Sunday, 28 April, 2024
HomeMedico-LegalRAF heads to ConCourt in battle against medical aid payments

RAF heads to ConCourt in battle against medical aid payments

The Road Accident Fund (RAF) is now turning to the Constitutional Court after its application to appeal a ruling in favour of Discovery Health was dismissed by the Supreme Court of Appeal.

“The Road Accident Fund will be petitioning the Constitutional Court for leave to appeal and will not comment further,” spokesperson Linda Rulashe told The Citizen.

Medical schemes submit claims to RAF after footing the bill for members who suffered injuries in road accidents, but the agency was taken to court by Discovery for non-payment of medical aid costs.

The RAF has argued that it had “no duty to reimburse a medical scheme if an accident victim’s expenses have already been paid”, but the High Court ruled against the agency.

‘No compelling reasons for an appeal’

Now, in their judgment, SCA Judges Zamani Mhlangulela and Christiaan Van Der Merwe said there was nothing compelling the court to hear the RAF's appeal of the High Court judgment.

“The application for leave to appeal is dismissed with costs on the ground that there are no reasonable prospects of success in an appeal, and there is no other compelling reason why an appeal should be heard.”

The RAF first lost the medical scheme case before Judge Mandla Mbongwe in the Gauteng High Court (Pretoria) last year, which declared its internal directive to stop reimbursing medical schemes illegal. An appeal against the judgment, which also restrained the RAF from implementing its policy, also failed in January.

On 20 February, the fund filed papers directly to the SCA.

RAF must pay up

Discovery CEO Ryan Noach said the SCA judgment should put an end to the debacle.

“Discovery Health is still awaiting the 18(3) judgment (compelling the RAF to comply and pay up) to further enforce the SCA ruling, which will also supplement the various court findings of the unlawfulness of the RAF‘s internal directive,” he said.

“…Discovery is confident the RAF will, as a responsible citizen, fully comply with the ruling and immediately resume paying past medical expenses in respect of injured medical scheme members.” He accused the fund of “unlawfully discriminating” against medical scheme members by excluding them from payments.

RAF’s woes multiply

Cases against the RAF by accident victims continue to swamp various courts.

Mpumalanga High Court Judge President Francis Legodi recently issued RAF bosses with personal cost orders for failing to execute their duties and leaving cases in disarray. RAF also removed its panel of lawyers in 2020 without a contingency plan.

In their appeal against Legodi’s judgment, RAF CEO Collins Letsoalo and the board claimed they were unaware of litigation by two of the claimants, saying Legodi had made a mistake.

They told the court they were never going to allow attorneys – whose term had expired and “acted contrary to the interests of RAF” – to continue with their services.

In another adverse judgment in February in the same court, Legodi ordered Letsoalo and the board to explain why they rejected medical expenses claims.

Legodi further invited all medical schemes and other interested parties affected by the RAF’s policy to join and file their own affidavits in the matter.

 

The Citizen article – Embattled RAF heads to ConCourt after SCA dismisses its Discovery appeal (Restricted access)

 

See more from MedicalBrief archives:

 

RAF turns to Appeals Court over medical aids directive ruling

 

Triumph for medical schemes as RAF denied leave to appeal payment ruling

 

RAF heads for Appeal Court over medical aid payout ban ruling

 

Court bid to halt new RAF medical tariffs

 

 

 

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