The Gauteng High Court (Pretoria) has rejected Discovery Health’s leave to appeal against the judgment that the Road Accident Fund could not be compelled to immediately process medical scheme members’ legitimate claims, pending a Constitutional Court process.
Judge Nomsa Khumalo said Discovery “had failed to prove on a balance of probabilities an irreparable loss occasioned by the suspension of the order”, reports BusinessLIVE.
“There is therefore no measure of certainty that another court would arrive at a different conclusion,” she said.
Medical schemes have historically submitted claims to the RAF after footing the bill for members injured in road accidents, but in August, the RAF announced it would no longer fork out for medical scheme members’ past hospital and medical claims.
Discovery took the RAF to court, which then interdicted the RAF from implementing an internal directive to reject all claims for expenses where these 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.
The RAF has since approached the Constitutional Court for recourse. Discovery, which claimed medical aids are losing R2m daily 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.
Khumalo also ruled against Discovery in the matter, leading to its appeal.
Neither of her judgments, however, touched on the merits of the matter, as that would be decided on by the apex court in due course.
That outcome will effect 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 Khumalo’s decision, saying: “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 they have a right to coerce members to claim from social security funds.”
Kirstie Haslam, partner at DSC Attorneys, said there would probably be widespread opposition – from various civil society interest groups – to the Bill’s introduction.
“The Bill seeks to treat the symptom and not the cause. The RAF is largely the author of its own misfortune by virtue of systemic administrative incompetence,” she said.
“A significant part of the problem is the volume of claims, which is directly attributable to our unacceptably high collision rate, which is, in turn, in significant part due to inadequate enforcement of traffic laws.”
Meanwhile, the RAF has told the Council for Medical Schemes (CMS) to withdraw a recently published article by two of its staff – which said its refusal to refund schemes was “not in line with the Medical Schemes Act” – and to “stay in its lane”.
The writers had said the RAF should continue reimbursing medical aids for the cost of members’ treatment after vehicle accidents, reports Business Day.
“The level of misinformation in this article cannot be left unchallenged,” the RAF told the CMS after publication of the article.
Two weeks ago, the CMS ran an article on the financial industry website FA News explaining that when the RAF does not pay for care relating to road accidents, it disadvantages all medical aid members. This is because medical aid money is shared in a fund between all members.
When the RAF does not pay up, there is less money available for all beneficiaries.
The RAF said medical schemes have no right to be reimbursed from a “social benefit fund”, and criticised the regulator for taking Discovery Health’s side, calling it a “sudden alliance, unholy it seems”.
“The CMS should stay in its lane and stick to its mandate, as per the Medical Schemes Act.”
BusinessLIVE article – Discovery Health dealt a setback in court fight with RAF (Open access)
Business Day – Stay in your lane, Road Accident Fund tells Council for Medical Schemes
See more from MedicalBrief archives:
Discovery appeals dismissal of application for RAF to resume payments
Court blow for Discovery Health in RAF feud
Discovery wins court bid to stop ‘rogue’ RAF’ directive
RAF amendment Bill 'discriminates' against medical scheme members