Medical aid scheme Discovery on Thursday asked a full Bench (three judges) of the Gauteng High Court, Pretoria to hold the Road Accident Fund and its CEO, Collins Letsoalo, in breach of an earlier judgment.
The judgment had ordered the fund to resume paying medical funds after it has also paid its medical aid members following a vehicle accident.
Advocate Wim Trengove SC told the judges, led by Gauteng Judge President Dunstan Mlambo, that they would not, at this stage, ask the court to declare that the fund and Letsoalo were in contempt of court.
Trengove argued that it was enough to get an order that the RAF was in breach of the earlier order, as they would later pursue an application to hold Letsoalo in contempt of court.
That, he said, would go alongside an application during the second leg of the proceedings, if they were successful in this application, to ask for a possible jail sentence if Letsoalo and the fund were found to be in contempt of court.
But Trengove said as that leg of the proceedings would entail a possible jail sentence as a sanction, Discovery wanted to give Letsoalo time to answer whether he and the fund were in wilful contempt of the court order issued in October 2022. He said Discovery also wanted to give Letsoalo time to answer to a further application regarding a possible jail sentence.
Last year, the Constitutional Court spoke the last word when it refused to entertain an application by the RAF for leave to appeal against a ruling in which a judge earlier 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.
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.
The court earlier declared the directive pertaining to medical aid payments unlawful. This followed an urgent application by Discovery Health.
The court subsequently dismissed an application by the RAF for leave to appeal against that judgment.
The RAF then approached the Supreme Court of Appeal for leave to appeal, but was also turned down. The fund then decided to head to the apex court, where it also lost.
The effect of the Constitutional Court ruling is that claimants who belong to medical aid schemes retain the right to claim medical expenses incurred after an accident, from the RAF.
But Discovery has turned to a full Bench to ask for an order that the RAF and Letsoalo be compelled to adhere to the October 2022 judgment.
It cited letters the RAF wrote to 10 claimants in which the RAF, despite the October 2022 judgment, refused to compensate them for medical expenses which had been paid to them by their medical aid schemes.
That, Discovery said, showed that the fund did not adhere to the court order. Discovery said the fund and Letsoalo were implementing a directive that staff should not reimburse claims from medical aid schemes.
Trengove said that clearly showed that the fund was in breach of the earlier court order.
He said that a few days after the Constitutional Court had refused the fund leave to appeal, the fund issued further directives, barring the payment of medical expenses in cases where the medical aid schemes had paid their members.
He said Discovery had launched the proceedings on behalf of its members and the general public.
Advocate Jaap Cilliers SC, who argued together with advocate Cedrick Puckrin SC for the fund, said Discovery’s application was ill founded and premature.
Cilliers said Discovery lacked the legal standing to bring the application, as the RAF Act stated that only claimants and service providers could litigate against the fund.
He also disputed the argument that Discovery was acting in the public interest and said it was relying on 10 letters received by nameless claimants that the fund would not pay them their past medical expenses.
Cilliers said the claimants should follow the normal court process followed by creditors and debtors and issue summons against the fund for the payments if they wanted to take the matter further.
He said Discovery had not proved that the fund was in breach of the court order, as the time when it wrote letters to the 10 claimants and refused payments, it had been entitled to do so.
Cilliers told the court that that was done while the fund was embroiled in appeal proceedings regarding the 2022 order, which, at the time, had suspended the order.
Judgment was reserved.
Pretoria News
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