Court ruling forces RAF to pay medical aid schemes
THE Road Accident Fund (RAF) does not fall under the Department of Employment and Labour.
The shenanigans and the dysfunctionality of the RAF almost mirrors the largely dysfunctional Department of Employment and Labour.
As an aside, it must be mentioned the only functional element within the Department of Employment and Labour is the Commission for Conciliation, Mediation and Arbitration.
In the past week, we have seen two interesting court rulings against the RAF.
First, a few days ago, the RAF lost its application to appeal against a 2022 court ruling. The court said the RAF would have to continue paying the medical aid schemes (a third party) for medical expenses incurred on behalf of injured patients (members of the schemes) who had been in vehicle accidents. The medical schemes have paid out the medical service providers who had attended to the members injured in road accidents. In turn, the medical-aid schemes would claim the money from the RAF.
Although the RAF was taking years to pay the medical schemes, at least it was, more or less, being done. The medical schemes had the clout and ability to hold the RAF to account, claim large amounts and even go to court if the amounts hadn’t been paid. Obviously, the injured individual does not have the wherewithal to take the RAF to court.
Invariably, the RAF would not pay the medical service providers either, leaving a situation where medical service providers did not want to administer to road accident fund victims. The system is falling apart and those who have had accidents can testify to the nightmare they have had to try to claim. The only reason the RAF, a statutory body, wanted to stop paying the third-party service providers (medical aid schemes) was that the medical aid schemes had the financial ability to hold the RAF to account.
The RAF is aware individuals cannot hold it to account because of the prohibitive legal costs and the enormously long wait for the courts to adjudicate the claims.
The solution the RAF came up with was to introduce a policy stating it would no longer pay third-party medical aid schemes. This destroyed the injured person’s ability to see medical doctors of their choice through their medical aids. Stopping the payment to medical aids would stop the medical aids helping the injured individuals as the medical aids are not liable for road accident victims.
The court, sensibly, ruled the change in protocol was illegal and the RAF had to continue paying the third-party medical aid schemes. The RAF was being stopped in mid-air, and wanted to try to appeal this but was denied leave to appeal.
The system, thought up by duplicitous ministers, is repeating itself within the Department of Employment and Labour. After at least three years of debate, the Compensation Fund, wanting to introduce the non-payment of third parties, could not introduce that non-payment through the legislative change.
The nasty minister of employment and labour chose to look at a sneaky way around the problem – to introduce regulations trying to stop third party intervention in the Compensation Fund.
In essence, the Compensation Fund, being as broken as the RAF, is notoriously paying out very few claims. If an injury occurs at work, the individual is covered by the Compensation Fund and should be able to go to a doctor of their choice.