Lawsuits against health insurance plans in Brazil’s São Paulo up 391% from 10 years ago

RIO DE JANEIRO, BRAZIL – Between January and August this year, the São Paulo courts (TJSP) ruled on 22,366 lawsuits against operators, according to a survey conducted by the Group for the Study of Health Plans at USP’s School of Medicine.

During the same period in 2011, when the survey began, the number of lawsuits was only 4,554, making this year’s numbers 391% greater.

There were 10,625 claims in lower courts and 11,741 in appellate courts. Considering the 169 working days in the 8 months of this year, the TJSP heard an average of 132.3 cases daily.

Regarding the cases tried in the appellate courts, among the complaints that take consumers to court are issues with coverage exclusions and treatment refusals, which represent 60.4% of rulings.

According to attorney Rafael Robba, part of the study group, the numbers reflect the daily issues users face. In his opinion, the lack of regulation by the National Agency for Supplementary Health (ANS) for certain types of plans and the difficulty beneficiaries have in settling these complaints with operators lead to a growing demand for the courts.

The number of clients of healthcare insurance plans has been dropping in São Paulo since 2015, with a slight rebound in the past 2 years. In March 2021, 17.3 million people were registered as covered by health plans in the state. The figure is lower than 10 years ago, when 17.6 million people had health insurance in the city.

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