Clipping of news on Brazilian Culture, Law and Citizenship
08/12/2016
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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The Fourth Panel of the Superior Court of Justice (STJ) reformed a decision of the Court of Justice of Rio Grande do Sul (TJRS) and determined that an insured return to the health plan operator the amounts received for the purchase of drugs for cancer treatment.
Diagnosed with pancreatic cancer in 2008, the insured was covered by the health plan. Despite chemotherapy, there was progression of the disease to the abdomen region. The doctor in charge prescribed five boxes of a drug at a total cost of R$ 11,460.35.
The request for the new drug was denied by the operator. The insured filed an action requesting a preliminary injunction, and the lower court granted the guardianship advance to oblige the insurer to provide the medication. In the judgment of the merits of the action, however, the judge considered the insured's claim unfounded and revoked the injunction.
Good faith
The operator resorted to the TJRS to be reimbursed the amount spent with the drug, but the judges considered that the insured had received the resources in good faith. In disagreement, the insurer turned to the STJ.
In her vote, the rapporteur, Minister Isabel Gallotti, stated that the case perfectly conforms to the orientation already established by the STJ for situations involving the reimbursement of social security resources, when the preliminary decision is revoked.
According to the rapporteur, contrary to what has been decided by the TJRS, the STJ's guidance must be followed, "in the sense that the reform of the decision that precedes the tutela obliges the plaintiff to indemnify the amounts spent by the opposing party with compliance with the measure Revoked. "
Provisional decision
Isabel Gallotti stressed that "as well as provisional execution, the anticipation of protection is also fulfilled under the risk and responsibility" of who requires it, and must compensate for the damages suffered if the measure is revoked, as a consequence of the dismissal of the request.
"I observe that the party who claims the anticipation of the effects of the tutela does it through a lawyer and therefore knows of its precariousness and reversibility, since it is deferred after a non-exhaustive cognition judgment and should be subject to the return of the received Unduly, "said the minister, whose vote was accompanied by a majority of the ministers of the Fourth Group.
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Insured will return to the health plan value received for treatment after revocation of injunction
This notice refers to the file (s):
REsp 1312836
Source: STJ
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This article was translated by an automatic translation system, and was therefore not reviewed by people.