STJ: plan cannot terminate patient with serious illness – 06/22/2022 – Daily life

The Second Section of the STJ (Superior Court of Justice) determined this Wednesday (22) that health plan operators that unilaterally terminate collective agreements are obliged to maintain the bond of patients hospitalized or undergoing treatment for serious diseases.

The decision, which should be followed by lower courts in similar actions, establishes that operators must guarantee the continuity of treatment until medical discharge.

The cases of a woman undergoing treatment against breast cancer and a minor with chronic disease were analyzed. Both went to court and managed to continue coverage, but the operator appealed to the STJ, which has now standardized the understanding.

The rapporteur of the case, Minister Luís Felipe Salomão, recalled that the law already prohibits operators of individual health plans from terminating the contract during the user’s hospitalization, in any case, and stated that the understanding must be extended to collective plans.

“Beneficiaries cannot be excluded when they are being treated for a serious illness or undergoing medical treatment that jeopardizes their livelihood,” he said.

The thesis defended by the rapporteur was that “the operator, even after the regular exercise of the right to unilateral termination of the collective plan, must ensure the continuity of the assistance care prescribed to the hospitalized user or in full medical treatment that guarantees his survival or his physical safety until the effective discharge, provided that the holder fully bears the due consideration”.

The other ministers unanimously followed the rapporteur’s vote.

For public defender Sander Gomes Pereira Junior, from the Federal Public Defender’s Office, the breach of contract cannot put the lives of users at risk.

“It is a contract that is abruptly interrupted, with evident damages both to the state of health and sometimes to the life of the beneficiary”, he argued, before the ministers’ vote.

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