Automatic healthcare benefits and liability regime based on the origin of the contingency

Abstract

Our Social Security System includes health benefits. However, when the legislator recognises the possibility that an employer could choose an insurance company to provide cover for professional contingencies, the aforementioned benefit can be dispensed either directly by the Healthcare Administration, or indirectly through the collaborating entities, such as insurance companies. The insurance companies then assume the management and expense related to the services when they arise within a professional context, while when they do not - such as from a common origin - the responsibility lies with the Administration itself. Problems arise when there is a change regarding the consideration of the event and in the potential reimbursement of medical expenses requested by the entity that assumed the benefit without it being its responsibility.