A man who was seriously injured in a car accident has asked the Gauteng High Court (Pretoria) to overturn a decision by the Road Accident Fund (RAF) to no longer pay for expenses already disbursed by a medical scheme to a claimant – the organisation having said car accident victims have already been compensated by medical aids and thus it is under no obligation to reimburse them.
Phineas Mawila said in papers filed at court that he was lodging this application in the interest of all victims of vehicle accidents as it would adversely affect everyone who had lodged a claim with the RAF.
The RAF has said claimants belonging to medical schemes had already been paid for their medical expenses, and thus had not suffered a financial loss, so there was no obligation for it to reimburse them, reports The Mercury.
But Mawila said this was wrong in law, as road accident victims remained contractually obliged to reimburse their medical aids on recovery of the money from the RAF. He said by introducing this new policy, the RAF was attempting to escape its statutory obligations and liability by shifting its financial burden on to stakeholders.
Not only did this undermine the RAF's purpose, but it would have severe consequences for the industry and constitute a limitation on the rights of the members of medical schemes.
He said the RAF circular was inconsistent with the Constitution and the organisation had made the decision unilaterally, without a public participation process. “This application concerns issues of material prejudice, not only to me but also to all potential claimants under the RAF Act who have medical aid and where the medical aid pays for the medical expenses incurred as a direct result of the accident.”
The case is slated to be heard on 26 September. The RAF must still file its responses to the application.
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