The Gauteng High Court (Pretoria) has dismissed Discovery Health’s bid to compel the Road Accident Fund (RAF) to immediately process medical scheme members’ claims until the Constitutional Court decides on the dispute.
Discovery said it would now have to carry daily losses of up to R2m, reports BusinessLIVE.
Medical schemes have traditionally submitted claims to the RAF after carrying the costs for members injured in road accidents, but last August, the RAF announced it would no longer pay for past hospital and medical claims issued by medical aid scheme members.
Discovery immediately 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 Supreme Court of Appeal for leave to appeal but its application was dismissed for lack of a prospect of success.
Undeterred, the RAF has since approached the Constitutional Court for recourse.
Discovery, however, went back to the High Court seeking an order forcing the fund to immediately resume payments until the apex court decides on its appeal. It argued that since the decision in August, it had lost R138m and this would climb to R500m if the decision were allowed to stand for a year.
It has also warned that if the RAF’s position prevails, medical aid schemes may find it viable to exclude claims for medical expenses arising from car accidents.
The company also argued that the non-refund by the RAF of past medical expenses would mean members would be unable to access other medical treatment due to their coverage limit and medical savings being exhausted.
However, on Monday, the High Court said Discovery had not made out a case that it would suffer irreparable harm until the apex court heard and decided on its dispute with the RAF.
“… The payment of benefits is instead dependent on the monthly premiums that the medical schemes receive from their members.”
Discovery Health CEO Ryan Noach said the company would appeal the judgment, “but it is important to remember this decision has no bearing on the fact that the RAF directive has been declared unlawful”.
“We remain highly optimistic that the Constitutional Court will find in favour of Discovery Health, which will be to the benefit of all medical scheme members, to ensure fairness and equity in the RAF claims handling processes.”
SA has about 800 000 road accidents every year.
BusinessLIVE article – New twist in Discovery Health’s feud with RAF (Restricted access)
See more from MedicalBrief archives:
Discovery wins court bid to stop ‘rogue’ RAF’ directive
RAF heads to ConCourt in battle against medical aid payments
RAF heads for Appeal Court over medical aid payout ban ruling