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The applicable statute of limitations for exercising a claim for reimbursement of medical and hospital expenses allegedly covered by the health plan (or health insurance) contract, but which were not paid by the operator, is ten years. reproduction In the case at hand, the court considered the refusal to pay for the medicine abusive, and the consumer asked for a refund of the amounts This was the understanding reached by the 2nd Section of the Superior Court of Justice, in a case judged on March 11th, whose ruling was published this Wednesday (3/6). The decision standardizes the jurisprudence — until then not consolidated — on the subject.
When deciding, the ministers relied on two Binance App Users Data precedents — from the 2nd Section (EREsp 1.280.825/RJ) and Special Court (EREsp 1.281.594/SP) — according to which, for claims based on contractual liability, it applies the ten-year term of article 205 of the Civil Code, as there is no law that sets a shorter term. The ruling makes a difference with Topic 610 decided by the panel in a repetitive appeal (Special Appeals 1,361,182/RS and 1,360,969/RS), according to which the right to complain about undue payment to a health plan due to an adjustment clause considered Abuse prescribes in three years, according to the Civil Code of 2002 — or in 20 years, if the Civil Code of 1916 applies.
In other words, all claims based on health plan or health insurance contracts must observe the statute of limitations of ten years, except those that request the return of amounts paid due to the declaration of nullity of a contractual clause (topic 610). Review of the thesis The definition of the 2nd Section falls within a broad context, which allows the review of Theme 610 by the collegiate. The chance to re-analyze the case is being processed in the Question of Order in Petition 12.602/DF, raised by Minister Nancy Andrighi precisely because she identified jurisprudential divergence within the scope of the STJ.
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發表於 2024-3-3 18:59:06