New RAF ruling on medical expenses faces legal challenge

COMMUNICATION from the Road Accident Fund (RAF) to its claim handlers stating 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 will on September 26 ask the Gauteng High Court in 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 had lodged a claimed 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, claimants with medical aids which footed their medical expenses did not suffer a financial loss, hence there was no duty on the RAF to reimburse them.

But Mawila said this communication was wrong in law as road accident victims remained contractually obliged to reimburse their medical aids on recovery of the money from the RAF.

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 onto the industry stakeholders.

Mawila said this not only undermined the purpose of the RAF, but 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 RAF circular was inconsistent with the Constitution. “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 said it was of public importance and of universal application and benefit to all potential claimants with medical aids who claimed from the RAF for past medical expenses.

Mawila added that the RAF decided on this unilaterally without embarking on a public participation process.

The RAF must still file its responses to the application.