If you have contracted health insurance, you should know that the insurance company is responsible for the professional negligence of the doctors included in the medical list drawn up by the company. The recent ruling of the Supreme Court of April 13, 2016 comes to consolidate this jurisprudential doctrine.
In all the analogous sentences so far we find the same circumstances: “An insured goes to a professional on the medical chart of his insurer with whom he has contracted health care insurance and suffers damage as a result of a defective service provided by that professional. The insured sues the medical professional, clinic or hospital jointly with the insurance company. In this case, the Supreme Court condemns the company as jointly and severally liable together with the medical professional or center.
When is the company condemned for the negligence of a medical professional of its health insurance?
In all the cases that have occurred so far, the following conditions have been present, which for the Supreme Court are sufficient to declare the liability of the insurer:
- The health insurance coverage included the provision of the health service by a medical chart drawn up by the insurer.
- The provision of the service was carried out by the professionals or centers included in the medical chart drawn up by the insurer.
- The provision of the health service was defective or negligent.
The Supreme Court will only condemn the company when the contracted policy is a health care policy, that is, a health insurance policy in which the insurer guarantees the insured the provision of the service directly through doctors or medical centers included in your medical chart.
In cases where the contracted policy contemplates the free choice of doctor or medical center, what we commonly know as reimbursement health insurance in which the insured himself freely chooses the doctor or center, the company is not responsible for case of negligence or defective service.
In cases of mixed policies in which the insured has the company's medical chart at his disposal but can also freely choose other doctors or centers, the company incurs liability only when the defective or negligent service has been provided by a professional or center of your medical chart.
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