LEGAL CONSEQUENCES OF VIOLATION OF THE VOLUNTARY HEALTH INSURANCE CONTRACT UNDER UKRAINIAN LAW

Abstract

The article is devoted to the study of the peculiarities of the legal consequences of violation of the contract of voluntary medical insurance under the legislation of Ukraine. Special attention is paid to the legal consequences of violation of the contract of voluntary medical insurance, such as: unilateral refusal of the contract, modification of the contract, payment of a penalty. The legal positions of the jurisprudence on the issues under consideration are given. The study of the legal consequences of breaching the health insurance contract is important in connection with the following. Such an appropriate form of mutual expression of the will of two or more persons is of scientific interest in view, firstly, of the increase in the share of the said contract in the structure of insurance and, secondly, of the direction of development of state policy in modern conditions in the field of health care. In the article there are specified the features of the medical insurance contract. There are also specified its peculiarities. Examining the legal consequence of a violation of a voluntary health insurance contract, such as a unilateral refusal, it was established that the Civil Code of Ukraine grants certain freedom to the parties in the event of termination of the contract. However, the legislation establishes certain restrictions in case of unilateral refusal of the insurer from the personal insurance contract. Cases of the insured's refusal to make insurance compensation are summarized in the category: those caused by the intentional behavior of the insured person (submission of false information about the fact of the occurrence of the insured event, as well as intentional actions of the insured person (insured person) aimed at the occurrence of an insured event, noncompliance with the prescriptions of the attending physician, which led to a complication of the disease)as well as those whose reasons do not depend on the insured's will (insured person) (receiving services that exceed the insured amount, suffering injuries or illnesses due to force majeure or receiving medical services that are not included in the insurance program). Having considered the judicial practice in cases of unilateral refusal of the contract, it was established that in case of violation of the contract of voluntary medical insurance, it is common for the insured to inattentive study the circumstances in which the insurer is obliged to make certain payments, as well as a false belief that they are not covered by the insurance case.