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Otra vez las prepagas en la mira de la justicia

Otra vez las prepagas en la mira de la justicia

Las obras sociales y prepagas están muchas veces nombradas y referidas en los fallos judiciales, esto sucede porque las mismas justifican su falta de cobertura basadas en la ausencia de reglamentación de algunas leyes.
Afortunadamente los jueces en estos casos ponen en foco el bien jurídico tutelado que es LA SALUD, y en sus fallos otorgan aquello que se les solicita, pero siempre evaluando las distintas circunstancias particulares. Ahora bien, es necesario para ello buscar la tutela judicial, esto es realizar un juicio de amparo, que es sumarísimo, lo que significa que los plazos son muy breves porque el objetivo es que se resuelvan rápidamente las cuestiones.

Tal es el caso (CAMARA CIVIL Y COMERCIAL FEDERAL- SALA III Causa n° 2568/2019/1/CA2 “Incidente de apelación R.J.A. SWISS MEDICAL S.A. en autos R.J.A. c/ SWISS MEDICAL S.A. s/ Sumarísimo de Salud”. Juzgado 2, Secretaría 3) de fecha 16 de abril de 2019 en el que una persona discapacitada solicitó un amparo, en el que además pidió una medida cautelar para que le brinden cobertura integral de la prestación de asistente domiciliario las 24 horas del día (cuidado personal, higiene y kinesiología diaria), más pañales.
La Sala III de la Cámara Nacional de Apelaciones en lo Civil y Comercial Federal señaló que el actor (quien reclama) reviste su condición de discapacitado y por lo tanto goza del reconocimiento diferenciado de derechos que el legislador le confirió a ese universo de personas al sancionar la ley 24.901.

La mencionada Sala determinó que “la falta de reglamentación de aspectos relacionados con el derecho a la salud no obsta a que, en ciertas situaciones, los jueces puedan subsanarla teniendo en cuenta las garantías constitucionales involucradas (artículo 42 de la CN) y las circunstancias particulares de cada conflicto … ese vacío normativo puede ser llenado acudiendo a prestaciones que puedan asimilarse en cuanto a su naturaleza, contenido y finalidad a aquella que requiere el afiliado”, añadiendo que “el valor del módulo a determinar es el que opera como límite de la obligación de la EMP, en caso de optar el actor por un prestador por fuera de la cartilla…”.

En este caso Swiss Medical S.A. podrá cumplir con la cobertura reclamada en dos modalidades: a) con prestadores propios con cobertura al 100% o b) con prestadores ajenos, a opción de la parte actora, con un límite cuantitativo.

Si tenés dudas sobre la prestación que te da tu obra social o prepaga, consultanos.

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