Higher premiums looming

Discovery Health intends to appeal judgment, 'given its implications'.

- Roy Cokayne

Higher medical aid premiums are a looming possibility if a judgment in favour of the Road Accident Fund (RAF) is not successfully appealed.

The court ruled that the fund was not liable for payment of past medical expenses of accident victims whose medical schemes had already paid those costs.

The majority judgment was handed down last week by a full bench of the High Court in Pretoria by Gauteng Division Judge President Judge Dunstan Mlambo and Judge Noluntu Bam. Judge Ingrid Opperman dissented.

Opperman referred to the order handed down on 27 October, 2022 by Judge Mandla Mbongwe in the High Court in Pretoria that declared unlawful the 12 August 2022 RAF directive, which instructed its employees not to make any payments to claimants if their medical aid scheme had paid for their medical expenses arising from a road accident.

She said Mbongwe listed the consequences for Discovery Health scheme members and their clients if the RAF directive was implemented and said rejection of claims meant that:

Medical aid schemes would no longer be receiving reimbursement for past medical expenses incurred for treatment of their clients whose rights to recover these expenses from the RAF stood to be taken away;

Medical aid schemes would suffer a significant, unplanned loss of income that would require that they reassess and increase monthly premiums payable by their clients to ensure the sustainability of the schemes;

Members would be prejudiced in that they would contribute to the RAF fuel levy, but not receive full compensation from the RAF in the event of sustaining injuries caused by the wrongdoing of a negligent driver; and