Post by account_disabled on Jan 31, 2024 13:25:20 GMT 2
Traditional health plans cannot have clauses that limit days of hospitalization, but those that provide co-funding can. This is because they have another type of contractual nature and, therefore, are cheaper. With this understanding, the 3rd Panel of the Superior Court of Justice accepted an operator's appeal and reversed a conviction for payment of moral damages because the company activated a co-participation clause in the cost of a psychiatric hospitalization lasting more than 30 days. The understanding of the first and second instance is that, despite the legal provision (article 16 of Law 9,656/98), the clause would be abusive, as it restricts the period of hospitalization.
The operator was ordered to continue Buy Phone Number List hospitalization, in addition to paying moral damages to the plan holder. The patient invoked article 51 of the Consumer Protection Code (CDC), which considers null and void a contractual clause that restricts a fundamental right or obligation inherent to the contract. The Court of Justice of Rio de Janeiro, when analyzing the case, ruled in favor of the patient and mentioned the STJ's Summary 302, which considers the contractual clause that limits the days of hospital stay to be abusive. But, for the mi#####sters of the 3rd Panel of the STJ, the case has a particularity which is the express provision of when the co-participation clause is activated.
Express prediction For the mi#####ster rapporteur of the appeal, Nancy Andrighi, U#####med did not commit any contractual infraction that justifies its conviction. The judge explained that the TJ-RJ ruling is at odds with the group's understanding, which considers the co-participation clause to be legitimate when previously expressed. In cases where there is a contractual provision, the clause that triggers co-participation is valid. According to the mi#####ster, the device is intended to maintain the balance between the benefits and considerations that involve the management of the costs of health plan contracts.
The operator was ordered to continue Buy Phone Number List hospitalization, in addition to paying moral damages to the plan holder. The patient invoked article 51 of the Consumer Protection Code (CDC), which considers null and void a contractual clause that restricts a fundamental right or obligation inherent to the contract. The Court of Justice of Rio de Janeiro, when analyzing the case, ruled in favor of the patient and mentioned the STJ's Summary 302, which considers the contractual clause that limits the days of hospital stay to be abusive. But, for the mi#####sters of the 3rd Panel of the STJ, the case has a particularity which is the express provision of when the co-participation clause is activated.
Express prediction For the mi#####ster rapporteur of the appeal, Nancy Andrighi, U#####med did not commit any contractual infraction that justifies its conviction. The judge explained that the TJ-RJ ruling is at odds with the group's understanding, which considers the co-participation clause to be legitimate when previously expressed. In cases where there is a contractual provision, the clause that triggers co-participation is valid. According to the mi#####ster, the device is intended to maintain the balance between the benefits and considerations that involve the management of the costs of health plan contracts.