A prepaid medicine company must compensate a Viedma affiliate with one million pesos for having denied coverage and accusing her of falsifying information, the Judiciary of Río Negro reported today.
“They denied her coverage once morest a breast tumor, following accusing her of having falsified the affidavit prior to medical discharge,” the official information indicated.
The decision was adopted by Judge Leandro Oyola, head of Civil Court No. 3 of Viedma, in the case of a young woman who contracted a plan at the Aca Salud company in February 2020 and in the affidavit stated that at that time she did not detected “breast nodules, cysts, or tumors,” but two months later a routine check-up was performed that suggested a biopsy.
The following year, “an increase in the size of the nodular image in the left breast was determined and a histological puncture study under ultrasound guidance was ordered”, which was performed under the coverage of his plan.
The doctors decided to perform a puncture during that intervention and both extractions were sent to the laboratory for diagnosis that same day, but it was then that the defendant company refused to provide coverage.
According to official information, the patient’s family had to pay for the treatment, while the prepaid indicated that she was found “in the presence of a pathology of which the plaintiff was fully aware.”
For the social work, the patient acted “in bad faith, hiding necessary information at the time of hiring, for which reason the contractual termination corresponded.”
In this framework, civil justice framed the case in the Consumer Defense Law.
“It is necessary to remember that this regulation seeks to achieve a balance between those who are parties to a consumer relationship, through a legal protection system designed in favor of the weaker party,” said the magistrate.
In this way, the conflict was locked around the veracity of the information provided by the young woman in the affidavit at the time of contracting the plan and the reasons why she was terminated from that coverage.
In this sense, justice took into account documentary evidence such as the medical history and the sworn statement, and considered the testimony of the medical staff that treated the patient.
“It is not observed that he has retracted or not provided additional documentation in his possession,” said the judge.
In this context, he confirmed that “the affidavit was made in February, while the first manifestation was detected in April”, and that “just a year later, in the annual examination, the growth of the benign tumor was verified”.
In this way, he ordered the definitive restoration of the benefits, which was ordered by a precautionary measure and a compensation of one million pesos was imposed as punitive damage. (Telam)
