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HomeMedico-LegalRAF heads for Appeal Court over medical aid payout ban ruling

RAF heads for Appeal Court over medical aid payout ban ruling

The Road Accident Fund (RAF) is unhappy with the judgment issued last month in which the High Court put an end to a payout ban for members of medical aids, and will now ask for leave to appeal the before the Supreme Court of Appeal.

The Gauteng High Court (Pretoria) declared the directive by the RAF not to pay for past hospital and medical claims issued by members of medical aid schemes unlawful. As a result, the RAF was interdicted from implementing the directive, reports The Star.

In a notice filed in court, the RAF said it was in the public interest to appeal this judgment.

Lawyers acting for the RAF said in the notice that Judge Mandla Mbongwe made several mistakes in law in the judgment.

At the time, the judge criticised the RAF for issuing the directive against the legislation, and because it was done without consulting any of the stakeholders or the public.

The order followed an urgent application by Discovery Health after the RAF issued a directive stating it would make no payments to claimants if their medical aid scheme had already paid for claims arising from a vehicle accident.

Discovery argued that medical aid schemes would be out of pocket if the directive to reject claims for past medical expenses already paid were implemented.

The RAF has cited various points where it claimed the court had erred in the judgment. “It is … in the public interest that the issues … be authoritatively and finally determined by an appeal court,” it stated.

Discovery Health earlier argued that not only did the RAF Act not allow the entity to refuse paying for the medical expenses which a road accident victim had already incurred, but such a decision would have dire financial consequences for medical aid schemes.

The RAF argued that there was no obligation on it to reimburse claimants who had claimed their expenses from their medical aid schemes.

Mbongwe concluded that the RAF Act did not provide for the exclusion of benefits that the victim of a vehicle accident had received from a private medical aid scheme for past medical expenses. The RAF could not free itself of the obligation to pay full compensation to victims of motor vehicle accidents. Thus, the challenged directive fell outside the RAF’s authority, the judge said.

No date has yet been set for the hearing of the application for leave to appeal.


The Star PressReader article – RAF fights medical aid payout ban ruling (Open access)


See more from MedicalBrief archives:


Discovery wins court bid to stop ‘rogue’ RAF’ directive


Discovery challenges RAF directive in court


Accident victim challenges RAF decision on medical aid payments




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