The Court docket of Appeals of Rancagua accepted the safety enchantment introduced in opposition to the isapre Cruz Blanca SA, annulled the unilateral disaffiliation carried out by the pension well being establishment for the alleged use of fraudulent medical licenses, and ordered the quick reinstatement of the recurrent. In a unanimous ruling, the Second Chamber of the enchantment court docket established the unlawful and arbitrary actions of the isapre, by not proving that the member had improperly obtained any profit.
It’s indicated that there isn’t a precedent that “permits us to conclude that the appellant has formally requested or improperly obtained, for himself or for any of his beneficiaries, advantages that don’t correspond to them or which can be better than people who apply, particularly whether it is thought-about that the The regional COMPIN (Fee on Preventive Drugs and Incapacity) reported that it approved the 4 medical licenses, for the reason that relaxation granted is throughout the estimated time for the restoration of the medical situation. With out prejudice, it factors out that the medical depart was partially approved as a result of it overlapped by 2 days with the earlier depart,” the ruling states.
The decision provides that “on this order of concepts, the asymmetry by which the affiliate finds itself in relation to Isapre can’t be ignored, so the choices that the latter adopts concerning the well being contract that binds the events, must at all times be based, a circumstance that doesn’t happen on this species because it has not been confirmed that the appellant introduced fraudulent licenses, for the reason that controlling physique – COMPIN – approved them as legitimate.”
For the court docket of enchantment, “the actions of the respondent have an effect on the belongings of the appellant, violating his basic proper of property derived from the contract, since, since he doesn’t have protection from Isapre, he should disburse his personal sources to acquire his care. medical. Then again, the regulation of the contract is violated, which violates the best of property over the advantages agreed upon with the respondent.”
It’s indicated that the Isapre determination “lacks reasonableness, turning into, as acknowledged, along with being unlawful, it’s arbitrary. On this method, the enchantment for cover in opposition to Isapre Cruz Blanca SA was accepted with out prices and, consequently, the disaffiliation to which the appellant was topic is nullified, ordering his quick reinstatement, with all of the rights granted to him by the contract and the regulation”.
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