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Gert Nel Incorporated is a preferred Discovery Health Medical Scheme panel attorney
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In terms of Rule 15.7A of Discovery Health Medical Scheme’s rules a member should inform Discovery of their intention to claim from any other party for instance the Road Accident Fund and reimburse the Scheme with any payments made in respect of a member’s or dependants injuries.
Gert Nel Incorporated assists members of the Scheme to understand and comply with the applicable rules whilst at the same time ensuring that members receive the full spectrum of compensation claimable in terms of the Road Accident Fund Act 56 of 1996, as amended.
The following is an extraxt from a moneyweb interview on the 8th of October 2013:
“Discovery Health Medical Scheme members have full cover for claims related to a motor vehicle accident
Members of the Discovery Health Medical Scheme are fully covered for injuries or any other healthcare claims that result from a motor vehicle accident or any other injury.
These claims are paid in line with a member’s plan choice and the guidelines established for the Prescribed Minimum Benefits. Discovery Health settles claims as soon as they are received, including those resulting from motor vehicle accidents.
Claims paid by the RAF for healthcare expenses already paid by a medical scheme must be reimbursed to the medical scheme
If members decide to institute claims against the third parties responsible for sustained injuries, this is their own decision. Should the RAF pay out for medical expenses already paid by the Scheme, members are then required to refund these claims to the scheme. The Council for Medical Schemes has ruled unequivocally in favour of the Discovery Health Medical Scheme on this issue, concluding that the scheme is entitled to claim reimbursement of medical expenses paid in respect of RAF matters. This is in accordance with the Scheme’s rules and in terms of common law principles.”
Related Links
- Explanation of Attorney and Client fees – subject to medical aid contribution
- Download an extract from Discovery’s rules governing the recovery of expenses against a third party (RAF).
- You can’t claim from your medical scheme and the RAF
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