Christmas celebrations will never be the same for families in Greater Florianopolis. This is because in the early morning of December 25, 2016, an insured person from the health plan called the mobile intensive care unit care service, and the attendant denied his request.
The service was provided to the uncle of the insured subject to a health insurance plan that paid regularly. A man who suddenly fell ill died a few hours later in a hospital in Greater Florianopolis after being rescued by Samu.
The man was saved by Samu but ended up dying in the hospital — Photo: Disclosure / ND
In connection with the humiliation suffered, the TJSC (Court of Santa Catarina) confirmed the right to compensation for non-pecuniary damage to the insured woman in the amount of 12 thousand reais. The amount will still be adjusted by interest and monetary adjustment. The amount must be paid by the health plan operator based in Greater Florianopolis.
When calling the health plan’s emergency services, the insured was told by the attendant that the record was not found. Thus, the plan employee offered the same service for an additional fee of 1.8 thousand reais. Faced with an impasse, the woman called Sam.
“In this particular case, an unlawful act by a health care operator is evident, which, although not formally refusing emergency care to the dependent of his counterparty (plaintiff), created an obstacle to its implementation by demanding payment of expenses. for mobile resuscitation. In other words, this behavior is a real negative for the contract for the provision of SOS services,” said the speaker, Judge Monteiro Rocha, 2nd Civil Chamber of the TAJ, in his vote.
What did the operator say?
At the same time, the operator claimed that there was no denial of service, only a problem with finding registration. She reported that the insured did not show the correct state of health of the victim and that she refused any assistance, opting for Samu. Because of this, the operator applied for a review of the decision, which was rejected by the courts.
Source: Ndmais