A new directive by the Road Accident Fund (RAF) that it will no longer pay for past medical expenses for car accident victims who have medical aid has been declared unlawful, reports Fin24.

In a ruling handed down yesterday, Gauteng High Court (Pretoria) Judge Mandla Mbongwe reviewed and set aside the 2 August directive, authored by the acting chief claims officer, and interdicted the fund from implementing it.

He pointed to the fact that there had been no prior consultation with stakeholders.

Instead, the fund had ‘gone rogue’.

The court challenge was launched by leading medical scheme administrator Discovery Health, in its own interests, the public interest and on behalf of the estimated 9m South Africans who belong to medical schemes.

It argued that the ‘communique’ was inconsistent with the fund's obligations under the Road Accident Fund Act to pay compensation to those who suffer loss, injury or damages from road accidents.

This obligation and liability is unaffected by the insurance contract between the victim and the medical scheme, it contended.

In his ruling, Mbongwe said the rationale behind the directive was that claimants whose past medical expenses had already been paid by their medical aids, had not ‘suffered any loss or incurred those expenses’. 

The judge said in the presentation of its case, Discovery had listed the consequences of the directive, reports Fin24.

These included that medical aid schemes would no longer be reimbursed for past medical expenses incurred by their clients leading to ‘significant, unplanned loss of income’, which would, in turn, lead to an increase in monthly premiums for members. 

Discovery had also said that members would be prejudiced because they contributed to the RAF fuel levy but would not receive full compensation.

Medical aid schemes might also change their rules to exclude such expenses – forcing members to pay for these costs upfront themselves and claim from the RAF later.

Mbongwe said the purpose of the RAF Act was to give maximum protection to people who had suffered loss or damage as a result of negligent driving.

He said while the Act did provide for some exclusions, it did not provide for the exclusion of benefits to someone whose past medical expenses had been paid by a private medical scheme. He said this principle had already been firmly established in other decided cases. 

Discovery had been justified in approaching the court on an urgent basis.

Full report on the Fin24 site

Judgment