The Insurance Market and the Repetitive Themes Affected by the STJ until October 2020

Below are the repetitive appeals affected by the STJ up to October 2020, involving the Insurance Market:Topic: 1016

Process (s): ReSP No. 1.716.113/DF, ResP No. 1.721.776/SP, ResP No. 1.723.727/SP, ResP No. 1,728,839/SP, ResP No. 1.726,285/SP, ResP No. 1.715,798/RS and ReSP No. 1,873.377/SP

Rapporteur: Min. Paolo di Tarso Sanseverino

Question submitted to trial: (a) Validity of a collective health plan contractual clause that provides for adjustment by age group; and (b) Burden of proof of the actuarial basis of the adjustment.

Date of allocation: 17/8/2020 (new linked process)

Scope of the order to suspend proceedings: There is a determination to suspend the processing of all pending individual or collective cases that concern the delimited issue and are pending in the national territory (judgment published in the DJe of 10/6/2019).

Topic: 1045 (Theme originating from Controversy No. 138/STJ)

Process (s): ReSP No. 1,836,823/SP and ResP No. 1,839,703/SP

Rapporteur: Min. Moura Ribeiro

Question submitted to trial: Define the (im) possibility of extending the period of coverage provided for in paragraph 1 of art. 30 of Law No. 9,656/98 in the event that the beneficiary continues to require constant medical treatment for the illness that affects him.

Date of allocation: 21/2/2020.

Scope of the order to suspend proceedings: There is no determination of a national suspension of all proceedings (judgment published in the DJe of 21/02/2020).

Topic: 1047 (Theme originating from Controversy No. 157/STJ)

Process (s): ResP No. 1,841,692/SP and ResP No. 1,856,311/SP.

Rapporteur: Min. Raul Araújo

Question submitted to trial: Validity of a contractual clause that allows the unilateral termination, regardless of appropriate motivation, of collective corporate health insurance with less than 30 (thirty) beneficiaries.

Date of allocation: 26/3/2020.

Scope of the order to suspend proceedings: There is no determination of a national suspension of all proceedings (judgment published in the DJe of 26/3/2020).

Topic: 1067 (Theme originating from Controversy No. 127/STJ)

Process (s): ReSP 1.822.420/SP, ResP 1.822.818/SP, and ReSP 1.851.062/SP

Rapporteur: Min. Marco Buzzi

Question submitted to trial: Definition of the thesis referring to whether or not health plans require coverage of the in vitro fertilization technique.

Date of allocation: 7/10/2020

Scope of the order to suspend proceedings: There is a determination to suspend the processing of all pending individual or collective cases that concern the delimited issue and are pending in the national territory (judgment published in the DJe of 7/10/2020).

Topic: 1068 (Theme originating from Controversy No. 148/STJ)

Process (s): ReSP 1,845,943/SP and ReSP 1,867,199/SP

Rapporteur: Min. Ricardo Villas Bôas Cave

Question submitted to trial: Define the legality of the clause that provides for additional coverage for total permanent functional disability (IFPD) in a group life insurance contract, making the payment of insurance compensation conditional on the loss of the insured's independent existence.

Date of allocation: 9/10/2020

Scope of the order to suspend proceedings: There is a determination to suspend the processing of all pending individual or collective proceedings concerning the issue and pending in the national territory (art. 1,037, II, of the CPC/2015), with the exception of the granting of emergency temporary guardianships, when the requirements are met. (judgment published in the DJe of 9/10/2020).

Topic: 1069 (Theme originating from Controversy No. 186/STJ)

Process (s): ReSP 1,870,834/SP and ReSP 1,872,321/SP

Rapporteur: Min. Ricardo Villas Bôas Cave

Question submitted to trial: Definition of mandatory funding by the health plan for plastic surgery in post-bariatric surgery patients.

Date of allocation: 9/10/2020

Scope of the order to suspend proceedings: There is a determination to suspend the processing of all pending individual or collective proceedings concerning the issue and pending in the national territory (art. 1,037, II, of the CPC/2015), with the exception of the granting of emergency temporary guardianships, when the requirements are met. (judgment published in the DJe of 9/10/2020).

Source: https://www.stj.jus.br/sites/portalp/Processos/Repetitivos-e-IACs/Saiba-mais/Boletim-de-Precedentes