Clipping of news on Brazilian Culture, Law and Citizenship
1/27/2017
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Transparent image
STJ sets in three years maximum period to request restitution of any kind of readjustment; Already deadlines to reimburse costs arising from negative coverage and compensation for medical error or service failure are different
Has your health plan's tuition already suffered some increase that you consider abusive? If you want to question this readjustment in Justice and ask for a refund of what paid the most, be aware: the maximum period to file a lawsuit for this purpose is three years, according to a final decision of the Superior Court of Justice (STJ).
The period was defined by the STJ when judging a Special Appeal (REsp nº 1.360.969 / RS) on the subject, in September 2016. It is worth requesting the reimbursement of any type of adjustment of the health plan: annual, by change of Age group or by accident rate.
Previously, there was a lot of discussion in the courts about what the statute of limitations would apply to such cases. There were four distinct positions regarding the prescription period - one, three, five and 10 years.
The decision of the STJ represented a setback for the consumer, because among the possible interpretations of deadlines, he adopted the second worst, in disagreement with understandings that the Court itself used to adopt earlier. The definition must be followed in the lower courts of the Judiciary in all decisions on the subject.
Idec clarifies that while the health plan contract is in effect, the consumer may question the abusiveness of a readjustment clause at any time. What was limited to three years is the deadline to get back what was paid the most.
Other deadlines
There are also other statutory deadlines for requesting compensation for losses with health plans. Look:
Refunds under contract
In the case of reimbursement resulting from the choice of a non-accredited provider (doctor, laboratory etc.), the consumer must comply with the deadlines provided for in the contract. For example, if the plan gives 30 days from the receipt of the medical consultation to send the request for reimbursement, this will be the applicable term to request it from the operator.
If the consumer has complied with this deadline and the operator refuses the refund for another reason, the deadline for bringing a court action is still discussed by the courts.
There are precedent decisions of the STJ that understand that the period would be one year, but Idec believes that now the tendency of the Court is to consider the same deadline set for the return of undue readjustments, that is, three years.
Reimbursement in case of negative coverage
If the health plan has refused to cover a procedure (a surgery, for example), and the consumer paid from his or her own pocket, the deadline for claiming this expense is 10 years, according to an agreement signed by the STJ's 3rd class Special No. 1176320).
Indemnity for medical error or other failure to provide the service
The deadline in this case is five years, as provided for in Article 27 of the CRC. It applies to health plans under Summary 469 of the STJ.
Source: Idec
Our news is removed in full from our partners' websites. For this reason, we can not change the content of these even in cases of typos.
This article was translated by an automatic translation system, and was therefore not reviewed by people.