South Africa’s Road Accident Fund is now rejecting claims from people with medical aid

South Africa’s Road Accident Fund (RAF) earlier this month instructed all RAF offices via an internal statement to reject claims from individuals for past medical expenses which were covered by medical aids, reports EWN.

Despite R3.93 of every litre of fuel in the country going to the RAF, regardless of who paid for it, the fund argues that individuals with medical aid are covered by their insurance and therefore incur no expenses and suffer no losses when in an accident.

“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,” said EWN.

The RAF is now being challenged in this decision both by accident victims as well as Discovery Health. The matter is set to go to court in September.

Legal challenge

EWN reports that a Limpopo resident, Phineas Mawila, was involved in an accident in 2017 for which he was not responsible and he is now challenging the RAF in court to review and set aside its new internal policy.

Mawila said he was catching a lift home on 27 May 2017 and while doing so the driver of the car he was in acted irresponsibly and the vehicle rolled, leading to the passengers suffering from severe injuries and Mawila being hospitalised for three and a half months.

His medical aid covered the almost R1-million bill, but in his claim to the RAF, Mawila said he would recompensate the medical aid once the RAF claim pays out.

After this new rule, however, Mawila’s claim to the RAF may be rejected and he could be liable to pay back the medical scheme out of his own pocket and be left in a dire financial situation.

He argues the RAF does not differentiate between those with medical aid and those without, and that the new policy also wasn’t submitted for public consultation and no prior announcements were made before it was implemented.

According to Mawila’s legal representative, Jason Ruiters of Roets & Van Rensburg incorporated, the RAF’s new policy could leave many individuals with medical aid in terrible situations.

“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,” said Ruiters in an interview with EWN.

“The net result of this decision by the RAF is that a claimant will now be left out of pocket.”

Ruiter further said the RAF is obliged to compensate any third party for loss or damage which may have arisen from a car accident.

“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,” he said.

“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.”

Mawila also filed a Rule 16 A notice which lays out the constitutional issues in his case, and other parties are invited to join this application.