<\/p>\n
The Road Accident Fund (RAF) has been interdicted with immediate effect by the Supreme Court of Appeal (SCA) from making any deductions from compensation paid to claimants on the basis that their medical expenses have been or will be paid by their medical aid schemes.<\/p>\n
The SCA issued this ruling in a judgment handed down on Friday to an appeal lodged by Discovery Health.<\/p>\n
The appeal related to a December 2024 judgment of a full bench of the High Court in Pretoria dismissing Discovery\u2019s request for an order declaring the RAF to be in breach of a previous high court order related to the fund\u2019s liability for the payment of the past medical expenses of road accident victims who are members of medical schemes.<\/p>\n
The SCA on Friday set aside and replaced the judgment of the High Court by declaring that the RAF and former RAF CEO Collins Letsoalo are in breach of the court\u2019s order and judgment dated 27 October 2022 and \u201cof their constitutional duty to obey and implement the judgment\u201d.<\/p>\n
The 27 October 2022 judgment by Judge Mbongwe declared unlawful a 12 August 2022 RAF directive, which instructed RAF employees not to make any payments to claimants if their medical aid scheme has already paid for their medical expenses arising from a road accident.<\/p>\n
Read:
RAF ordered to pay R2.2m to pedestrian and slapped with punitive cost order
RAF tries to \u2018make a mockery of the court\u2019 in medical expenses dispute
New Discovery court ruling: RAF must pay \u2018medical aid\u2019 claimant\u2019s past expenses
Seven \u2018mistakes\u2019 in RAF past medical expenses high court judgment \u2013 CMS<\/p>\n
ADVERTISEMENT<\/p>\n
CONTINUE READING BELOW<\/p>\n
The SCA on Friday further interdicted the RAF and Letsoalo, with immediate effect, from giving effect to the directives they issued on 13 April 2023 and 2 November 2023.<\/p>\n
These two directives were issued by the RAF following Judge Mbongwe\u2019s order on 27 October 2022.<\/p>\n
Discovery claimed these directives perpetuated the RAF\u2019s breach of that order by continuing to reject claims for past medical expenses because the victim\u2019s medical aids have already paid them.<\/p>\n
It further claimed Letsoalo and the RAF have sought to circumvent the judgment by adopting a new \u2018phantom\u2019 directive on 13 April 2023, which it has refused to disclose to Discovery.<\/p>\n
This \u2018phantom\u2019 directive related to the obligations of medical schemes under the Medical Schemes Act to provide PMBs (prescribed minimum benefits) for emergency treatment required by medical scheme members.<\/p>\n
The SCA ordered the RAF and Letsoalo to take all necessary steps to comply with the judgment within 14 days and to report their compliance in writing to the court\u2019s registrar and Discovery Health\u2019s attorneys.Costs were awarded against the RAF and Letsoalo.<\/p>\n
The judgment of the full court of the High Court dismissing Discovery\u2019s application, which it has now successfully appealed to the SCA, potentially had significant implications for medical aid members in the form of higher medical aid premiums.<\/p>\n
ADVERTISEMENT:<\/p>\n
CONTINUE READING BELOW<\/p>\n
Discovery Health previously indicated that medical schemes incur an irrecoverable loss of about R500 million per year when the RAF fails to pay medical scheme members for past medical expenses incurred in road accidents.<\/p>\n
Judge Mbongwe listed the consequences for Discovery Health\u2019s scheme members and their clients if the RAF directive was implemented, and recorded that the rejection of claims to pay past medical expenses to claimants meant that:<\/p>\n
Medical aid schemes would no longer receive reimbursement for past medical expenses incurred for the treatment of their clients, whose rights to recover these expenses from the RAF were set to be taken away.
\nMedical aid schemes would suffer a significant, unplanned loss of income, requiring them to reassess and increase monthly premiums payable by their clients to ensure the schemes\u2019 sustainability.
\nMembers would be prejudiced in that they would contribute to the RAF fuel levy but would not receive full compensation from the RAF in the event of sustaining injuries caused by the wrongdoing of a negligent driver.
\nMedical aid schemes might find it viable to exclude claims for medical expenses arising from motor vehicle accidents, which would entitle RAF claimants to claim for past medical expenses, but this in turn would undermine the very purpose of the schemes because members would be forced to incur the costs upfront and claim later.<\/p>\n
Judge Tati Makgoka, with SCA judges Caroline Nicholls, Phillip Coppin, Esther Steyn, and acting judge Fiona Dippenaar concurring, said on Friday the agreement between medical aid schemes and their members provides that the medical aid scheme pays the claimant\u2019s medical expenses and, when the claim is settled, the member reimburses the medical aid scheme.<\/p>\n
Judge Makgoka said reimbursement is not the same as sharing proceeds.<\/p>\n
\u201cAccordingly, an agreement between a medical aid scheme and a member who claims under the RAF Act to reimburse the medical aid scheme for past medical expenses does not fall within the provision\u2019s scope,\u201d he said.<\/p>\n
#Discovery #wins #SCA #appeal #RAF #medical #expense #deductions<\/p>\n","protected":false},"excerpt":{"rendered":"
The Road Accident Fund (RAF) has been interdicted with immediate effect by the Supreme Court…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4],"tags":[3922,21857,5358,13693,2277,11450,15394,894],"_links":{"self":[{"href":"https:\/\/stock999.top\/index.php?rest_route=\/wp\/v2\/posts\/18408"}],"collection":[{"href":"https:\/\/stock999.top\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stock999.top\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stock999.top\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stock999.top\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18408"}],"version-history":[{"count":0,"href":"https:\/\/stock999.top\/index.php?rest_route=\/wp\/v2\/posts\/18408\/revisions"}],"wp:attachment":[{"href":"https:\/\/stock999.top\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stock999.top\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stock999.top\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}