Among several of the benefits he had for being a worker of the Superior Audit of the Federation (ASF) – the maximum controlling body of the country – was the Major Medical Expenses Insurance.
He began to count on this benefit when he entered the institute in 2011. He had no problem until six years later, when He married a person of the same sex.
It was then that the public servant began to suffer a series of discrimination acts by the insurer who climbed up to leave her without coverage already her wifeeven when the latter was pregnant.
After the irregularities of the insurance company, The couple took the case to the courts and until the last instance, where the Supreme Court of Justice of the Nation (SCJN) issued a sentence. This is the story.
The problems began at the end of 2017, when the ASF employee included her wife in the insurance for major medical expenses. Instead of registering it as spousethe insurer included it in the documents as “PM.SEX”, acronyms to refer to “same sex couple”.
Annoyed with this, the official requested the correction and issuance of new documents with the correct term – County – pointing out that it is not only a Act of discriminationbut in the policy and its general conditions this definition does not appear –pm.sexo– what could cause ambiguities in the application of insurance.
The insurer, then, made the corrections.
A year later, already in 2018, the insurance company issued a new record for the headline holder with the surprise that his wife was again added as “PM.Sexo” and not as a spouse. Not only that, within the coverage, No treatments or medical procedures related to pregnancy were includedas would cease and natural birth.
Before he could make the claim before the insurer, the major medical expenses insurance was canceled by the ASF as part of the austerity measures promoted by the government of then President Andrés Manuel López Obrador.
Given this scenario, the insurance company communicated with the worker and offered to keep the insurance for her and her partner until the beginning of 2019, to later make an offer to follow.
Although he thought twice for the background, he accepted the offer since they would respect the age of more than a decade and include the procedures related to motherhood.
After accepting the proposal and passing the agreed period, the insurer sent her the price of insurance and The contract was concluded Safe for major medical expenses. It was only necessary for the couple to receive the documentation from the Insurance Policyas well as their General conditionsbut never arrived.
For both it was vital to know this information and that the insurance company did not give it interferes, among other things, with its family planning since They had decided have a child through in vitro fertilization and needed to know the details of their coverage.
The delay in the delivery of the information caused noise in the marriage, because the rest of the heterosexual partners in the ASF did were sent all the documentation within a few days.
The insurer finally gave them the information 10 months after the signing of the contract taking a surprise: The general conditions of insurance were not the same that they had offered in their price leaving them without maternity coverage – only for having undergone a fertilization process – when they had already begun the procedure for their pregnancy.
Tired of the situation, the employee of the ASF and his wife They decided to cancel insurance, They stopped paying and demanded the insurance company that would take care of pregnancy expensesbut he refused.
When the couple’s daughter was born, at the end of 2020, and the insurance company insisted on her position of not paying the medical expenses of pregnancy, They filed a complaint before the National Commission for the Protection and Defense of Users of Financial Services (Condusef).
However, not reaching an agreement, the now Homarental family filed a lawsuit against the insurer demanding the contract cancellation of the insurance, the Return of payments accrued, More interestas well as a compensation for the loss of antiquity they had generated and by the Moral damage.
The arguments in their demand were clear: the insurance they gave them was not the same that they had been offered in the initial contribution, they did not receive the general conditions of coverage in a timely manner and were victims of constant discrimination because they were a same -sex couple.
At the end of 2022, when his child had already turned two years old, the twenty -eighth court of oral process and domain extinction in Mexico City sentenced in favor of marriage and demanded that the insurance company make the corresponding payments.
Clearly disagree with the sentence, the insurer presented an amparo trial ensuring that The initial contribution coincided with the coverage of the contract already signed, including the exclusion of infertility treatments and their consequences, and despite them at no time the plaintiffs requested a rectification and hired insurance.
Also They rejected some damage or discriminationthat the term “same couple” is widely used, even by the Court, and that in any case, The alleged discriminatory acts had already prescribed.
The sixteenth collegiate court in civil matters of the first circuit took the case and partially granted the amparo To the insurer, giving only the prescription of the acts of discrimination, but reaffirming the rest of the sentence against him.
With this result, both parties presented a review resource taking the case to the SCJN. The First Court Chamber rejected the Court’s decision to qualify the acts of discrimination as prescribed.
His argument is that although the two years had passed in which this crime expires, moral damage is based on an affectation to integrity, honor and dignity, so a claim of this nature cannot undergo such a short period of prescription.
It was so The SCJN decided to revoke the sentence of the court and ordered that a new one considering that the two -year prescription of the discriminatory acts is disproportionate and, instead, apply the broadest that is the ten -year.
The court ruling was issued this 2025, when the couple’s daughter is already close to five years of age and eight years old when the irregularities began with the insurance company.
With this decision, most of the points of the original sentence in favor of the couple are maintained as the nullity of the contract, the reimbursement of premiums, the payment of interest and compensation for loss of seniority.
