Nosana v Road Accident Fund
| Jurisdiction | http://justis.com/jurisdiction/166,South Africa |
| Judge | Molitsoane J |
| Judgment Date | 08 September 2023 |
| Citation | 2023 JDR 3457 (FB) |
| Hearing Date | 06 June 2023 |
| Docket Number | 1092/2021 |
| Court | Free State Division, Bloemfontein |
Molitsoane J:
The Plaintiff instituted a claim for damages arising out of injuries sustained from the negligent driving of a motor vehicle. The defendant conceded liability on the basis that it shall pay 100% of the plaintiff’s proven or agreed damages.
2023 JDR 3457 p2
Molitsoane J
The issues of future medical expenses, future loss of earnings as well as general damages were settled on the basis as set out in the order below.
The past hospital and medical expenses remain unresolved. It needs to be recorded that the plaintiff originally claimed an amount of R471 511-93. The defendant paid an amount of R409 714-17 leaving a balance of R61 797-76. It is this balance which is the subject of this dispute.
During the hearing of this matter, the parties agreed that the expert reports of the plaintiff attached to their respective affidavits be handed in as evidence in terms of Rule 38(2). Counsel for the Defendant also admitted on behalf of the Defendant the correctness of the contents of the reports aforesaid. No expert reports were handed into evidence on behalf of the Defendant. The Defendant also handed into evidence the affidavit of Tanusha Tia Hoosen, an employee of Discovery Medical Aid Scheme in which she set out the expenses incurred by her employer as past medical and hospital expenses. It is undisputed that the Plaintiff was a member of Discovery Medical Aid- Scheme. The expenses incurred are also not in dispute.
The crisp issue for determination in this case is whether the plaintiff is entitled to claim the expenses incurred by the medical aid on behalf of the Plaintiff.
The opposition to the payment of the balance of the past medical aid was based on the Internal Communique from the Acting Chief Claims Officer of the defendant addressed to all regional managers of the defendant. The said communique instructed the regional managers as follows:
“All Regional Managers must ensure that their teams implement the attached process to assess claims for past medical expenses. All RAF offices are required to assess claims for past medical expenses and reject the medical expenses claimed if the Medical Aid has already paid for the medical expenses. The regions must use the prepared template rejection letter (see attached) to communicate the rejection. The reason to be provided for the
2023 JDR 3457 p3
Molitsoane J
repudiation will be that the claimant has sustained no loss or incurred any expenses relating to the past medical expenses claimed. Therefore, there is no duty on the RAF to reimburse the claimant. Also attached is a list of Medical Schemes. Required outcome: immediate implementation of the process and 100% compliance to the process.’’
As a starting point, it appears that the defendant originally had no problem in paying for past hospital and medical expenses incurred by Plaintiff which arose as a result of the injuries sustained and ultimately settled by the Medical Aid Scheme. The only reason that the defendant now refuses to make a payment of the balance is as a result of the communication as set out above. During the hearing of this matter, no submissions were made that the original payment for past medical expenses were made in error or were not due, or even still that were not paid for by the medical aid scheme. Counsel for the Defendant did not make any submissions as to why the past medical expenses paid, differed from the ones left for later adjudication. It is also not the case for the Defendant that the past medical expenses were not incurred.
Section 17(1) of the Road Accident Act, 56 of 1996 obliges the RAF, subject to certain exclusions and limitations, to compensate any person where injury has been sustained or death occurred as a result of the negligent driving of a motor vehicle. It is important to note that the Defendant in this case seeks to escape liability on the basis that the past medical expenses were paid for, by the medical aid scheme.
It is to be noted that the damages the plaintiff claims must be assessed at the time the injury was sustained. It is in my view irrelevant if the medical aid undertook to pay for his medical expenses or even indeed paid for them. The issue of whether the Plaintiff had a medical aid or not has...
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