Consumer News

Justice reverses increased abusive health plan

01/28/2013

Favorable decision that the client did not accept adjustment of nearly 100% in delivery, due to the exchange of old, a precedent favorable to thousands of consumers
 
BY AURELIO GIMENEZ
 
Rio - A judgment by the 3rd Special Civil Court of Rio de Janeiro gives new impetus to consumer relations between customers and companies in the health plan. The decision at the end of last month in the first instance sentenced the operator Amico Health Ltd, linked to the group Amil, to repay amounts paid extra for an insured who has suffered in the monthly adjustment of nearly 100%. In addition to returning to the previous level, the company was ordered to pay punitive damages in the amount of R$ 1000.
 
As the statistician Ricardo Souza de Oliveira, 43, in April 2012 he was surprised to see that your monthly plan Dix Amico increased from R$ 176 to R$ 304. The adjustment, according to the operator, occurred due to change in age of the insured. Such a situation is provided by law and regulated by the ANS (check the tracks of readjustment in the table below).
 
'ME FEEL injured'
 
Ricardo argues that there is nothing in the contract about the adjustment for age and which, upon contact with the operator, received the reply that "nothing could be done."
 
"I felt aggrieved, an increase was abusive. So I resorted to Justice through the National Association of Consumer Technical Assistance and Worker (Anacont), "says the insured.
 
"Over 60 years can no longer be reset by age. But many operators are still trying to cheat the elderly. Now, some companies make an adjustment abusive to people under 60. This decision is precedent favorable to consumers, "says the lawyer José Roberto Oliveira, president of Anacont.
 
In the sentence was highlighted that the operator has not provided evidence that "the economic and financial equation of the contract was that showed shaken or altered level of claims to justify size increase in the provision," by altering old. Last year, Richard's wife, Claudia, dependent on the level, made 44, which would justify the change of age and readjustment.
 
Percentage adjustment must be included in contract
  

 
Through a statement, the carrier said Amico follows the legislation and regulated by the ANS, which allows adjustment for age.
 
General Manager Economic Financial and Actuarial ANS, Rosana Neves reports that in addition to annual adjustment stipulated by the agency, operators can adjust the monthly payment by age.
 
According to Rosana, the percentage adjustment for age should be expressly mentioned in the contracts. If nothing is written, the operator can not promote increased tuition, warns the executive.
 
Expert praises sentence
Rosana Neves says there is a limit to apply for adjustment of the percentage change in age. This calculation is done by the operator, taking into account statistical and frequency that customers use health plans, according to age.
 
Lawyer of Rego Consultants and Associates, Ericka Gavinho says that the sentence took into account the proportionality and reasonableness of applying a percental, making the adjustment abusive. "Between law and justice, applied the rule in favor of the consumer. This is always the most injured. It is a commendable decision, "says the expert on consumer protection.


Source: The Day - Online

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