Fear as a sales tactic and an increase in the price of insurance policies

May 15 , 2020 // Specialty

Published in Redacción Médica

Humanity faces an invisible enemy that has received the name of Covid-19, much more murderous and lethal than what we were told. We have to fight in our homes, on the street and in health centers, with a very clear front located in each of our hospitals, -today sustained by the determination of the professionals who occupy them-, and an incapable rearguard because their leaders They are also since this conflict began.

Except for the solidarity of the majority, everything has gone wrong and reasons are not lacking: we have bargained in what was previously our main and most outstanding service, the restroom. And to top it all, the mismanagement of our authorities, after the first attack on China and then on Italy, has contributed effectively to the fatal outcome. Information has been hidden, demonstrations and mass events have been allowed that the WHO had repeatedly advised against, they have not wanted to react in time due to excessive protection of finances against health, data is falsified, not all tests are done because there is no test and our loved ones have died because there were no respirators for them or because they were abandoned in some homes to their fate. And it is a real shame because there is no lack of means, rather inadequate management.

From the Association 'El Defender del Paciente' we want to warn that, in the face of such a scenario of insecurity, criticism, weakness and pain, it is the right moment for opportunists to appear in the form of law firms, platforms or associations created these days with the apparent The purpose of helping, when, in reality, they contain mercantile motives whose intention is to take advantage of the moment and make claim to those who have suffered a loss despite not having the slightest chance of winning the lawsuit.
For this reason, to avoid unfounded claims, the Association has been a pioneer in developing the Decalogue of the reasons for claiming health damages derived from Covid-19.

And among the reasons that will stand out due to their greater casuistry are the abandonment of the elderly in nursing homes, the contagion of health professionals and their families due to lack of tests and PPE, or patients who have died waiting for a respirator or have not been admitted to the ICU on a waiting list poorly managed by public administrations.
It may be claimed in the cases in which patients do not have access to the assistance they need, when they could have been referred to another public or private center with more means, either outside the same or a different Autonomous Community. And we are not talking about referral of critical patients between hospitals, but about having offered patients with symptoms the option of going to the center with less care burden so that, when subsequent complications appear, they have some opportunity.

In cases of vital urgency, when a patient cannot be treated in the public health of her Autonomous Community because she is saturated, the Law determines that she may go to another center. However, due to an inexcusable lack of organization, the public administrations have not managed it, with the consequences that we now know.

Nor does it seem appropriate to speak of war. Those who use this term do so to pave the way to the institute of force majeure - an unforeseeable and unavoidable event or that being foreseeable would be irresistible - and thus avoid their responsibility.

In short, physicians can rest easy because from the Association 'The Patient Defender' we consider that there will not be an increase in claims, demands or complaints against them as a result of the contagion of coronavirus. They are not responsible for the tragedy we are experiencing, they are rather part of the attack. Without a doubt, the legal actions are going to focus on public administrations and some private residences.

And the main procedure will be the claim before the Ministry of Health and the Health Service of the corresponding Autonomous Community, when it is shown that the damage is unlawful, that is, that the victim or injured party has no obligation to bear it. This would include the lack of initiative from the Ministry of Health and the Health Departments of the respective Autonomous Communities despite having, in advance, the example of Italy and China. Long before the situation in Spain got out of hand, the WHO had warned us of the urgent need to buy protective equipment and medicines, but those responsible ignored it and decided to wait and see what would happen.

And another procedure will be the one that faces the injured parties and certain public and private health insurers before the civil jurisdiction.
In any of the cases, except for isolated exceptions, the physician will not be the person responsible for the harmful consequences. Claims may be successful when it is proven that, in the specific case, the person responsible for the assistance - normally the Public Administration - could have avoided the damage or reduced the risk. For this reason, the Association advises against collective claims. Identity of cases is not given here as in banking law. Each victim or injured party deserves individualized treatment from an expert, legal, administrative and, where appropriate, judicial point of view.

But, be careful, because in the current situation there will also be law firms that seek to obtain economic performance from the medical sector through fear. We have already seen it when some lawyer from the office

Legal Group, dedicated to the defense of insurance companies and, when the occasion arises, patients, has been able to publish an article in which it is publicized without shame. And, after introducing the reader to the scene of fear, she offers her services adorned by a repeated rally surrounded by numerous applause.

Thus, the aforementioned lawyer frightens the medical sector with phrases such as “many Autonomous Health Services do not offer insurance policies to their professionals”, “insurers can exclude claims due to the state of alarm; there may be franchises or simply not having enough contracted capital ", and ends with a phrase that goes beyond reality by stating that" perhaps the one who has to face the expenses and compensation is the professional himself ".

And not happy with such statements, he predicts an increase in the prosecution of our health professionals. But calm down because, according to his text, “if a vocation defines us, it is the passion for your defense”; that is, they are there to save the doctors, after paying their fees, of course. There is no doubt that this offer, preceded by an atmosphere of panic, should be subject to a deontological review.

In short, it is true that there will be an increase in judicialization, but it is unquestionable that the infantry will point towards the public administrations, in no way towards the doctors, so the tactic of fear must be discarded from the legal point of view to remain reserved for sellers of insurance policies. On the other hand, it is necessary to notice something about which is seldom talked about in our field; We refer to the rejection of out-of-court agreements by certain lawyers, who are usually always the same, to cause litigation that will then be charged from the insurers and, subsequently, prolong them forever to make them as profitable as possible. Such behaviors are the ones that cause an increase in litigation and that the compensation doubles due to interest, as the fees of some are doubled.

El miedo como táctica de venta e incremento del precio de pólizas de seguro

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