Discovery Health will turn to the Gauteng High Court, Pretoria, next month to obtain an urgent order to declare the Road Accident Fund CEO, Collins Letsoalo, in contempt of court for allegedly not adhering to three court orders pertaining to the payment of medical claims.
Under the directive, the RAF made it clear that it would not make payments in cases where claimants’ medical aid schemes had paid for their accident-related injuries.
Last month, the Constitutional Court refused to entertain an application by the RAF for leave to appeal against a ruling in which a judge had put an end to its directive that it would no longer pay for past claims for medical expenses by members of medical aid schemes injured in vehicle accidents.
Last year, the court has found the directive illegal. The RAF, in turn, launched several unsuccessful applications in a bid to appeal the judgment, including the recent one in the Constitutional Court.
The apex court turned down the fund’s application for leave to appeal on a technicality, after it ruled that the appeal did not fall within its jurisdiction.
While the judgment remains in place, which puts an end to the RAF’s August 2022 directive, the fund said an amended directive had replaced it.
Discovery Health and the RAF, however, do not see eye to eye on the matter, with the health insurance giant adamant on holding the fund in contempt of court if it did not adhere to the previous court orders.
The fund, on the other hand, says the amended directive absolved the RAF from last year’s judgment against it.
In papers filed in the urgent application, Discovery Health is asking for an order declaring the fund and its CEO to be in contempt of court.
Discovery Health general manager Jeffrey Katz said in court papers that the fund was rejecting claims if the claimant’s medical scheme had paid for the medical expenses incurred by the claimant.
He is asking that the RAF be ordered to accept the claims, or else Discovery Health would return to court to ask for Letsoalo to be jailed for contempt of court.
The RAF was given until November 22 to file its opposing papers.
Katz said that ever since the August 22 directive (which was declared illegal by the court) large numbers of of claims were being settled or finalised daily, based on the unlawful directive.
“Claimants are likely to accept such unlawful settlement offers as past medical expenses are one of a number of heads of damages claimed by them to support themselves and their families,” he said.
Katz said that when that happened, medical aid schemes could not recover past medical expenses it had paid to its members.
“The effect of the August 2022 directive is that the RAF is unlawfully refusing claims for past medical expenses for which it is statutorily liable to compensate road accident victims. As a result, medical schemes are unable to reclaim the costs.”
Katz said medical aids were suffering enormous irrecoverable losses as a result.
He said that shortly after the Constitutional Court judgment last month, Letsoalo and other RAF officials had said they would continue to refuse to resume payments of expenses that medical schemes had paid.
Katz said the RAF had sought to circumvent the judgment by adopting a new directive, which he referred to as “the phantom directive”.
Under the amended directive, issued in April, the fund will reject the payment of prescribed minimum benefits and emergency medical conditions claimed by medical schemes on behalf of its members who are victims of vehicle accidents.
Katz said that as the directive was issued in April, the RAF had failed to disclose it in its subsequent bids to appeal last year’s judgment.