Discovery Health has appealed the dismissal by the Gauteng High Court (Pretoria) of its application seeking to compel the Road Accident Fund (RAF) to immediately resume the processing of claims and payments to medical scheme claimants.

CEO Dr Ryan Noach has confirmed that it has lodged an appeal against the judgment dismissing its Section 18(3) application.

The appeal is set down to be heard this week.

The application was lodged after the court declared unlawful an RAF directive that no payments must be made to claimants by the fund if their medical aid scheme has already paid for their medical expenses arising from a road accident. 

Moneyweb reports that there has been widespread condemnation of the RAF directive, which was issued on 12 August 2022 by the RAF’s acting chief claims officer and declared unlawful on 27 October 2022 following an urgent application by Discovery Health.

Both the High Court and SCA have dismissed the RAF’s leave to appeal the ruling.

This led to it applying to the Constitutional Court for leave to appeal the High Court judgment.

Noach said the RAF has failed to recommence claims processing for medical scheme members despite the unlawfulness of its directive, as per the High Court rulings.

‘Consequently, Discovery Health filed a Section 18(3) application in the urgent court to compel the RAF to resume claims processing of medical scheme members’ legitimate claims, pending the Constitutional Court considerations and judgment,’ he said.

Noach previously told Moneyweb that Discovery Health’s successful litigation achieved protection for members of medical schemes against discrimination by the RAF, which sought to unlawfully discriminate against medical scheme members by excluding them from RAF payments.

In dismissing Discovery Health’s Section 18(3) application, Judge NV Khumalo said Discovery Health’s suggestion that ‘medical schemes are suffering irrecoverable losses of millions of rands on a daily basis’ is incorrect and does not constitute an exceptional circumstance notes Moneyweb.

She said its offer for an undertaking requires the RAF to pay over to Discovery Health the monies that are payable to the member claimants so as to ring-fence the money based on the misguided and incorrect premise that medical schemes have a reimbursement claim to recover ‘millions of rands’ from their members through the RAF, which will be negated while the appeal procedures are pursued. 

‘The right to compensation being enforceable by the member claimant is therefore no legal basis for payment to be made to the applicant (Discovery Health),’ she said.

Full Moneyweb report