Clipping of news on Brazilian Culture, Law and Citizenship
03/27/2012
This article was translated by an automatic translation system, and was therefore not reviewed by people.
SAO PAULO - The Fourth Chamber of the Supreme Court (Supreme Court), to accommodate the use of an insured against a carrier's health plan can not be determined to the insurer to invoke the grace period to restrict funding for emergency procedure.
The rapporteur of the appeal, the Minister Luis Felipe Solomão said it is possible the establishment of any contractual grace period, in accordance with Article 12 of Law 9656. However, the minister said, the clause V of the same law establishes the maximum period of 24 hours to cover the urgent and emergency cases.
The minister also said that contracts of insurance and health care are pacts of cooperation and solidarity, captive and long term, governed by the principle of objective good faith and the social function, with the main objective of ensuring that the consumer care and safety .
"The Consumer Protection Code provides for the necessity of adapting products and services to the legitimate expectation that the consumer has, in the case of agreed onerous contract of health insurance, not to be helpless when it comes to urgent and essential medical procedure the preservation of his life, "said Solomão.
The case
The case occurred in September 2002 when one of the largest operators of the country's health plan refused to pay for the procedures of chemotherapy, surgery, hospital and related, related to a minor with the brain tumor diagnosed.
At the time, the insurer argued that the smallest group consisted of two deprivation of the contract being submitted to a grace period of 180 days from the date of accession to the insurance. In judging the case, the TJSP (Court of São Paulo) considered valid clause that set the grace period, if only because the period was consistent with the limits imposed by the specific legislation and the fact was known to the minor's legal representative.
However, the Court held that the insurer had an obligation to bear the cost of hospitalization in the first 12 hours of care, including examinations also request prior to surgery.
The defense appealed the insured, however, the Supreme Court, arguing that Article 35-C of Law 9.656/98 does not limit the cost of urgent or emergency procedures to the first 12 hours of admission, arguing that the insurance holder has adhered to a plan hospital, which, according to Resolution 13 of the Board of Complementary Health, states that, in contracts for hospital plan, there should be coverage for emergency room visits and emergency admission to evolve since the admission of the patient until his discharge.
Source: The Day on Line
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This article was translated by an automatic translation system, and was therefore not reviewed by people.