Many of us rely on our medical scheme to ensure that in the unlikely event of a loved one being injured in a motor vehicle accident they receive the very best medical care money can buy.
A recent decision by the Road Accident Fund (the RAF) to no longer include claims for past medical expenses paid by medical schemes in payments made on claims made against the RAF, might result in the current cost of medical scheme cover escalating even further.
Discovery Health is taking on the Road Accident Fund on this decision which was made this year after these expenses have been paid to claimants in the ordinary course of handling claims since the Road Accident Fund came into existence almost 25 years ago.
Discovery Health’s urgent urgent application to have the RAF’s directive set aside was heard on 1 September 2022 before Judge Mbongwe of the Gauteng Division of the High Court – Pretoria.
Judge Mbongwe delivered his judgement on 26 October 2022 and held that the directive is unlawful, that it is reviewed and set aside, and that the RAF is interdicted and restrained from implementing the directive.
The RAF was quick to bring an application for leave to appeal to which Discovery Health responded by bringing a counter–application in terms of sections 18(1) and 18(3) of the High Courts Act in which they asked the court to rule that the judgement handed down by Judge Mbongwe must be implemented, and not suspended as is usually the case when an application for leave to appeal is brought.
These two applications were heard on Friday 2 December 2022. Judgement was reserved and is eagerly awaited given the huge implication of the outcome of this matter on the medical schemes industry, which relies on the income it derives from claims made against the RAF by their members for past medical expenses in determining the premiums currently charged for medical cover for road accident claims.