A new directive from the Road Accident Fund (RAF) rejecting claims for past medical expenses if the claimant’s medical aid had already been paid has been contested by medical schemes, with Discovery Health launching an urgent application against the RAF and Transport Minister Fikile Mbalula asking the Gauteng High Court (Pretoria), to declare the move unlawful.
Discovery Health said the RAF decision would have dire financial consequences for all medical aid schemes, and that this loss could be in the region of R500m a year, reports Cape Times.
Last week, MedicalBrief reported that a man who had been seriously injured in a car accident had also asked the court to overturn the RAF’s decision. Phineas Mawila said he was lodging the application “in the interest of all victims of vehicle accidents as it would adversely affect everyone who had lodged a claim with the RAF”.
Professor Roseanne Harris, head of policy and regulatory affairs at Discovery, said about 15% of South Africans had private medical insurance. The RAF's 2019/20 annual report records that it paid out R3.3bn to claimants.
A conservative estimate, then, indicates the annual value of claims for past medical expenses where the medical scheme has already paid would be R500m a year.
Harris said medical schemes paid members’ medical expenses in accordance with the benefits due to them under their policy and then assisted them to claim these expenses – and any other heads of damages – from the RAF.
She said the latest notice from the RAF without prior warning meant that medical schemes would now carry the full cost of expenses after a vehicle accident. “This will put a huge strain on medical schemes in circumstances where they have had no opportunity to prepare for the change,” she said.
It will be argued during the urgent application next week that the RAF Act makes no provision for limiting liability in cases where a private medical scheme has already paid a claimant's past medical expenses.
Cape Times PressReader article – Medical aid weighs in on new RAF directive (Open access)
See more from MedicalBrief archives:
Accident victim challenges RAF decision on medical aid payments
Mbalula and RAF scrabble to prevent release of Auditor-General’s findings
6 law firms fail in bid to oust RAF boss