The Road Accident Fund (RAF) has welcomed a significant ruling by the full bench of the Gauteng High Court in Pretoria, which dismissed Discovery Health’s efforts to compel the fund to reimburse the medical scheme for costs paid to its members involved in car accidents.
This decision not only reaffirms the RAF’s obligations but also sets a precedent that may influence future claims and court actions.
The case stemmed from Discovery Health’s claim that the RAF, under the leadership of CEO Collins Letsoalo, violated an earlier judgment mandating the fund to reimburse medical expenses for accident-related injuries after paying the medical schemes. The core issue revolved around whether the RAF should cover past medical expenses for road accident victims already compensated by their medical aid schemes.
In August 2022, the RAF issued a directive that rejected claims for past medical expenses from road accident victims who had already been compensated by their medical schemes.
The fund justified its decision on the basis that these claimants had not suffered any loss—a stance that sparked legal action from Discovery Health seeking to overturn the directive.
Discovery asserted that the RAF’s directive was unlawful, and it successfully pushed for an urgent court review that halted the fund from denying claims based on this directive.
However, the RAF continued to issue further directives to deny claims from insured individuals who had previously been reimbursed for their medical expenses, prompting Discovery to return to court to argue that the RAF was in breach of the 2022 judgement.
During the hearings, presiding Judge President Dunstan Mlambo scrutinised the RAF’s defence, noting the financial viability of medical schemes
like Discovery Health, which operate independently of the RAF.
The court pondered whether the RAF should prioritise funding medical contributions for a select group of privately insured individuals, rather than focusing on the many claimants who are often financially disadvantaged due to road accidents.
In an emphatic conclusion, the court found that the RAF’s reliance on its subsequent directives did not constitute a breach of the earlier judgement. This verdict may set a critical legal groundwork for similar disputes in the future.
“What we were called to decide in this case is whether by relying on the two subsequent directives, the fund breached the Mbongwe J judgment (the 2022 judgment). We find that it did not,” the court stated.
In response to the ruling, Letsoalo expressed elation, viewing the outcome as vindication for the RAF’s management. He acknowledged facing considerable criticism yet defended their decision to uphold their course of action. “This outcome is now case law which will be studied by law students and quoted in court cases well into the future,” he stated.
Moreover, the court imposed punitive costs on Discovery Health, further intensifying the implications of this ruling and signalling the judiciary’s stance on similar matters between medical schemes and the RAF.
Pretoria News