Discovery Health has suffered a setback in its legal wrangle with the Road Accident Fund (RAF) over medical schemes’ right to claim reimbursements for past medical expenses from the fund.

BusinessLIVE reports that the Gauteng High Court (Pretoria) on Friday rejected Discovery’s leave to appeal against a June judgment that the RAF could not be compelled to immediately process medical scheme members’ legitimate claims until the Constitutional Court decides on the dispute between the parties.

‘Discovery has been found to have failed to prove on a balance of probabilities an irreparable loss occasioned by the suspension of the order. Consequently, the argument on the harm being irreparable and the order of final effect refutable. There is therefore no measure of certainty that another court would arrive at a different conclusion,’ Judge Nomsa Khumalo ruled.

Medical schemes have historically submitted claims to the RAF after footing the bill for members injured in road accidents.

However, the RAF rocked the boat when it announced that it would no longer pay for past hospital and medical claims issued by members of medical aid schemes.

Angered by the directive, Discovery dragged the RAF to court.

The court interdicted the RAF from implementing an internal directive to reject all claims for medical expenses where these expenses were paid by medical schemes, not by the claimants.

The RAF then approached the SCA for leave to appeal.

However, it dismissed its application for lack of a prospect of success.

BusinessLIVE notes that the RAF has since approached the Constitutional Court for recourse.

Discovery, which claimed medical aids are losing R2m a day due to the RAF’s directive, went back to the High Court seeking an order forcing the fund to immediately resume payments until the apex court decides on its appeal.

The BusinessLIVE report notes that Khumalo also ruled against Discovery in the matter, leading to its appeal – on which she has now poured cold water.

Both Khumalo’s judgments did not touch on the merits of the matter as that would be decided on by the apex court in due course.

That outcome will have an enormous bearing on some of the changes proposed in the draft RAF amendment Bill currently out for public comment, particularly as it relates to medical aid members, whichever way the Constitutional Court rules. 

The RAF welcomed the ruling.

‘The fund continues to call for the protection of medical scheme members against abuse and being put under duress and undue influence. The contributions of the medical schemes could never have been determined with this false premise that medical schemes have a right to coerce its members to claim from social security funds,’ the RAF said in a statement.

Full BusinessLIVE report