The Court of Appeals of Valdivia ordered that Isapre Cruz Blanca cover the copay for the surgery of one of its affiliates. The insurer stated that the intervention originated from an unreported pre-existing illness. In total, the company must reimburse $2,448,000 and pay the costs of the case.
The Valdivia Court of Appeals upheld a protection appeal filed against Isapre Cruz Blanca.
The company rejected the co-payment for the operation to which it submitted one of its affiliates, arguing that the intervention originated in an undeclared pre-existing disease.
The foregoing despite the fact that the diagnosis of the disease that required surgery was made months after contracting the insurance of health.
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In a unanimous decision, the Second Chamber of the Court of Appeals ordered Isapre Cruz Blanca to reimburse the affiliate the sum of $2,448,000 and pay the costs of the case.
According to what is read in the ruling, with the information presented by the woman, it could be understood that the denial of reimbursement has ceased, as the Isapre in question has indicated in its report, which has not been accredited.
“Thus things are, being the obligation of the isapre to provide the required coverage in the particular case, having recognized the denial of the required provision and considering that such action is arbitrary in nature and is in violation of the guarantee of equality before the law, the Court must adopt the appropriate protection measures to protect the legitimate exercise of the affected right”, it was written in the ruling.
In its argument in podium, the representative of the affiliate was emphatic in affirming that there has been no p No response from the respondent entity, despite its multiple requests.