Discovery Health says the Road Accident Fund and its CEO are in breach of a court order that said the fund could not withhold payments for past medical expenses covered by medical aids.
While initially Discovery, in its application before Gauteng Judge President Dunstan Mlambo and judges Ingrid Opperman and Noluntu Bam on Thursday, were seeking orders of contempt of court, Trengrove said it was now only seeking an order of"breach" and to compel compliance. The RAF was unsuccessful in its appeals to both the Supreme Court of Appeal and the Constitutional Court.
"But that agreement is merely an agreement to avoid double-compensation. That the medical aid pays upfront and if the member recovers , then that member will reimburse the medical aid," Trengove said. "Our courts have held that medical schemes, for the purposes of claims, are akin to insurance, and claims cannot be taken into account when determining the quantum of liability," Trengove said.But advocate Cedric Puckrin, who appeared with advocate Gerhard Cilliers for the fund, said Trengove had argued his case"with rose-coloured glasses".
Cilliers suggested that Discovery had no standing in court, and that it was up to individual claimants to take their matters to court."It is not Discovery's case that RAF is enforcing the 2022 directive. It wants you to go further and ask you to find that the subsequent directives are the same. And we submit that is not the proper process to follow. It is an abuse of the process."
Source: Healthcare Press (healthcarepress.net)
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