STJ confirms health plan obligation to reactivate contract after agreement

health plan agreement
Minister Nancy Andrighi / Credit: Sergio Amaral

In a unanimous vote, the ministers of the 3rd Panel of the Superior Court of Justice (STJ) denied Unimed’s appeal and confirmed the company’s obligation to reactivate a consumer’s health plan contract, whose coverage had been canceled after 60 days of default. . After termination, there was a renegotiation of the debt, payments were resumed, but coverage was not reinstated.

For the minister Nancy Andrighi, rapporteur of the case, the company acted in bad faith. “Despite the fact that the plan holder was duly notified of the termination of the contract, the operator renegotiated the debt, and after notification, it received the payment of the next monthly fee. In my view, it is contradictory behavior, offensive to good faith. Therefore, I am dismissing the appeal with the increase in fees”.

The other members of the court agreed. “Totally contradictory,” said minister Moura Ribeiro. “Very clear contradictory”, added Villas Boas Cueva.

After being notified that the service could be terminated due to late payments, the consumer renegotiated the settlement of the three outstanding installments with the operator so that the plan, canceled at that time, could be reinstated. In the months following the agreement, Unimed sent new tickets to the user, which were effectively paid, but the service was not reactivated.

Unimed argued that, since the debts lasted for more than 2 months, the customer did not meet the conditions for resuming the contract. Faced with the refusal, the user decided to file a request for urgent relief at the Goiás Court of Justice (TJGO) to restore coverage.

The consumer, wife and children used Unimed coverage since 2006. The woman has breast cancer and needs recurrent medical care.

In the first instance, Judge Alessandra Gontijo do Amaral also rejected Unimed’s appeal and determined that the conditions of the previous health plan contract were maintained, as Unimed admitted the payment of a new charge.

At the time, in a new appeal, the company stated that the slip sent to the beneficiary would have been issued before the termination of the contract and refuted that it had acted in a contradictory manner. The argument was rejected by judge Jehovah Sardinha de Moraes, of the 6th Civil Chamber of the TJGO.

The case was judged in REsp 1,995,100.

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