Discovery to challenge RAF directive in court

Discovery Health has launched an urgent application in the Pretoria high court against the Road Accident Fund (RAF) and transport minister Fikile Mbalula to interdict the RAF from implementing a directive in terms of which the RAF will cease to pay for all past hospital and medical expense claims by medical scheme members with immediate effect.

It is asking the court to declare the directive unlawful. The RAF is a statutory body that pays for the medical expenses of road accident victims. It is funded by a fuel levy paid by all motorists on each litre of petrol purchased.

In terms of the directive, which was issued on August 12, no payment will be made if the claimant’s medical aid has already paid for the expenses. 

Medical aids pay for medical expenses arising from a motor vehicle accident in accordance with the benefits due to their members under their policy and then assist their members to claim these expenses from the RAF. They say the RAF’s directive will cause them to suffer financially.

According to media reports, the RAF argues that claimants belonging to medical schemes have already been paid for their medical expenses arising from road accidents and therefore have not suffered a financial loss, so there is no obligation on the fund to reimburse them. The reports quote from papers filed by road accident victim Phineas Mawila, who is also challenging the directive, saying that road accident victims remain contractually obliged to reimburse their medical aids after they have been paid out by the RAF.

It will be argued during Discovery’s urgent application 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.

 “The RAF began rejecting valid medical claims submitted by people who are members of any medical schemes,” Discovery said in a statement on Friday. It says it is acting on behalf of its administered client medical schemes and in the public interest.  

“To the best of our knowledge, this directive was issued without any consultation or notice to medical schemes, their members, attorneys or related role players. Despite extensive endeavours to engage with the RAF on the unilateral directive and related matters, Discovery Health has not received any response from senior leadership at the RAF whatsoever,” the statement said.

 “It is our firm contention that medical scheme members’ valid road accident related medical claims should be processed and paid by the RAF on the same basis as any other eligible claimant — as has been the case for the past 80 years. The RAF is legally required to provide compulsory cover, and to compensate people who suffer damages as a result of a road accident within SA’s borders.”

It says the RAF directive “unlawfully discriminates against medical scheme members who can’t access RAF medical benefits, despite still contributing to the RAF’s funding pool through fuel levies,” Discovery said.

ensorl@businesslive.co.za