RAF in trouble for new policy to stop paying for past medical aid expenses

The Road Accident Fund (RAF) is being hauled to court over a contentious new policy to stop paying out for past medical expenses covered by medical aid.

A Limpopo man who was left unable to walk for months on end after a car crash in May 2017, is challenging the move.

He said it unfairly discriminated against medical aid members like him and violated their basic human rights.

Moreover, this isn’t the only court action the fund is facing over the policy. Discovery Health, too, is challenging it.

The controversial move was announced in an internal communique published earlier this month, which states that all RAF offices must now reject claims for past medical expenses – which were covered by medical aid on the grounds that these claimants “sustained no loss or incurred any expenses”.

Last week, though, Phineas Mawila – represented by Roets & Van Rensburg lncorporated – filed an application in the Pretoria High Court seeking to have the communique reviewed and set aside.

In his papers, Mawila explained how he was getting a lift home on the morning of 27 May 2017 when he was involved in an accident.

“Whilst so traveling it appeared that the driver of my vehicle tried to overtake another motor vehicle and moved over into the lane of oncoming traffic. We arrived at a speed hump in the road and as such, the driver of my vehicle swerved into the Ieft-hand lane. The driver then lost control over the motor vehicle and it rolled. We came to a stop next to the road on the left-hand side,” he said.

He suffered a range of injuries, leaving him in hospital for a total of three-and-a-half months and having to undergo physiotherapy before he could walk again.

According to Mawila, medical aid footed the bill for the almost R1 million in medical expenses he racked up as a result of the accident at the time.

But he undertook to include its outlay in his claim against the RAF and to recompense the scheme when that claim paid out. And on the back of this communique, he argued in his papers that he could now be liable to pay back these monies himself and left out of pocket as a result.

Mawila argued that the RAF Act doesn’t differentiate between claimants who have medical aid and those who don’t.

Mawila’s position was that the RAF’s newly adopted policy was unconstitutional and impacted on the constitutionally enshrined rights to equality, human dignity, freedom and security of the person, health care and social security, just administrative action, and access to courts.

He further argued that as far he was aware, there was no prior warning nor any public consultation.

“That patently prejudiced those who might otherwise have been able to regularise their affairs. I certainly proceeded to prosecute my case in the belief that I would be entitled to claim compensation for past medical expenses under the Act,” he said.

He wants the communique declared unconstitutional and invalid and for the court to review it and set it aside.

He has also filed a Rule 16 A notice, laying out the constitutional issues his case raises and inviting other interested parties to join the case.

Speaking to the publication, Mawila’s lawyer – Jason Ruiters of Roets & Van Rensburg lncorporated – explained that the RAF’s new policy had serious implications for all claimants on medical aid,

“This is because a claimant has a contractual obligation to reimburse his medical aid for past medical expenses covered or paid by them once he is successful with his RAF claim. The decision by the RAF to reject a claim for past medical expenses means that the RAF will not be paying for such past medical expenses while a claimant is under a contractual obligation to repay the medical expenses to his medical aid. The net result of this decision by the RAF is that a claimant will now be left out of pocket”.

“In terms of the RAF Act, the fund is obliged to compensate any third party for loss or damage which the third party might have suffered, caused or arising by a motor vehicle accident,” he said.

“The impact of this communique is that the RAF escapes liability and will now not be paying for claims for past medical expenses where a road accident victim has medical aid. Never before has such a limitation existed with regard to such claims. Nowhere in the act or any other law or any regulation in the RAF, exempts them from paying such costs.”

The matter is set to come before the court late next month.

The RAF had not responded to a request for comment at the time of publishing.

-EWN

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