The Western Cape High Court has ordered the Road Accident Fund (RAF) to pay medical expenses even when covered by medical aid schemes.
The significant ruling delivered on 4 February 2025 ordered the RAF to compensate the estate of the late Anwar Esack for medical expenses incurred prior to his passing.
Esack, who sustained severe injuries in a car accident on 11 December 2015, lodged a claim against the RAF after it failed to compensate him for his medical expenses. Unfortunately, he died on 4 May 2020 while the matter was still pending. Following his death, his wife, Rahldeyah Esack, took over the claim as the executrix of his estate.
At the hearing, it emerged that most aspects of the claim had been settled, except for the past hospital, medical, and related expenses amounting to R115,436.14. The RAF contested liability, arguing the expenses had already been paid by Esack's medical aid scheme, Discovery Health.
However, Rahldeyah's counsel argued that the payment by the medical aid scheme was irrelevant in determining liability. They invoked the common law principle stipulating that a contract between a third party does not affect the rights and duties of other parties involved in litigation. Thus, it was contended that the RAF remained liable for compensation despite Discovery's payment of the medical costs.
The court was tasked with determining not only the liability of the RAF but also the implications of recent judicial interpretations surrounding medical aid benefits and their deductibility from claims against the Fund.
Judge LG Nuku ultimately ruled in favour of the the widow, asserting, “The deceased incurred past medical and hospital expenses. These were paid by the deceased’s medical-aid scheme, and I have been asked to assume… that the past hospital and medical expenses paid by the deceased’s medical aid scheme relate to prescribed minimum benefits”. His decision reinforced that the obligations of Discovery Health did not absolve the RAF of its responsibility to the deceased’s estate under the law.
In terms of compensation, the RAF was ordered to pay R935,477.28 for the deceased’s loss of earnings alongside the medical expenses. Payments must be made within 180 days, and the RAF will incur interest on the awarded amounts from 14 days after the order. Notably, the court mandated substantial legal costs to be covered by the RAF, reflective of the complexity involved in calculating damages related to a self-employed claimant.
#Conviction
