ConCourt rejects RAF medical scheme appeal bid
The Constitutional Court has rejected the application by the Road Accident Fund (RAF) to appeal against a High Court ruling compelling it to resume payments to medical schemes.
A Business Day report says this puts a final nail in the coffin to RAF efforts to stop honouring claims from medical schemes for members who have been injured in traffic accidents.
The apex court’s decision has industry-wide implications, as it provides medical schemes and their administrators with legal assurance that they can continue a long-standing practice of covering their members’ medical bills for injuries sustained in traffic accidents, and then claiming the money back from the RAF.
It may also influence the outcome of the RAF Amendment Bill, released for public comment in early September, which proposes that medical scheme members become ineligible for cover from the fund.
The RAF has been locked in a legal battle with medical scheme administrator Discovery Health, which challenged its decision in August 2022 to unilaterally cease reimbursing medical schemes.
Discovery Health won an urgent High Court application in 2022 to have the fund’s internal directive to stop paying medical schemes declared unlawful and set aside, but was then fought by the RAF all the way to the Constitutional Court.
Discovery Health has previously said RAF’s refusal to pay was costing it R2m a day, notes the Business Day report.
‘The Constitutional Court ruling means that medical scheme members retain the right and entitlement to claim medical expenses from the RAF, in accordance with the Act and over a century of common law precedent,’ said Discovery Health CEO Ryan Noach.
‘An important fairness and equity principle has prevailed, and represents a victory in the public interest for all members of medical schemes in SA.’
The decision to stop paying claims constituted ‘clear discrimination’ against medical scheme members, who paid the same fuel levies towards the RAF as all other road users, he said.
Discovery Health’s client schemes are owed about R140m by the RAF, said Noach.
RAF CEO Collins Letsoalo said the organisation will not resume payments of expenses that had been paid by medical schemes.
‘Our position has always been that we will not pay for prescribed minimum benefits and emergency medical conditions, as prescribed by the Medical Schemes Act,’ he said.
Yesterday. the Constitutional Court rejected the RAF’s application to appeal, saying the matter does not concern the jurisdiction of the court.
It awarded a costs order to Discovery Health.
Article disclaimer: While we have made every effort to ensure the accuracy of this article, it is not intended to provide final legal advice as facts and situations will differ from case to case, and therefore specific legal advice should be sought with a lawyer.