{"id":52390,"date":"2026-03-20T14:29:07","date_gmt":"2026-03-20T17:29:07","guid":{"rendered":"https:\/\/justicapotiguar.com.br\/?p=52390"},"modified":"2026-03-20T14:34:08","modified_gmt":"2026-03-20T17:34:08","slug":"operadora-de-plano-de-saude-tera-que-indenizar-e-ressarcir-custos-com-fisioterapia","status":"publish","type":"post","link":"https:\/\/justicapotiguar.com.br\/index.php\/2026\/03\/20\/operadora-de-plano-de-saude-tera-que-indenizar-e-ressarcir-custos-com-fisioterapia\/","title":{"rendered":"Operadora de plano de sa\u00fade ter\u00e1 que indenizar e ressarcir custos com fisioterapia"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"1024\" height=\"576\" src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-1024x576.jpg\" alt=\"\" class=\"wp-image-52393\" srcset=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-1024x576.jpg 1024w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-300x169.jpg 300w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-768x432.jpg 768w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-1536x864.jpg 1536w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2026\/03\/revealing-shot-female-nurse-helping-elderly-woman-recover-her-muscles-after-accident-she-is-lying-hospital-bed-retirement-home-2048x1152.jpg 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><figcaption>Foto: Freepik<\/figcaption><\/figure>\n\n\n\n<p>A 2\u00aa C\u00e2mara C\u00edvel do TJRN manteve um julgamento inicial determinando que uma operadora de plano de sa\u00fade reembolse integralmente as despesas que uma usu\u00e1ria teve com fisioterapia realizada fora da rede credenciada, al\u00e9m de indeniza\u00e7\u00e3o por danos morais. A decis\u00e3o tamb\u00e9m manteve o dano moral indeniz\u00e1vel, pela negativa de cobertura de tratamento fisioter\u00e1pico em domic\u00edlio, em um segundo momento.<\/p>\n\n\n\n<p>A paciente \u00e9 portadora de paraparesia crural esp\u00e1stica (CID G82.1) com hist\u00f3rico de acidente vascular cerebral (CID G45.1), encontrando-se em cadeira de rodas e com perda progressiva de for\u00e7a muscular em membros inferiores.<\/p>\n\n\n\n<p>Conforme a decis\u00e3o, sob relatoria da desembargadora Berenice Capux\u00fa, o valor arbitrado a t\u00edtulo de indeniza\u00e7\u00e3o, fixado em R$ 5 mil, mostra-se proporcional e razo\u00e1vel, atendendo aos princ\u00edpios da modera\u00e7\u00e3o e da proporcionalidade, bem como \u00e0s fun\u00e7\u00f5es compensat\u00f3ria e pedag\u00f3gica da repara\u00e7\u00e3o civil, n\u00e3o comportando redu\u00e7\u00e3o.<\/p><div class=\"kflar69ee5426cb82a\" ><!--<a href=\"https:\/\/bit.ly\/3QdrqTZ\" target=\"_blank\">\n<img src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2023\/09\/mobile-geral.gif\"\/><a\/>--><\/div><style type=\"text\/css\">\r\n.kflar69ee5426cb82a {\r\ntext-align: center;\r\n}\r\n@media screen and (min-width: 1201px) {\r\n.kflar69ee5426cb82a {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 993px) and (max-width: 1200px) {\r\n.kflar69ee5426cb82a {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 769px) and (max-width: 992px) {\r\n.kflar69ee5426cb82a {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 768px) and (max-width: 768px) {\r\n.kflar69ee5426cb82a {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (max-width: 767px) {\r\n.kflar69ee5426cb82a {\r\ndisplay: block;\r\n}\r\n}\r\n<\/style>\r\n<div class=\"yjttr69ee5426cb811\" ><!--<a href=\"https:\/\/bit.ly\/3QdrqTZ\" target=\"_blank\">\n<img src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2023\/09\/desktop-geral.gif\"\/><a\/>--><\/div><style type=\"text\/css\">\r\n.yjttr69ee5426cb811 {\r\ntext-align: center;\nmargin-bottom: 1em;\r\n}\r\n@media screen and (min-width: 1201px) {\r\n.yjttr69ee5426cb811 {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 993px) and (max-width: 1200px) {\r\n.yjttr69ee5426cb811 {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 769px) and (max-width: 992px) {\r\n.yjttr69ee5426cb811 {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 768px) and (max-width: 768px) {\r\n.yjttr69ee5426cb811 {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (max-width: 767px) {\r\n.yjttr69ee5426cb811 {\r\ndisplay: none;\r\n}\r\n}\r\n<\/style>\r\n\n\n\n\n<p>\u201cA quantia, ali\u00e1s, acompanha o patamar costumeiramente arbitrado nesta Corte envolvendo casos de sa\u00fade em que n\u00e3o houve efetiva desassist\u00eancia do servi\u00e7o, mas ileg\u00edtima a negativa da entidade mantenedora do plano\u201d, refor\u00e7a a desembargadora.<\/p>\n\n\n\n<p>O julgamento ainda esclareceu que, ao ser comprovada a inexist\u00eancia de vagas na rede credenciada dentro do prazo fixado pela Ag\u00eancia Nacional de Sa\u00fade (ANS) e demonstrado que a pr\u00f3pria operadora orientou a benefici\u00e1ria \u00e0 realiza\u00e7\u00e3o do tratamento de forma particular, \u00e9 devido o reembolso integral das despesas suportadas, sobretudo diante da revelia reconhecida no primeiro feito.<\/p>\n\n\n\n<p>\u201cCorreta, portanto, a condena\u00e7\u00e3o ao reembolso integral dos valores comprovadamente despendidos pela apelada, no montante de R$ 8.580, uma vez que o atendimento particular somente ocorreu em raz\u00e3o da aus\u00eancia de vagas na rede credenciada, circunst\u00e2ncia reconhecida pela pr\u00f3pria recorrente\u201d, completa a relatora.<br><br><em>Fonte: TJRN<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A paciente \u00e9 portadora de paraparesia crural esp\u00e1stica, com hist\u00f3rico de acidente vascular cerebral, encontrando-se em cadeira de rodas e com perda progressiva de for\u00e7a muscular.<br \/><a class=\"more-link\" href=\"https:\/\/justicapotiguar.com.br\/index.php\/2026\/03\/20\/operadora-de-plano-de-saude-tera-que-indenizar-e-ressarcir-custos-com-fisioterapia\/\">Mais&#8230;<\/a><\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/52390"}],"collection":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=52390"}],"version-history":[{"count":2,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/52390\/revisions"}],"predecessor-version":[{"id":52394,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/52390\/revisions\/52394"}],"wp:attachment":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=52390"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/categories?post=52390"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/tags?post=52390"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}