RAF fights medical aid payout ban ruling

Road Accident Fund plans to apply for leave to appeal judgment overturning its directive

THE Road Accident Fund (RAF) is unhappy with the judgment issued last month in which the court put an end to a payout ban for members of medical aids.

The North Gauteng High Court, Pretoria, declared the directive by the RAF not to pay for past hospital and medical claims issued by members of medical aid schemes unlawful. The RAF was as a result interdicted from implementing the directive.

But, the RAF said in a notice filed in court that it was in the public interest to appeal this judgment. It will ask the court for leave to appeal the judgment before the Supreme Court of Appeal in Bloemfontein.

Lawyers acting for the RAF said in the notice that Judge Mandla Mbongwe made several mistakes in law in the judgment.

The judge at the time was highly critical of the fact that the RAF had issued the directive against the legislation, and because it was done without consulting any of the stakeholders or the public.

The order followed an urgent application by Discovery Health after the RAF issued a directive that it would make no payments to claimants if their medical aid scheme had already paid for claims arising from a vehicle accident.

Discovery argued that medical aid schemes would be out of pocket if the directive to reject claims for past medical expenses already paid was implemented.

The RAF now cited various points on which it claimed the court had erred in the judgment. It said it was confident that if the appeal court took a second look at the facts, it would rule in favour of the RAF. “It is necessary and in the public interest that the issues which are the subject of the directive … be authoritatively and finally determined by an appeal court,” it stated.

It contended that the appeal court judges should determine whether all medical schemes had a claim against the RAF in circumstances where they had settled the claims of health service providers who rendered services to victims of road accidents.

Discovery Health earlier argued that not only did the RAF Act not allow the entity to refuse paying for the medical expenses which a road accident victim had already incurred, but such a decision would have dire financial consequences for medical aid schemes in the country.

The RAF argued that there was no obligation on it to reimburse claimants who had claimed their expenses from their medical aid schemes.

Judge Mbongwe concluded that the RAF Act did not provide for the exclusion of benefits that the victim of a vehicle accident had received from a private medical aid scheme for past medical expenses. The RAF could not free itself of the obligation to pay full compensation to victims of motor vehicle accidents. Thus, the challenged directive fell outside the RAF’s authority, the judge said.

No date has yet been set for the hearing of the application for leave to appeal.