Tension between RAF, medical aid schemes finally boils over

Tensions between the Road Accident Fund (RAF) and the Council for Medical Schemes (CMS) have reached a boiling point as the mooted overhaul of South Africa’s road accident benefits becomes polarising.

The draft RAF Amendment Bill, published for public comment this month, which if enacted will significantly curtail benefits paid to road accident victims, has divided public opinion, and raised the ire of medical aid schemes.

RAF this week tore into CMS, telling it to “stay in its lane”, in a statement that suggests the medical aid members are not above other members of society.

“It would seem, it has become a norm that those that are unsuccessful in trying to frustrate the objectives of the RAF strategy to resort to misinformation, which at first looked to us like confabulations. It is always an attempt to portray the RAF as an organisation that is in disarray, recalcitrant and an organisation in a crisis”, RAF said.

RAF added: “One will struggle to find facts in all these attacks; it is purely misinformation, lies and more lies.”

Some of the contentious features of the draft bill is that hit-and-run accident victims will not be compensated if the bill becomes the law of the land.

The proposed amendments also don’t allow for compensation for any person who is not a South African citizen or direct permanent resident.

Currently, a claim for loss of income is paid out in a lump sum. Under the new system, claimants will receive annuity (partial) payments that will eventually equal the lump sum.

There is also the qualification that the amount payable is subject to periodic review of the RAF’s liabilities. If a claimant dies before full annuities are received, the payments will stop, and their heirs will inherit nothing.

The implication for the medical aid schemes and medical aid members is also huge as there would be no reimbursement of expenses covered by medical aid/insurance.

 “We predict this will drastically increase premiums with dire consequences for all medical aid members,” Justin Erasmus, chairperson of the Personal Injury Plaintiff Lawyers Association (Pipla) said.

Pipla said it had already received more than 5 000 objections to the bill, which, it says if it becomes law, will negatively impact the rights of all drivers, passengers and pedestrians to claim compensation for injuries they suffer in a motor vehicle accident.

Dr Herman Edeling, chairperson of South African Medico-Legal Association, said it would be a tremendous shame if poor people are deprived of general damages compensation, which is separate to loss of earnings and medical expenses.

“In principle, victims can get compensation for medical expenses under section 17, however the RAF does not pay upfront. So, to put this in perspective, if you are unemployed and have no money, or your life is devastated from the injury, you now cannot pay for treatment. You will be expected to pay for all your medical needs upfront and then claim back from RAF, so in essence the annuity payments are worthless.”

“The general damages claim is what people use to get treatment and survive in the event of a life changing event. With the new bill, people will get nothing. As a medical practitioner, I believe this is immoral and professionally I believe it is unethical.”

The CMS had previously raised concerns about the exclusions of medical aid members.

However, RAF said the CMS was posturing. “The CMS is acting ultra vires to its own mandate and in the process undermining its role in protecting the most vulnerable, members of medical schemes. What is next really? Refusal to pay public hospitals because those without medical aid receive free medical treatment, and medical scheme members are also taxpayers entitled to free medical care?”

The CMS said it would not be commenting on RAF’s missive.

“The CMS will submit its comments on the draft RAF Bill.”

The public has until October 7 to comment on the bill.

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