Pretoria - The Gauteng High Court, Pretoria, has dismissed an application by the Road Accident Fund (RAF) for leave to appeal against the court’s judgment declaring a directive pertaining to medical aid payments unlawful.
A judge earlier put an end to a directive the RAF had issued in August, saying it would no longer pay for past hospital and medical claims issued by members of medical aid schemes.
Judge Mandla Mbongwe was highly critical of the fact that the RAF had issued the directive – because it was against the RAF Act and was done without consulting any stakeholders or the public.
The order followed an urgent application by Discovery Health after the RAF directive was issued stating that with immediate effect, it would make no payments to claimants if their medical aid scheme had already paid for their medical expenses arising from a vehicle accident.
Discovery argued that medical aid schemes would be out of pocket if the new directive to reject claims for past medical expenses already paid, be implemented. 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 each medical aid scheme in the country, Discovery said.
Judge Mbongwe ruled the legal position was that the RAF could not free itself of the obligation to pay full compensation to vehicle accident victims. Thus, the challenged directive falls outside the authority of the RAF.
The court set aside and interdicted the implementation of an internal directive by the acting RAF chief claims officer for the rejection of claims for past medical expenses already paid by claimants’ medical aids.
Aggrieved, the RAF said the rationale behind the directive was that the claimant had not incurred any expenses relating to past medical expenses as these were carried by their medical aids. It said the court erred in its judgment another court should take a new look at the case.
Turning down leave to appeal, the court this week said the fact that medical aids reimburse their members for medical expenses, had nothing to do with the RAF and did not exempt it from paying these expenses.
Pretoria News