Discovery Health has revealed it will seek to hold the Road Accident Fund (RAF) in contempt of court if it fails to comply with this week’s Constitutional Court decision to honour claims lodged on behalf of members injured in traffic accidents. A Business Day report says this follows it losing its legal battle to overturn a High Court interdict secured in 2022 declaring its decision to exclude claims from medical scheme members unlawful, after the Constitutional Court rejected its application to appeal the lower court’s ruling. In what the Business Day calls a surprise turn of events, RAF CEO Collins Letsoalo told the newspaper on Wednesday the RAF would not resume payments to medical schemes, despite the apex court’s decision. ‘We are surprised by Mr Letsoalo’s position, which appears not only to be antagonistic but also flies in the face of the clear and strong position taken by the courts,’ said Discovery Health CEO Ryan Noach. He added Letsoalo’s ‘alleged assertion that the RAF will not pay the claims of these road users who are medical scheme members is – to the best of our understanding – contemptuous of the explicit ruling of the High Court, which both the SCA and now the Constitutional Court have affirmed. ‘Should the RAF fail to process these valid claims, then unfortunately, as a last resort, we would be left with no alternative but to seek to enforce the court’s ruling through a further application for a contempt and enforcement order,’ said Noach.
The RAF yesterday dug in its heels, saying it stands by the position it previously articulated to Business Day. ‘There are no implications on the RAF following the Constitutional Court decision. The court order did not deal with any merits. It raised issues of a lack of jurisdiction,’ said Letsoalo. When asked to respond to the medical scheme’s threat to seek a contempt of court and enforcement order if the RAF fails to resume paying medical scheme claims, he said: ‘They must not litigate through the media. We will not be blackmailed. If they want to go to court, so be it.’ Letsoalo said the RAF issued an internal directive on 12 April stating its legal position about prescribed minimum benefits (PMBs) and emergency medical conditions, and how those claims should be processed. ‘That directive has neither been challenged nor set aside and thus still applies.’ He previously told Business Day the RAF’s position has always been that it will not pay for prescribed minimum benefits and emergency conditions.
Moneyweb requested further clarity and details from the RAF about the directive referred to by Letsoalo but has not received a response yet. It says this request was prompted by the fact that Judge Mandla Mbongwe’s judgment handed down in the Gauteng High Court (Pretoria) in October 2022 referred to a Discovery Health application to review and set aside an RAF directive issued on 12 August 2022 by the RAF’s acting chief claims officer. Mbongwe declared this directive unlawful. This directive instructed RAF employees not to pay claimants if their medical aid scheme has already paid for their medical expenses arising from a road accident. Noach said yesterday it is unaware of any further directive. ‘The only directive we know about is the internal memo sent by the RAF on 12 August 2022,’ he said. Noach added that PMBs are defined by the Medical Schemes Act and are ‘relevant only to the conduct of medical schemes in terms of how specific conditions are funded’. ‘PMBs have no legal bearing whatsoever on the RAF,’ he said.
