Adjustment index in group health insurance plans: in favor of procedural objective good faith in cases of inaction by the health insurance providers

Abstract

The current jurisprudence of the Brazilian Superior Court of Justice (STJ), when recognizing the abuse in loss ratio-based adjustments in group health insurance plans, prevents the application of the ANS index for individual plans as a substitute. This orientation, however, seemingly encourages health insurance providers to disregard their burden of proof and the principle of objective good faith, thus delaying proceedings in which they are defendants. This research aims to diagnose the distortions within this jurisprudential guideline and propose short- and long-term solutions to correct it.