Judicial intervention in insurance plans contracts: an analysis of the jurisprudence of the Court of São Paulo

Abstract

The goal of this study is to analyze the jurisprudence of the Court of Law of the São Paulo State that deals with the contractual relationship between health insurance operators and their beneficiaries, in order to verify the occurrence of judicial intervention in the years 2016 and 2017 and map the arguments used. The research looked into 38 decisions on the subject and the analysis of the collected data allowed the creation of a typology of reasons adopted by the court, namely: (i) intervention based on principles, (ii) intervention based on legally binding summaries of previous opinions; (iii) intervention based on the Consumer Defense Code; and (iv) intervention based on the specific legislation and regulation that governs health insurance plans. As a result of the research carried out, it was possible to conclude that judicial intervention is a constant alternative measure for the realization of the right to health and that in 95% of the judicial decisions, more than one reason of the typology created is present.