Pretoria - Communication from the Road Accident Fund (RAF) to its claim handlers stating that it would no longer pay for expenses already disbursed by a medical scheme to a claimant is being challenged in court.
Phineas Mawila, who was seriously injured in a car accident earlier, will on September 26 ask the Gauteng High Court, Pretoria, to have the circular sent by the RAF overturned.
He said in papers filed at court that he was lodging this application in the interest of all victims of vehicle accidents as it would adversely affect everyone who lodged a claim with the RAF.
The reasoning of the RAF for no longer paying for past medical expenses was that those claimants with medical aid were compensated for the medical bills which they issue to the various schemes.
According to the RAF’s reasoning, claimants with medical aids which footed their medical expenses did not suffer a financial loss, and therefore, there was no duty on the RAF to reimburse these claimants.
But Mawila stated that this communication was wrong in law as road accident victims remained contractually obliged to reimburse their medical aid schemes upon recovery of the money from the RAF.
The RAF thus remained liable as the “statutory insurer” for personal injury claims arising out of motor vehicle accidents, and it was not entitled to benefit from a contract concluded between a claimant and a third party, it was stated.
Further, it was said that by introducing this new policy, the RAF sought to escape its statutory obligations and liability by shifting its financial burden on to the industry stakeholders.
Mawila said this not only undermined the purpose of the RAF, but it would have severe consequences for the industry and constitute a limitation on the rights of the individual members of medical schemes.
According to him, the circular issued by the RAF was inconsistent with the Constitution and thus invalid.
“This application concerns issues of material prejudice, not only to me but also to all potential claimants under the RAF Act who have medical aid and where the medical aid pays for the medical expenses incurred as a direct result of the accident.”
Mawila added that it was a matter of significant public importance and of universal application and benefit to all potential claimants with medical aids who claimed from the RAF for past medical expenses.
“Virtually on a daily basis, injured victims such as me are involved in vehicle accidents and qualify for compensation from the RAF under the provisions of the Act, which applies to both those with medical aid and those without medical aid.
“Numerous claims are lodged with the RAF by road accident victims who do in fact have their own private medical aid.”
Mawila said the circular distinguishes between those claimants with medical aid and claimants without medical aid despite the fact that they have all suffered damages by way of past medical expenses caused from motor vehicle accidents.
He said the impact of the circular was that the RAF would not be accepting liability and would not be paying for claims in respect of past medical expenses where a road accident victim had medical aid which covered the related expenses.
“Never before has such a limitation existed with regard to claims of this nature, and nowhere in the Act or any other law or regulation is the RAF exempted from paying such costs under circumstances where the medical aid has covered the costs.”
Mawila said the RAF decided on this unilaterally without embarking on a public participation process.
The RAF must still file its responses to the application.
Pretoria News