# Seema Goyal 在 Fortis 醫院接受治療後，因保險公司部分拒絕其醫療理賠，向消費者委員會申訴。

*biotech · news · 2026-05-17 · Hindustan Times*

## Key points

- 委員會裁定「非典型增生」為保單涵蓋的癌前病變。
- 保險公司必須支付 Seema Goyal ₹43,090 及自 2025 年 4 月 3 日起 9% 利息。
- New India Assurance 亦被命令支付 ₹20,000 作為精神痛苦及訴訟費用。
- 儘管保單有限制，機器人手術治療非典型增生等癌前病變仍可能獲得理賠。

The commission, comprising president S.K. Aggarwal and members Paramjeet Kaur and Lt Col Jasbir Singh Bath, ordered the insurer to pay ₹43 K along with interest and compensation to complainant Seema Goyal, a resident of Sector 68, Mohali. Goyal had approached the consumer panel after the insurance company partially rejected her medical claim arising from treatment at Fortis Hospital, Mohali, in October 2024. The hospital raised a bill of ₹2.12 lakh for the treatment. The insurer approved ₹65,000 towards surgery charges and later paid only ₹15,972 for medical investigations, pharmacy and related expenses. The complainant alleged that she paid the remaining amount from her own pocket and sought reimbursement of ₹43,090, which she claimed was still pending. In its reply, the insurance company stated that robotic surgery expenses were admissible only for malignant cancer, brain, heart and spine-related ailments under the policy terms and conditions. Since the complainant was not diagnosed with cancer, the insurer argued that the deduction was justified. After examining the medical records, the commission observed that the complainant had been diagnosed with “Atypical hyperplasia on endometrial biopsy”. The order noted that the condition has a significant connection with cancer and is considered a precancerous condition with a risk of progressing to endometrial cancer. The commission held that the condition was covered under Clause D(9) of the policy and observed that there was no justification for deducting the disputed amount from the claim. The bench directed New India Assurance to pay ₹43,090 with 9% annual interest from April 3, 2025, within 30 days. The insurer was also directed to pay ₹20,000 towards mental agony, harassment and litigation expenses.

**Companies:** New India Assurance
**Countries:** India

[Read the full story on Hindustan Times](https://www.hindustantimes.com/cities/chandigarh-news/mohali-consumer-panel-directs-insurer-to-refund-robotic-surgery-claim-101778958510685.html)

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