In a development that has industry-wide implications, the Gauteng High Court (Pretoria) has denied the Road Accident Fund (RAF) leave to appeal against its ruling last year that the fund’s decision to stop paying medical schemes was unlawful.
The latest ruling now gives medical schemes and their administrators assurance that they can continue to claim from the RAF on behalf of their members, reports BusinessLIVE.
For decades, medical schemes have covered the cost of their members’ hospital and medical bills, in accordance with the benefits they are due in terms of their policy, and then claimed the money back from the RAF. Last August, the RAF unilaterally decided to stop paying for medical expenses for road accident victims who belonged to medical schemes.
The decision was successfully challenged by SA’s biggest medical scheme administrator Discovery Health, which won an urgent High Court application to have the fund’s internal directive – to stop paying medical schemes – declared unlawful and set aside. The RAF’s subsequent application for leave to appeal was dismissed with costs on Monday.
“The setting aside of this unlawful directive protects members from having to pay twice for protection against medical expenses associated with road accidents: through the fuel levy and then again through their medical scheme contributions,” said Discovery Health CEO Ryan Noach. “This ruling therefore benefits all medical scheme members and is strongly in the public interest.”
Judge Mandla Mbongwe was highly critical of the fact that the RAF had issued the directive – because it was against the RAF Act and was done without consulting any stakeholders or the public, notes a Pretoria News report.
Mbongwe ruled the legal position was that the RAF could not free itself of the obligation to pay full compensation to vehicle accident victims. Thus, the challenged directive falls outside the authority of the RAF.
Turning down leave to appeal, the court this week said the fact that medical aids reimburse their members for medical expenses, had nothing to do with the RAF and did not exempt it from paying these expenses.
Pretoria News – court-dismisses-road-accident-funds-case-on-medical-aid-payments
See more from MedicalBrief archives:
RAF heads for Appeal Court over medical aid payout ban ruling
Discovery wins court bid to stop ‘rogue’ RAF’ directive
Accident victim challenges RAF decision on medical aid payments