In this February 2024 judgment, the Pretoria High Court rejected the Road Accident Fund’s argument that it is not liable for medical scheme members’ past medical expenses paid by the injured person’s medical scheme following a motor vehicle accident.

Section 19 of the Road Accident Fund Act, 1996 excludes the RAF’s liability in certain circumstances, and the RAF argued that section 19(d) of the Act meant that it is not liable to pay damages if a person has insurance for the damage.   

Here, the court repeated the Supreme Court of Appeal’s view that the purpose of Section 19(d) is to protect injured persons from entering into champertous (unlawful litigation funding) agreements. 

Our courts have expressly approved the way Section 19 functions; the supplier’s (in this case, the medical scheme’s) right to claim from the RAF is conditional on the validity and enforceability of the injured person’s claim and does not to render the scheme’s claim unenforceable against the RAF:

“for if [an injured person’s] claim is valid and enforceable and the supplier’s is not, the Fund would still be liable to compensate the [injured person] who in turn remains contractually liable to the supplier”.

The court reaffirmed that an agreement between a medical aid and an injured person is an insurance agreement and not champertous.  The court referred to and accepted that it is bound by various judgments that have held, as a matter of principle, that payment by a medical aid does not relieve the RAF “of its obligation to compensate the plaintiff for past medical expenses.

This is not the first time the RAF has made this argument.  The RAF has consistently been unsuccessful in its argument before various courts and was unsuccessful once again. 

The court discussed and reaffirmed the principles of double compensation and a new intervening cause (res inter alio actos) and the judgment will therefore be of interest to all insurers engaging in both recoveries and dispute resolution processes. 

The general principle is that benefits received by a claimant from their own insurers and other paid-for indemnifiers are not to be taken into account in claiming or reducing damages claimed. 

The case is Road Accident Fund v Sheriff of the High Court for the District of Centurion East and Another (122825/2023) [2024] ZAGPPHC 149 (19 February 2024)