 5,001 to Rs. 10,000 (4) Rs. 10,001 to Rs. 20,000 What was the monthly income of victim before road crash? [SHOW D8 (5) Rs. 20,001 to Rs. 30,000 CARD & MENTION CODE] (6) Rs. 30,001 to Rs. 50,000 (7) Rs. 50,001 to Rs. 75,000 (8) Rs. 75,001 to Rs. 1,00,000 (9) More than Rs. 1,00,000 Traffic Crash Injuries and Disabilities: The Burden on Indian Society What was the approx. monthly contribution of victim in household D9 _________________________% total income before road crash? What was the occupation of victim before road crash? [MENTION CODE] [POST CODES] (7) Petty trader/ shop owner (1) Unemployed (8) Skilled worker D10 (2) Housewife (9) Businessmen/ self-employed Pre-crash occupation: ________________ (3) Agricultural Laborer (10) Salaried employee (Pvt/ Govt) (4) Other Laborer (11) Retired (5) Farmer (12) Student (6) Unskilled worker (13) Other (Specify): _________ ASK IF ROAD Crash VICTIM SURVIVED, ELSE GO TO NEXT SECTION Pre-crash, post-crash & current monthly income of road crash victim [SHOW CARD & MENTION CODE] [POST CODES] (1) Pre crash: Rs. __________________/ month (1) Not earning (2) Up to Rs. 5,000 (2) On resuming work after crash: D11 (3) Rs. 5,001 to Rs. 10,000 Rs. ________________________/ month (4) Rs. 10,001 to Rs. 20,000 (5) Rs. 20,001 to Rs. 30,000 (3) Current (as on 31 Jan 2020): (6) Rs. 30,001 to Rs. 50,000 Rs. ______________________/ month (7) Rs. 50,001 to Rs. 75,000 (8) Rs. 75,001 to Rs. 1,00,000 (9) More than Rs. 1,00,000 (1) Pre crash: _______________________% What was the monthly contribution of victim in household total in- D12 (2) On resuming work after crash: ____________% come? (3) Current (as on 31 Jan 2020): ___________% (1) Pre crash: _________________________ Pre-crash, post-crash and current occupation of road crash victim. D13 (2) On resuming work after crash: ________ [TAKE CODES FROM D10] (3) Current (as on 31 Jan 2020): ___________ Did the road crash victim return to his previous occupation/ school on (1) Yes D14 resuming work after crash? (2) No [GO TO D16] After how many days road crash victim returned to his regular work/ D15 _________________ days school? 206 APPENDIX 5: QUESTIONNAIRES D16 IF NOT RETURNED TO PREVIOUS OCCUPATION, how many days did it (1) _________________ days take to find a new job from the day of crash? (2) NA (1) Yes, almost the same On resuming work after crash, did victim maintain the same salary/ D17 (2) No, lower than previous wage as it was before the crash? (3) NA D18 Whether the victim underwent any sort of disability? (1) Yes (2) No [GO TO D22] (3) DK/CS [GO TO D22] (1) Yes Whether the victim requires ongoing mobility assistance (e.g. D19 (2) No wheelchair, walking frame, etc.) (3) DK/CS D20 What was the severity of crash victim disability? (1) Serious disability (Traumatic Brain Injury, ampu- tation, quadriplegic, etc.) (2) Partial disability (some functional loss but still can-do regular work) [GO TO D22] (3) Temporary disability; recovered [GO TO D22] (1) Para/ Quadriplegia (2) Acquired Brain Injury (3) Amputation of a limb (e.g. hand/foot/arm/leg) D21 What type of serious disability did victim sustain? (4) Permanent Blindness (5) Severe burns (6) Others (specify): ______________________ D22 Majorly, who took care of the victim after the crash? (1) Male member of the family (2) Female member of the family (3) Self (4) Anyone else (specify) _________________ (1) Male member of the family (2) Female member of the family D23 Majorly, who bought all the medicines to the recovering victim? (3) Self (4) Anyone else (specify) _________________ D24 Majorly, who cooked all the meals in the household and took care of (1) Male member of the family the daily needs of the victim? (2) Female member of the family (3) Self (4) Anyone else (specify) _________________ (1) Male member of the family Who accompanied the victim to the hospital/ doctor most of the (2) Female member of the family D25 time? (3) None (4) Anyone else (specify) _________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society SECTION E: ROAD CRASH VICTIM PROFILE S.N. Question Response E1 Has any member of household suffered from depression (cue: feeling (1) Yes low/ sad without any reason) due to impact of the road crash? (2) No (3) DK/CS E2 Has any household member developed any health issues/ complica- (1) Yes tions due to the aforesaid road crash? (2) No (3) DK/CS (1) Yes [IF YES] Has suffering member of the household taken medical E3 (2) No (doctor) consultation in this regard? (3) DK/CS E4 Has there been any change in the sleep pattern of any member of (1) Yes, difficulty in sleeping household since the road crash? (2) Sometimes; difficulty in sleeping (3) No, sleep well (1) Yes Has there been any change in dietary habits/ food intake of any E5 (2) No family member post the road crash? (3) DK/CS SECTION F: FINANCIAL/ SOCIAL IMPACT FOR THE HOUSEHOLD F1 As a result of road crash, what were the key impacts on your household A Financial impact 1 Decline in total income of household (1) Yes (2) No (3) DK/CS 2 Out of pocket expenses increased due to medical treatment (1) Yes (2) No (3) DK/CS 3 Had to sell/ mortgage some family assets (e.g. property, jewelry, (1) Yes (2) No (3) DK/CS vehicle, etc.) 4 Had to borrow money (from anyone) (1) Yes (2) No (3) DK/CS 5 Had to relocate for treatment for more than 30 days (1) Yes (2) No (3) DK/CS 6 Any household member had to relocate permanently (1) Yes (2) No (3) DK/CS 208 APPENDIX 5: QUESTIONNAIRES B Occupational impact 7 Change in working pattern of household members (1) Yes (2) No (3) DK/CS 8 Someone in household had to take up additional jobs/shifts (1) Yes (2) No (3) DK/CS 9 Someone in household had to give up study (1) Yes (2) No (3) DK/CS C Social impact 10 Living standard has decreased (1) Yes (2) No (3) DK/CS 11 Victim had to be accompanied by someone (1) Yes (2) No (3) DK/CS 12 Food consumption has decreased (1) Yes (2) No (3) DK/CS If survived, how many months did victim take for recovery (fit for F2 ____________________ months work) after road crash? Impact of road crash consequences on household w.r.t? 1 Decline in household income (1) Severe (2) Moderate (3) None 2 Living standard has decreased (1) Severe (2) Moderate (3) None 3 Food consumption has decreased (1) Severe (2) Moderate (3) None 4 Emotional impact on household (1) Severe (2) Moderate (3) None SECTION G: INSURANCE & COMPENSATION W.R.T THE VICTIM S.N. Question Response (1) Yes Was the vehicle in/ on which victim was traveling insured (2) No G1 at the time of road crash? (3) DK/CS (4) Not Applicable G2 [IF YES] Which type of MOTOR VEHICLE insurance? (1) Third party insurance (Liability) (2) Comprehensive insurance (3) DK/ CS (4) Others (specify): _____________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Yes, insured Was the other vehicle (colliding vehicle) involved in the (2) No, uninsured G3 crash insured? (3) Hit and run case (4) DK/CS G4 Was the victim covered under MEDICAL INSURANCE at the (1) Yes time of road crash? (2) No (3) DK/CS G5 Was the victim covered under LIFE INSURANCE at the time (1) Yes of road crash? (2) No (3) DK/CS G6 Did you/ your household member claim insurance after the (1) Yes, Motor vehicle insurance road crash? [MULTIPLE RESPONSE POSSIBLE] (2) Yes, Medical insurance (3) Yes, Life insurance (4) None (5) DK/CS (1) Yes Were you/ victim aware of compensation clauses and G7 (2) No schemes in the event of a road crash? (3) DK/CS G8 Type of schemes availed/ got compensation under the following Authority Availed Received eligible/ promised Compensation compensation received in (after crash) Government/ local (1) Yes (1) Yes 1 _________ months authorities (ex-gratia) (2) No [GO TO G8.2] (2) No [GO TO G8.2] 2 Motor vehicle insurance (1) Yes (1) Yes _________ months (2) No [GO TO G8.3] (2) No [GO TO G8.3] (1) Yes (1) Yes 3 Medical insurance _________ months (2) No [GO TO G8.4] (2) No [GO TO G8.4] 4 Life insurance (1) Yes (1) Yes _________ months (2) No [GO TO G9] (2) No [GO TO G9] (1) Yes Did victim/ nominee claiming compensation had to attend (2) No G9 court? (3) Not Applicable (4) DK/CS G10 Did victim/ nominee face any hurdles/ difficulties in ac- (1) Yes cessing the compensation money? (2) No (3) Not Applicable (4) DK/CS 210 APPENDIX 5: QUESTIONNAIRES Loss of income/ expenditure due to road crash and recovery Particular Total loss of income/ expenditure Proportion of [Mention amount] amount recovered/ due to be recovered from insurances Loss of income during the period of treatment including victim and family members income (members that Rs. ________________ ____________% attending victim) Loss of property/ vehicle etc. due to road crash Rs. ________________ ____________% Out of pocket expenses on treatment of victim including Rs. ________________ ____________% hospitalization, medicine, and related expenses Legal/ administrative/ compensation expenses including Rs. ________________ ____________% police, lawyer, etc. Compensation cost to other vehicle/ person involved in Rs. ________________ ____________% crash Other expenses (specify): ______________________________ Rs. ________________ ____________% What did you do/ get to cope up with the financial burden due to road crash? Arranged a loan (lenders, bank, (1) Yes (2) No Amount borrowed: Rs. ___________________ relatives, etc.) Sold/ mortgage assets (land, jewelry, (1) Yes (2) No Amount received: Rs. _______________________ motor vehicle etc.) Took on extra work by household (1) Yes (2) No Monthly extra earning: Rs. ________________ members Compensation from insurance com- (1) Yes (2) No Total amount: Rs. ________________________ pany (including vehicle/ life insur- ance, etc.) Received compensation under schemes (govt., local authorities, (1) Yes (2) No Total amount: Rs. ________________________ funeral expenses, etc.) Received compensation from em- (1) Yes (2) No Total amount: Rs. ________________________ ployer Dependent was provided job by (1) Yes (2) No Monthly income: Rs. _____________________ employer/ govt. Received compensation from other (1) Yes (2) No Total amount: Rs. ________________________ party involved in road crash Traffic Crash Injuries and Disabilities: The Burden on Indian Society Others (specify): ________________ (1) Yes (2) No Total Amount: Rs. ________________________ Was any major financial investment (1) Yes (2) No Total investment: Rs. ____________________ made on victim within 1 year prior to crash that could not be recovered? [e.g. Education fees/ donation, busi- ness set-up, organ transplant, etc.] If road crash victim died due to road crash, how much G14 Total expense Rs. _______________________ expenses incurred on the funeral? (1) Yes [What percentage: _________%] G15 Did the insurance cover any of the funeral expenses? (2) No On resuming Current (as on 31 Please provide following details about household [where Before crash G16 work after crash Jan 2020) victim survived] (Rs.) (Rs.) (Rs.) Average total monthly HOUSEHOLD INCOME from all sources (Approx.) [Please include all the income/ receipts of 1 ____________ ____________ ____________ every member of household from all sources such as job, profession, wages, rent, pension, gratuity, etc.] 2 Average total monthly household expenses on all items ____________ ____________ ____________ (Approx.) 3 Total number of members in the household ____________ ____________ ____________ SECTION H: PERCEPTIONS OF RESPONDENT ON ROAD SAFETY S.N. Question Response (1) Severe (2) Major According to you what is the level of impact of road crashes on the H1 (3) Moderate society? (4) Minor (5) Insignificant H2 Do you feel safe while commuting on the roads? (1) Always (2) Mostly (3) Sometimes (4) Rarely (5) Never 212 APPENDIX 5: QUESTIONNAIRES (1) Excellent (2) Very Good H3 How would you rate road safety in your neighborhood/ city? (3) Good (4) Average (5) Poor H4 Do you drive any motorized vehicle? [MULTIPLE RESPONSE POSSI- (1) M2W - Motorcycle/ Scooter/ Scooty BLE] (2) Car (3) Taxi (4) Three-wheeler/ Cycle/ Battery Rickshaw (5) Truck/ lorry/ Tractor (6) None (7) Others: _________________________ H5 [IF RESPONSE IS 1-5 TO H4], Do you feel safe driving in your neigh- (1) Always borhood/city? (2) Mostly (3) Sometimes (4) Rarely (5) Never [“THANK YOU” FOR YOUR TIME AND PATIENCE / KINDLY RE-CHECK IF ANY QUESTION IS LEFT BLANK] FIELD CONTROL INFORMATION INVESTIGATOR NAME DATE SIGNATURE SUPERVISOR NAME DATE SIGNATURE VERIFICATION BY: (NAMES & SIGNATURES) TL FE FM RE ACCOMPANIED SPOT/ BACK CHECKED SCRUTINIZED Traffic Crash Injuries and Disabilities: The Burden on Indian Society [SELECTION CRITERIA FOR TEST SAMPLE & BPL STATUS] Use the following table to check the eligibility of respondent for the survey based on - Monthly Household Income (MHI) - Number of adult members in household. Consider the highest value of the range of the coded response of A11 and number of adult members as per A10.1 to check eligibility. If the total MHI is below the eligibility range, provide response in A12 and proceed. Total number of adult Monthly Household Income A13. BPL household having MHI below members in household 1 Up to Rs.13,500 Up to Rs.2,163 2 Up to Rs.27,000 Up to Rs.4,326 3 Up to Rs.40,500 Up to Rs.6,489 4 Up to Rs.54,000 Up to Rs.8,652 5 Up to Rs.67,500 Up to Rs.10,815 6 Up to Rs.81,000 Up to Rs.12,978 7 Up to Rs.94,500 Up to Rs.15,141 8 Up to Rs.1,08,000 Up to Rs.17,304 9 Up to Rs.1,21,500 Up to Rs.19,467 10 Up to Rs.1,35,000 Up to Rs.21,630 214 APPENDIX 5: QUESTIONNAIRES QUESTIONNAIRE – CONTROL SAMPLE (T-10) City of Interview Serial No Place of Interview PREAMBLE and it is up to you to decide whether to participate. The interview will take about 25-30 minutes. You can decide not Good ……….....……: I am from MDRA (Marketing & Development to answer any question and can stop the interview at any Research Associates), a leading market and social research time. Everything that you report during the interview will be agency in India. We are currently conducting a survey to assess kept strictly confidential. Your responses would be combined the impact of road deaths on victims in terms of poverty and with responses given by other respondents and would not be social status for SaveLIFE Foundation (SLF) in collaboration identified separately. with the World Bank. [Please note that no payment/ money/ fee to be paid to anyone I want to ask for your permission to include you in our study in any manner for participating in this survey] SECTION A: QUALIFYING CRITERIA S.N. Question Response Has anyone in your household died or (1) Yes, death due to a road crash suffered serious injury from a road crash in the last 15 years? (2) Yes, serious injuries A1 (3) Yes, minor injuries [TERMINATE] [Serious/ severe injuries mean cases where (4) No [TERMINATE] victims attended hospital for treatment] A2 How many members of your household were (1) 1 member involved in that road crash? (2) More than 1 member [In case of more than 1 member, victim that contributed the most to the monthly household expenses before crash would be selected/ information about such victim would be asked. In case where victims contributed equally or not contributed at all, take details about the oldest victim at the time of crash.] Traffic Crash Injuries and Disabilities: The Burden on Indian Society Did road crash victim (as selected in A2) (1) Yes involve in more than 1 crash in last 15 A3 (2) No years where serious/ severe injuries were sustained. [If Yes, information about the latest crash would be taken] A4 What was the impact of the road crash on the (1) Died at the scene victim? (2) Died while being transported to hospital (3) Taken to hospital & discharged within 24 hrs. (4) Had to be admitted in the hospital for more than 1 day (5) Died in hospital within 30 days from the crash (6) Died after 30 days from the crash (1) Before Jan 2005 [TERMINATE] A5 When did the road crash happen? (2) Between Jan 2005 - July 2019 [CONTINUE] (3) After July 2019 [TERMINATE] A6 Crash victim’s relation with respondent (1) Self [GO TO A8] (2) Parent/ Grand parent (3) Son/ Daughter (4) Uncle/ Aunt (5) Nephew/ Niece (6) Spouse (7) Sibling (8) Father/ Mother-in-law (9) Brother/ Sister-in-law (10) Son/ Daughter-in law (11) Others (specify): _____________________ Did you use to live with the victim when the (1) Yes [CONTINUE] A7 road crash happened? (2) No [TERMINATE] A8 How do you term yourself in your household? (1) Head of the Household [HoH is the person (either male or female) that takes key decision in [A group of people staying together under the the household] same roof and sharing food from a common (2) Chief Wage Earner kitchen is called a Household. Persons living in [Chief wage earner is the person (either male or female) who contrib- hostels or messes and taking food from a com- utes the most to the household expenses] mon kitchen do not constitute a household.] (3) Other most affected member of the household [Member of the household that was most impacted due to crash after HoH and CWE] What was your age when the road crash (1) Less than 14 yrs. [TERMINATE] A9 happened? (2) More than 14 yrs. [CONTINUE] 216 APPENDIX 5: QUESTIONNAIRES Please provide following information about A10 your household members (as on 31 Jan Number 2020). Number of adult members above 18 yrs. of 1 age 2 Number of members below 18 yrs. of age 3 Total household members A11 Income: Please look at this card and tell me (1) Less than Rs.50 thousand [TERMINATE] which income group best indicates Total (2) Rs.50 thousand to Rs.1 Lakh Monthly Household Income. [SHOW CARD] (as (3) Rs.1 Lakh to Rs.2 Lakh on 31 Jan 2020). (4) Rs.2 Lakh to Rs.4 Lakh [Please include all the income/ receipts of every member of the household from all sources such (5) Rs.4 Lakh to Rs.6 Lakh as job, profession, wages, rent, pension, gratuity, (6) Rs.6 Lakh to Rs.10 Lakh etc.] (7) Rs.10 Lakh to Rs.15 Lakh (8) More than Rs.15 Lakh Based on the table provided in the annexure, is respondent eligible for the survey? (1) Yes [CONTINUE] A12 [Use the table provided at the end to check (2) No [TERMINATE] the eligibility of the respondent for the survey] SECTION B: RESPONDENT PROFILE S.N. Question Response B1 Respondent Name B2 Phone Number B3 Address B4 City B5 State (1) Bihar (2) Maharashtra (3) Tamil Nadu (4) Uttar Pradesh Traffic Crash Injuries and Disabilities: The Burden on Indian Society B6 Location of habitation (1) Urban (2) Rural B7 Gender (1) Male (2) Female B8 What was your age on last birthday? Mention age: _____________ years. B9 Highest Education of Respondent (1) Illiterate (2) Literate with no formal education (3) Did not complete primary education (4) Primary school (up to Class 5th) (5) Middle school (up to Class 8th) (6) Secondary school (up to Class 10th) (7) Senior secondary school (up to Class 12th) (8) Diploma (9) Graduate/college and above (10) Postgraduate/ University (11) Other (Specify): ____________________ B10 Occupation of respondent (1) Unemployed (2) Housewife (3) Farmer (4) Businessmen/ trader/ self-employed (5) Salaried employee (Pvt/ Govt) (6) Retired (7) Other (Specify): ________________ SECTION C: ROAD CRASH DETAILS S.N. Question Response When did road crash happen? (Mention date, C1 ___________________ [DD/MM/YYYY] month and year) C2 Where did the road crash happen? City/ location Name: _________________ Type of city/ location where road crash (1) Within the city of victim residence C3 happened (2) Other city 218 APPENDIX 5: QUESTIONNAIRES C4 Type of road on which crash happened (1) Expressway (2) National Highway (3) State Highway (4) City/ District/ Municipality roads (5) Village road (6) Other (specify): _____________________ Type of vehicles involved in the road crash [MENTION CODE] [POST CODES] Personal vehicles (1) M2W - Motorcycle/ Scooter/ Scooty (2) Car (3) Bicycle (1) Victim vehicle: _____________________ Commercial vehicles C5 (4) Taxi (2) Other offending vehicle: ______________ (5) Three-wheeler/ Cycle-Rickshaw/ Battery Rickshaw (6) Bus/ Minibus (7) Truck/ lorry/ Tractor Others (8) Pedestrian (9) None (10) DK/ CS (11) Others (specify): _______________________ C6 In which way victim was using vehicle/ road at (1) Driver/ Rider the time of crash. (2) Passenger/ Pillion (3) Pedestrian (4) Others: __________________ (1) Victim’s vehicle /vehicle in which victim was travelling Which vehicle was at fault at the time of the C7 (2) Other vehicle road crash? (3) DK/CS C8 Was the victim wearing helmet or seatbelt during (1) Yes, wearing helmet [2 wheeler users] the road crash? (2) Yes, wearing seatbelt [4 wheeler users] (3) Not wearing helmet/ seatbelt (4) Not applicable Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Ambulance (2) Police vehicle (3) Private vehicle C9 How was the victim transferred to the hospital? (4) Public vehicle (auto/ taxi/ etc.) (5) Not transferred to hospital [GO TO C19] (6) DK/CS (7) Others (specify): _________________ (1) Within 15 minutes (2) 16-30 mins [IF RESPONSE IS 1] Approx. time from crash C10 (3) 31-45 mins ambulance took to arrive at crash location? (4) Beyond 45 mins (4) DK/CS (1) Govt. C11 Which hospital was the victim taken to? (2) Private (3) Others (specify): ____________ (1) Yes C12 Was the victim admitted to the hospital? (2) No (3) DK/CS [IF YES] How long did victim had to stay in C13 ____________________ days hospital? (1) Immediately on reaching hospital (2) Within 10-30 mins On reaching hospital, how long it took before a C14 (3) 31-60 mins doctor/ nurse attended to the injury? (4) Beyond 60 mins (5) DK/ CS (1) Yes Did the victim face any discrimination or C15 (2) No prejudice by hospital officials/ staff? (3) DK/CS 220 APPENDIX 5: QUESTIONNAIRES C16 [IF YES], What kind of harassment/ prejudice did the victim/ attendant/ family face? [RECORD VERBATIM] _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ POSTCODES (1) Victim was not attended immediately at hospital (2) Asked to wait for police before attending victim (3) Made excuses and asked to take the victim to other hospital (4) Denied admission of victim to the hospital (5) Asked for money for treatment (6) Others (specify): ___________________________________ Among your acquaintances/ friends/ relatives, (1) Yes C17 does anybody work as a medical/ first aid staff (2) No [GO TO C19] at a medical facility or hospital? C18 Were they of any help during the treatment of the (1) Yes victim? (2) No (1) Yes C19 Was this road crash reported to the police? (2) No (3) DK/CS C20 Was a FIR filed after the road crash? (1) Yes (2) No (3) DK/CS (1) Yes [IF YES TO C20] Were the police officials C21 (2) No helpful/ cooperative during the process? (3) DK/CS C22 [IF NO TO C20] What were the reasons for not filing FIR? [RECORD VERBATIM] _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ POSTCODES (1) Was afraid of police harassment (2) Did not want to get into legal hassles (3) Fear of being asked to pay bribe (4) Did not feel need of filing FIR (5) Police official declined to file FIR (6) Others (specify): ___________________________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society Did you/ your family or offending vehicle user (1) Yes C23 file any case under Motor Accident Claims (2) No [GO TO C27] Tribunal (MCAT) after the road crash? (3) DK/CS [GO TO NEXT SECTION D] (1) Yes, Mention how many times: _________ Did you/ your family members have to visit court C24 (2) No for hearings? (3) DK/CS (1) Yes C25 Did you spend any money on litigation? (2) No (3) DK/CS (1) Yes C26 Is the case still ongoing in the courts? (2) No [IF NO TO C23], what were the reasons for not filing case? [RECORD VERBATIM] _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ (1) Out of court settlement was done (2) Unable to hire/ afford lawyer/ fee (3) Did not want to get into legal hassles (4) Did not feel need of filing case (5) To avoid work/ study loss due to court hearings (6) Others (specify): ___________________________________ SECTION D: ROAD CRASH VICTIM PROFILE S.N. Question Response ASK D1-D3 IF RESPONDENT IS OTHER THAN ROAD CRASH VICTIM (1) Male D1 Gender of the road crash victim (2) Female D2 Age of victim at the time of road crash Mention age: _____________ years. 222 APPENDIX 5: QUESTIONNAIRES (1) Illiterate (2) Literate with no formal education (3) Did not complete primary education (4) Primary school (up to Class 5th) (5) Middle school (up to Class 8th) Highest Education of victim at the time of road (6) Secondary school (up to Class 10th) D3 crash (7) Senior secondary school (up to Class 12th) (8) Diploma (9) Graduate/college and above (10) Postgraduate/ University (11) Other (Specify): ____________________ (1) Married Marital status of the victim at the time of road D4 (2) Single (Unmarried/ separated/ divorced/ widowed) crash Was the victim earning member of the (1) Yes D5 household before road crash? (2) No [GO TO D7] Was the victim chief wage-earning member (1) Yes [the person who contributed maximum to the (2) No D6 household monthly expenses] of the household before road crash? (1) Yes survived [GO TO D11] D7 Did the victim survive after road crash? (2) No, died due to road crash [GO TO D8] (1) Not earning (2) Up to Rs.50,000 (3) Rs.50,000 to Rs.1 Lakh (4) Rs.1 Lakh to Rs.2 Lakh What was the monthly income of victim before D8 (5) Rs.2 Lakh to Rs.4 Lakh road crash? [SHOW CARD & MENTION CODE] (6) Rs.4 Lakh to Rs.6 Lakh (7) Rs.6 Lakh to Rs.10 Lakh (8) Rs.10 Lakh to Rs.15 Lakh (9) More than Rs.15 Lakh What was the approx. monthly contribution of D9 victim in household total income before road _________________________% crash? Traffic Crash Injuries and Disabilities: The Burden on Indian Society What was the occupation of victim before road crash? [MENTION CODE] [POST CODES] (1) Unemployed (2) Housewife D10 (3) Farmer Pre-crash occupation: ________________ (4) Businessmen/ trader/ self-employed (5) Salaried employee (Pvt/ Govt) (6) Retired (7) Student (8) Other (Specify): ________________ ASK IF ROAD Crash VICTIM SURVIVED, ELSE GO TO NEXT SECTION Pre-crash, post-crash & current monthly income of road crash victim [SHOW CARD & MENTION CODE] [POST CODES] (1) Pre crash: Rs. __________________/ month (1) Not earning (2) Up to Rs.50,000 D11 (2) On resuming work after crash: Rs. ______/ month (3) Rs.50,000 to Rs.1 Lakh (4) Rs.1 Lakh to Rs.2 Lakh (3) Current (as on 31 Jan 2020): Rs. _____/ month (5) Rs.2 Lakh to Rs.4 Lakh (6) Rs.4 Lakh to Rs.6 Lakh (7) Rs.6 Lakh to Rs.10 Lakh (8) Rs.10 Lakh to Rs.15 Lakh (9) More than Rs.15 Lakh (1) Pre crash: _______________________% What was the monthly contribution of victim in D12 (2) On resuming work after crash: _______% household total income? (3) Current (as on 31 Jan 2020): ___________% (1) Pre crash: _________________________ Pre-crash, post-crash and current occupation D13 (2) On resuming work after crash: ________ of road crash victim. [TAKE CODES FROM D10] (3) Current (as on 31 Jan 2020): ___________ 224 APPENDIX 5: QUESTIONNAIRES Did the road crash victim return to his previous (1) Yes D14 occupation/ school on resuming work after crash? (2) No [GO TO D16] After how many days road crash victim returned D15 _________________ days to his regular work/ school? IF NOT RETURNED TO PREVIOUS OCCUPATION, (1) _________________ days D16 how many days did it take to find a new job from (2) NA the day of crash? (1) Yes, almost the same On resuming work after crash, did victim maintain D17 (2) No, lower than previous the same salary/ wage as it was before the crash? (3) NA (1) Yes Whether the victim underwent any sort of disabil- D18 (2) No [GO TO D22] ity? (3) DK/CS [GO TO D22] (1) Yes Whether the victim requires ongoing mobility D19 (2) No assistance (e.g. wheelchair, walking frame, etc.) (3) DK/CS (1) Serious disability (Traumatic Brain Injury, amputation, quadriple- gic, etc.) D20 What was the severity of crash victim disability? (2) Partial disability (some functional loss but still can-do regular work) [GO TO D22] (3) Temporary disability; recovered [GO TO D22] (1) Para/ Quadriplegia (2) Acquired Brain Injury (3) Amputation of a limb (e.g. hand/foot/arm/leg) D21 What type of serious disability did victim sustain? (4) Permanent Blindness (5) Severe burns (6) Others (specify): ______________________ (1) Male member of the family Majorly, who took care of the victim after the (2) Female member of the family D22 crash? (3) Self (4) Anyone else (specify) _________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Male member of the family Majorly, who bought all the medicines and (2) Female member of the family D23 administered medicines to the recovering (3) Self victim? (4) Anyone else (specify) _________________ (1) Male member of the family Majorly, who cooked all the meals in the (2) Female member of the family D24 household and took care of the daily needs of (3) Self the victim? (4) Anyone else (specify) _________________ (1) Male member of the family Who accompanied the victim to the hospital/ (2) Female member of the family D25 doctor most of the time? (3) None (4) Anyone else (specify) _________________ SECTION E: PSYCHOLOGICAL/ EMOTIONAL IMPACT ON HOUSEHOLD S.N. Question Response (1) Yes Has any member of household suffered from E1 depression (cue: feeling low/ sad without any (2) No reason) due to impact of the road crash? (3) DK/CS (1) Yes Has any household member developed any E2 health issues/ complications due to the (2) No aforesaid road crash? (3) DK/CS (1) Yes [IF YES] Has suffering member of the household E3 taken medical (doctor) consultation in this (2) No regard? (3) DK/CS (1) Yes, difficulty in sleeping Has there been any change in the sleep pattern E4 of any member of household since the road (2) Sometimes; difficulty in sleeping crash? (3) No, sleep well (1) Yes Has there been any change in dietary habits/ E5 food intake of any family member post the road (2) No crash? (3) DK/CS 226 APPENDIX 5: QUESTIONNAIRES SECTION F: FINANCIAL/ SOCIAL IMPACT FOR THE HOUSEHOLD F1 As a result of road crash, what were the key impacts on your household A Financial impact 1 Decline in total income of household (1) Yes (2) No (3) DK/CS Out of pocket expenses increased due to medical 2 (1) Yes (2) No (3) DK/CS treatment Had to sell/ mortgage some family assets (e.g. 3 (1) Yes (2) No (3) DK/CS property, jewelry, vehicle, etc.) 4 Had to borrow money (from anyone) (1) Yes (2) No (3) DK/CS 5 Had to relocate for treatment for more than 30 days (1) Yes (2) No (3) DK/CS Any household member had to relocate 6 (1) Yes (2) No (3) DK/CS permanently B Occupational impact 7 Change in working pattern of household members (1) Yes (2) No (3) DK/CS Someone in household had to take up additional 8 (1) Yes (2) No (3) DK/CS jobs/shifts 9 Someone in household had to give up study (1) Yes (2) No (3) DK/CS C Social impact 10 Living standard has decreased (1) Yes (2) No (3) DK/CS 11 Victim had to be accompanied by someone (1) Yes (2) No (3) DK/CS 12 Food consumption has decreased (1) Yes (2) No (3) DK/CS If survived, how many months did victim take for F2 ____________________ months recovery (fit for work) after road crash? Traffic Crash Injuries and Disabilities: The Burden on Indian Society Impact of road crash consequences on household w.r.t? 1 Decline in household income (1) Severe (2) Moderate (3) None 2 Living standard has decreased (1) Severe (2) Moderate (3) None 3 Food consumption has decreased (1) Severe (2) Moderate (3) None 4 Emotional impact on household (1) Severe (2) Moderate (3) None SECTION G: INSURANCE & COMPENSATION W.R.T THE VICTIM S.N. Question Response (1) Yes Was the vehicle in/ on which victim was traveling (2) No G1 insured at the time of road crash? (3) DK/CS (4) Not Applicable (1) Third party insurance (Liability) (2) Comprehensive insurance G2 [IF YES] Which type of MOTOR VEHICLE insurance? (3) DK/ CS (4) Others (specify): _____________________ (1) Yes, insured Was the other vehicle (colliding vehicle) involved in the (2) No, uninsured G3 crash insured? (3) Hit and run case (4) DK/CS (1) Yes Was the victim covered under MEDICAL INSURANCE at G4 (2) No the time of road crash? (3) DK/CS (1) Yes Was the victim covered under LIFE INSURANCE at the G5 (2) No time of road crash? (3) DK/CS 228 APPENDIX 5: QUESTIONNAIRES (1) Yes, Motor vehicle insurance (2) Yes, Medical insurance Did you/ your household member claim insurance after G6 (3) Yes, Life insurance the road crash? [MULTIPLE RESPONSE POSSIBLE] (4) None (5) DK/CS (1) Yes Were you/ victim aware of compensation clauses and G7 (2) No schemes in the event of a road crash? (3) DK/CS G8 Type of schemes availed/ got compensation under the following Compensation Received eligible/ promised Authority Availed received in (after compensation crash) Government/ local authorities (1) Yes (1) Yes 1 _________ months (ex-gratia) (2) No [GO TO G8.2] (2) No [GO TO G8.2] (1) Yes (1) Yes 2 Motor vehicle insurance _________ months (2) No [GO TO G8.3] (2) No [GO TO G8.3] (1) Yes (1) Yes 3 Medical insurance _________ months (2) No [GO TO G8.4] (2) No [GO TO G8.4] (1) Yes (1) Yes 4 Life insurance _________ months (2) No [GO TO G9] (2) No [GO TO G9] (1) Yes Did victim/ nominee claiming compensation had to attend (2) No G9 court? (3) Not Applicable (4) DK/CS (1) Yes Did victim/ nominee face any hurdles/ difficulties in (2) No G10 accessing the compensation money? (3) Not Applicable (4) DK/CS G11 Loss of income/ expenditure due to road crash and recovery Traffic Crash Injuries and Disabilities: The Burden on Indian Society Proportion of amount Total loss of income/ expenditure recovered/ due to S.N. Particular [Mention amount] be recovered from insurances Loss of income during the period of treatment including 1 victim and family members income (members that Rs. ________________ ____________% attending victim) 2 Loss of property/ vehicle etc. due to road crash Rs. ________________ ____________% Out of pocket expenses on treatment of victim including 3 Rs. ________________ ____________% hospitalization, medicine, and related expenses Legal/ administrative/ compensation expenses including 4 Rs. ________________ ____________% police, lawyer, etc. Compensation cost to other vehicle/ person involved in 5 Rs. ________________ ____________% crash 6 Other expenses (specify): ______________________________ Rs. ________________ ____________% G12 What did you do/ get to cope up with the financial burden due to road crash? Arranged a loan (lenders, bank, (1) Yes 1 Amount borrowed: Rs. ___________________ relatives, etc.) (2) No Sold/ mortgage assets (land, (1) Yes 2 Amount received: Rs. _______________________ jewelry, motor vehicle etc.) (2) No Took on extra work by household (1) Yes 3 Monthly extra earning: Rs. ________________ members (2) No Compensation from insurance (1) Yes 4 company (including vehicle/ life Total amount: Rs. ________________________ (2) No insurance, etc.) Received compensation under (1) Yes 5 schemes (govt., local authorities, Total amount: Rs. ________________________ (2) No funeral expenses, etc.) 6 Received compensation from (1) Yes Total amount: Rs. ________________________ employer (2) No Dependent was provided job by (1) Yes 7 Monthly income: Rs. _____________________ employer/ govt. (2) No Received compensation from other (1) Yes 8 Total amount: Rs. ________________________ party involved in road crash (2) No 230 APPENDIX 5: QUESTIONNAIRES (1) Yes 9 Others (specify): ________________ Total Amount: Rs. ________________________ (2) No Was any major financial investment made on victim within 1 year prior to crash that could not be (1) Yes G13 Total investment: Rs. ____________________ recovered? [e.g. Education fees/ (2) No donation, business set-up, organ transplant, etc.] If road crash victim died due to road crash, how much G14 Total expense Rs. _______________________ expenses incurred on the funeral? (1) Yes [What percentage: ___________________%] G15 Did the insurance cover any of the funeral expenses? (2) No Current (as on 31 Please provide following details about household [where Before crash On resuming work G16 Jan 2020) victim survived] (Rs.) after crash (Rs.) (Rs.) Average total monthly HOUSEHOLD INCOME from all sources (Approx.) [Please include all the income/ receipts 1 ____________ ____________ ____________ of every member of household from all sources such as job, profession, wages, rent, pension, gratuity, etc.] Average total monthly household expenses on all items 2 ____________ ____________ ____________ (Approx.) 3 Total number of members in the household ____________ ____________ ____________ SECTION H: PERCEPTIONS OF RESPONDENT ON ROAD SAFETY S.N. Question Response (1) Severe (2) Major According to you what is the level of impact of road H1 (3) Moderate crashes on the society? (4) Minor (5) Insignificant (1) Always (2) Mostly H2 Do you feel safe while commuting on the roads? (3) Sometimes (4) Rarely (5) Never Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Excellent (2) Very Good How would you rate road safety in your neighborhood/ H3 (3) Good city? (4) Average (5) Poor (1) M2W - Motorcycle/ Scooter/ Scooty (2) Car (3) Taxi Do you drive any motorized vehicle? [MULTIPLE H4 (4) Three-wheeler/ Cycle/ Battery Rickshaw RESPONSE POSSIBLE] (5) Truck/ lorry/ Tractor (6) None (7) Others: _________________________ (1) Always (2) Mostly [IF RESPONSE IS 1-5 TO H4], Do you feel safe driving in H5 (3) Sometimes your neighborhood/city? (4) Rarely (5) Never [“THANK YOU” FOR YOUR TIME AND PATIENCE / KINDLY RE-CHECK IF ANY QUESTION IS LEFT BLANK] FIELD CONTROL INFORMATION INVESTIGATOR NAME DATE SIGNATURE SUPERVISOR NAME DATE SIGNATURE VERIFICATION BY: (NAMES & SIGNATURES) TL FE FM RE ACCOMPANIED SPOT/ BACK CHECKED SCRUTINIZED NOTE: NO QUESTIONNAIRE WILL BE ACCEPTED WITHOUT COMPLETE FIELD CONTROL INFORMATION AND/ OR UNSIGNED AS AND WHERE APPLICABLE. 232 APPENDIX 5: QUESTIONNAIRES [SELECTION CRITERIA FOR TEST SAMPLE] Use the following table to check the eligibility of respondent for the survey based on - Monthly Household Income (MHI) - Number of adult members in household. Consider the highest value of the range of the coded response of A11 and number of adult members as per A10.1 to check eligibility. If the total MHI is above the eligibility range, provide response in A12 and proceed. Total number of adult members in household Monthly Household Income 1 More than 50,000 2 More than 1 Lakh 3 More than 1.5 Lakh 4 More than 2 Lakh 5 More than 2.5 Lakh 6 More than 3 Lakh 7 More than 3.5 Lakh 8 More than 4 Lakh 9 More than 4.5 Lakh 10 More than 5 Lakh Traffic Crash Injuries and Disabilities: The Burden on Indian Society QUESTIONNAIRE FOR TRUCK DRIVERS City of Interview Serial No Place of Interview PREAMBLE and it is up to you to decide whether to participate. The interview will take about 10-15 minutes. You can decide not Good ……………: I am from MDRA (Marketing & Development to answer any question and can stop the interview at any Research Associates), a leading market research agency in time. Everything that you report during the interview will be India. We are currently conducting a survey to understand kept strictly confidential. Your responses would be combined the awareness of Truck Drivers about compensation (in the with responses given by other respondents and would not be event of crash) and related provisions of the Motor Vehicle identified separately. Amendment Act, 2019 for SaveLIFE Foundation (SLF) in collaboration with the World Bank. [Please note that no payment/ money/ fee to be paid to anyone in any manner for participating in this survey] I want to ask for your permission to include you in our study SECTION A: RESPONDENT PROFILE S.N. Question Response A1 Respondent Name A2 Phone Number What was your age on last birthday? A3 ________________ years [READ OUT AND RECORD] (1) Illiterate (2) Literate with no formal education (3) Did not complete primary education (4) Primary school (up to Class 5th) (5) Middle school (up to Class 8th) A4 Highest Education of Respondent (6) Secondary school (up to Class 10th) (7) Senior secondary school (up to Class 12th) (8) Diploma (9) Graduate/college and above (10) Postgraduate/ University (11) Other (Specify): __________________ 234 APPENDIX 5: QUESTIONNAIRES (1) Up to Rs. 5,000 (2) Rs. 5,001 to Rs. 10,000 Please look AT THIS CARD and tell me which (3) Rs. 10,001 to Rs. 20,000 income group best indicates your monthly (4) Rs. 20,001 to Rs. 30,000 A5 income from truck driving profession? (5) Rs. 30,001 to Rs. 50,000 (6) Rs. 50,001 to Rs. 75,000 [SHOW CARD] (7) Rs. 75,001 to Rs. 1,00,000 (8) More than Rs. 1,00,000 (1) Less than 2 yrs. (2) 2-5 yrs. Since how long you have been in the truck A6 (3) 6-10 yrs. driving profession? (4) 11-15 yrs. (5) More than 15 yrs. (1) Private A7 Which sector do you work in? (2) Government (3) Others ______________________ (1) Self-owned A8 Who owns the truck you drive? (2) Owned by fleet owner/ company ___________________________ A9 Base City (from where you operate trucks) On an average, how many hours do you drive A10 ___________________________ hours in a typical day (out of 24 hrs.)? On an average, how many days do you work A11 ___________________________ days in a month? A12 What type of truck (category of truck) do you (1) Medium Motor Vehicle (B/w 7.5-12 tons) drive generally? [Mention category of truck (2) Heavy Motor Vehicle (Exceed 12 tons) based on Gross Vehicle Weight] (3) Trailer (1) Monthly Salary On what basis are monetary benefits provided (2) Number of Driving Hours A13 to you by the truck company or owner? (3) Trip wise (4) Other (specify): __________________ Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Settled by the driver from his salary In case of enforcement violations, who pays (2) Owner /Company pays for it A14 for the penalties? (3) Shared by both driver and owner (4) Other (specify): __________________ SECTION B: AWARENESS ABOUT MVAA & ROAD SAFETY RELATED ASPECTS S.N. Question Response I would like to ask you regarding a few aspects of motor vehicle and workers Somewhat B1 Fully Aware Not Aware act. Before this survey began were you aware of following: Aware AWARENESS OF MOTOR THIRD PARTY LIABILITY INSURANCE: Motor Third Party Liability insurance covers your liability for injuries (and property damage to a limited extent) to a others caused in an crash that is your fault. Additional coverage to include loss or damage to your own vehicle can be purchased as an add-on to Third Party Liability insurance, and is commonly called Comprehensive insurance  The purchase of Motor Third party liability insurance is compulsory and you 1 3 2 1 may be fined by the Police if vehicle in uninsured If the vehicle you are driving is UNINSURED, you (or the owner) may be 2 personally liable to pay for injuries caused to others if you are at fault for the 3 2 1 crash Motor Third Party liability insurance provides compensation to other people 3 3 2 1 for their injuries if the crash is your fault Motor Third Party liability insurance does not provide compensation for 4 3 2 1 injuries you incur if the crash is your fault If someone else is a fault for an crash and you incur injuries, you may be able 5 3 2 1 to claim compensation from the insurer the vehicle is insured with The compensation you are eligible to receive may be reduced if you 6 3 2 1 breach a traffic law Along with driver, truck attendant (khalasi) is also covered for benefits under 7 3 2 1 third party insurance under MVAA, 2019 236 APPENDIX 5: QUESTIONNAIRES The time limitation for filing of cases for compensation for injuries before the 8 3 2 1 Claims Tribunal is 6 months from the date of the crash 9 In case of road crash, insurance company is liable to designate an officer to 3 2 1 help you with the process of settlement of your claim b AWARENESS ABOUT THE CHANGES UNDER MVAA CHANGES The motor vehicle act has been amended in 2019 and came into force from 10 3 2 1 1st September 2019 11 The fines for traffic violations have been increased 3 2 1 If the application for driving license renewal is made after 3 years from the 12 3 2 1 date of expiry of license, then the licensing authority may refuse to renew Provision for protection of Good Samaritans from unnecessary trouble or 13 3 2 1 harassment from civil or criminal proceedings The provision for cashless emergency medical treatment of crash victim 14 3 2 1 injuries during the “golden hour” The increased compensation for hit and run cases is INR 2 lakhs for death 15 3 2 1 and INR 50,000 for grievous hurt under MVAA, 2019? Lumpsum compensation available for death and grievous injury, without the 16 need to prove fault of another party (this is an alternate to proceeding with an 3 2 1 injury claim against a third party or their insurer) (1) Yes, definitely Do you think with MVAA 2019 amendments would help in implementation of B2 (2) Yes, to some extent compliance w.r.t REGISTRATION of vehicle? (3) Not at all (1) Yes, definitely Do you think with MVAA 2019 amendments would help in implementation of B3 (2) Yes, to some extent compliance w.r.t LICENSING? (3) Not at all (1) Yes, definitely Do you think with MVAA 2019 amendments would help in implementation of B4 (2) Yes, to some extent compliance w.r.t INSURANCE REQUIREMENTS? (3) Not at all (1) Yes, definitely Do you think MVAA 2019 would improve safe driving behaviour among truck B5 (2) Yes, to some extent drivers? (3) Not at all (1) Yes Do you support the increased fines for traffic violations like drunk driving, B6 (2) No over speeding, distracted driving, non-usage of seat belts etc.? (3) DK/CS Traffic Crash Injuries and Disabilities: The Burden on Indian Society B7 Do you feel safe driving on the roads? (1) Always (2) Sometimes (3) Never [IF RESPONSE IS 2, 3] What are the reasons for feeling unsafe on the roads? [RECORD VERBATIM] _______________________________________________________________________________________________________________________ B8 _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ (1) Yes B9 Are you aware of third-party insurance cover? (2) No [GO TO NEXT SECTION] (3) DK/CS [GO TO NEXT SECTION] [IF YES], what is your understanding of third-party insurance? Explain. [RECORD VERBATIM] _______________________________________________________________________________________________________________________ B10 ______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ (1) Death According to you, what all does third-party insurance cover? (2) Injury/ Disability B11 (3) Property Damage [MULTIPLE RESPONSE POSSSIBLE] (4) All of above (5) Other (specify): ___________ SECTION C: INSURANCE COVERAGE AND COMPENSATION S.N. Question Response (1) Yes C1 Is your vehicle insured under motor vehicle insurance? (2) No [GO TO C3] Type of vehicle insurance [Motor Third Party Liability insurance (1) Third party insurance (Liability) covers your liability for injuries (and property damage to a limited extent) to others caused in an crash that is your fault. Additional (2) Comprehensive insurance C2 coverage to include loss or damage to your own vehicle can be (3) DK/ CS purchased as an add-on to Third Party Liability insurance, and is (4) Others (specify): ____________________ commonly called Comprehensive insurance] [IF RESPONSE TO C1 IS 2], What are the reasons for not having vehicle insurance? [RECORD VERBATIM] _____________________________________________________________________________________________________________________________ C3 _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ 238 APPENDIX 5: QUESTIONNAIRES C4 When did you last renew your vehicle insurance? [month & year] ________________________ [MM/YYYY] (1) Fleet Owner C5 Who paid the vehicle insurance premium amount mostly? (2) Driver (3) Others (specify): __________ (1) Yes Are you aware of the process of claiming insurance from the insurance C6 (2) No company in the event of a crash? (3) DK/CS SECTION D: PERSONAL ROAD CRASH EXPERIENCE S.N. Question Response While driving your truck, have you ever been involved in a road crash (1) Yes D1 where you sustained injuries? (2) No [END THE INTERVIEW] When did the most recent road crash happen? [Ask for the details of (1) Date: ___________ [DD/MM/YYYY] D2 latest crash] (2) Time: __________ [24 HRS. FORMAT] (1) City Name: ____________________ D3 Where did crash happen? (2) State Name: ___________________ (1) Yes D4 Was an FIR filed after the road crash? (2) No (3) DK/CS (1) Expressway (2) National Highway (3) State Highway D5 Type of road on which crash happened (4) City/ District/ Municipality roads (5) Village road (6) Other (specify): _________________ (1) Serious injury (attended hospital and admitted or treated at hospital) D6 Impact of the crash to self (2) Minor injury (not requiring hospital treatment) Traffic Crash Injuries and Disabilities: The Burden on Indian Society (1) Visited hospital for treatment but not admitted D7 Did you visit hospital after crash and were you admitted for treatment? (2) Admitted to hospital for treatment (3) Not visited hospital (1) Fatal crash (where victim died) (2) Serious injury (attended hospital and admitted or treated at hospital) D8 Impact of the crash to others party involved in crash (3) Minor injury (not requiring hospital treatment) (4) No Injury (5) DK/CS D9 VEHICLE INSURANCE DETAILS (1) Yes 1 Was your vehicle insured at the time of crash? (2) No [GO TO D10] (1) Third party insurance (Liability) Type of insurance with which your vehicle was insured at the time of (2) Comprehensive insurance 2 crash (3) DK/ CS (4) Others (specify): ________________ Did you/ your fleet owner claim insurance for personal injury after the (1) Yes 3 crash? (2) No [GO TO D10] (1) Yes 4 Was your claim approved by the insurance company? (2) No [GO TO D10] (1) Rs. _______________________ 5 What was the total claim amount? (2) DK/CS COMPENSATION TO/ FROM OTHER PARTY [OTHER THAN FROM AN D10 INSURER] (1) Yes, insured (2) No, uninsured 1 Was the other vehicle/ party involved in crash covered under insurance? (3) Hit and run case (4) DK/CS (1) Other party involved in crash 2 Who was at the fault during crash? (2) Self [GO TO D10.8] Did you receive any compensation for personal injury from other party, (1) Yes: Rs. _________ (mention amount) 3 who was not an insurer, involved in the crash? (2) No [GO TO D11] 240 APPENDIX 5: QUESTIONNAIRES 4 How many days did it take for the payment to be accessed? __________________________days (1) Yes 5 Did you face any challenges/ difficulties in accessing the money? (2) No (1) Yes 6 Did you have to visit court for claiming compensation? (2) No (1) Easy 7 How would you rate the compensation claim process? (2) Moderate (3) Difficult Did you/ fleet owner have to pay any compensation to other party (1) Yes: Rs. __________ (mention amount) 8 involved in the crash for injuries they sustained? (2) No D11 OTHER INSURANCES DETAILS (1) Medical Insurance Were you covered under any other personal injury insurance at the time (2) Life Insurance 1 of crash (other than Motor Vehicle Insurance)? (3) Other (specify): __________________ [MULTIPLE RESPONSES POSSIBLE] (4) None [GO TO D12] (1) Yes 2 Did you claim insurance? (2) No [GO TO D12] (1) Yes 3 Did you face any problems with your insurance company/ official? (2) No [IF YES], What type of problems did you face? [RECORD VERBATIM] 4 _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ D12 GOVERNMENT SCHEMES Did you apply for/ benefit from any road crash scheme run by the (1) Yes 1 Government after your crash? (2) No [END THE INTERVIEW] (1) Cashless treatment at hospital Type of schemes you applied for/ benefited from (2) Solatium fund for hit and run case 2 (3) Ex-gratia [MULTIPLE RESPONSE POSSSIBLE] (4) Others (specify): __________________ 3 How much total amount/ benefit did you receive? 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