Questão jurídica principal
Whether the insured retained a right to benefits when the physician’s cure order was submitted only after the cure had begun and ended.
Decisão extraída
No. Under the insurer’s AVB, the medical cure order had to be filed before the cure began; starting the cure earlier extinguished the benefit claim.
Fundamentação extraída
The AVB, approved by the federal social insurance office, were designed to prevent abuse and to allow the insurer to obtain further medical reports and assess coverage in advance. Since the cure order was issued only after the stay, the insurer could refuse payment for formal reasons.