- The RAF cannot refuse to pay past medical expenses because a medical scheme paid first.
- Judges confirmed medical aid benefits are private insurance and legally irrelevant to RAF liability.
- The fund’s appeal failed, and it must pay the full amount plus the costs of two counsel.
If you are injured in a crash and your medical aid pays your hospital bills, the Road Accident Fund (RAF) must still reimburse those costs. It cannot refuse payment simply because the account was already settled by a scheme.
That was the central issue before the High Court in the Western Cape. The RAF remains fully liable for past medical expenses, regardless of medical aid cover.
The ruling came after Nicolaas Johannes van Wyk, a motorcyclist seriously injured on the N1, obtained an order for more than R350 000 in past medical costs. His medical scheme had paid the hospital and specialist bills upfront. The RAF argued that because those expenses were already covered, he had suffered no compensable loss. The court disagreed and dismissed the appeal.
The accident and the claim
Van Wyk testified that he was riding home at dusk when a bakkie moved into his lane without lights. He braked and swerved but collided with the vehicle’s rear, lost control, and sustained multiple orthopaedic injuries. He was admitted to Milnerton Mediclinic and required extensive treatment.
His medical aid covered the immediate costs so that care could proceed without delay. As is standard practice, those amounts were then claimed from the RAF as part of his damages.
The trial court held the RAF 100 percent liable and ordered payment of R350,187.56 for past medical expenses. The fund appealed only that portion of the order.
Why the RAF must still pay
Judge JD Lekhuleni, writing for the full bench, said the law has long treated insurance benefits as collateral. In simple terms, a wrongdoer does not benefit because a victim prudently bought insurance.
A medical aid, the court explained, is simply another form of insurance. Payments made by a scheme arise from a private contract between the member and the scheme. They do not reduce the RAF’s statutory obligation to compensate.
Allowing the fund to deduct those payments would effectively reward it for the victim’s foresight and leave injured people exposed to repayment demands from their schemes. That would undermine the very purpose of the compensation system.
The judges stressed that the RAF steps into the shoes of the negligent driver. Its duty is to pay the full proven loss.
Directives rejected
The RAF relied on internal directives instructing staff to reject claims where medical schemes had already paid. The court found that these policies cannot override the law or earlier court orders that declared similar refusals unlawful.
An organ of state, the judges warned, cannot repeatedly change tactics to avoid a clear legal duty. The appeal was dismissed, and the RAF was ordered to pay the costs of two counsel.
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