Court Orders RAF to Pay Medical Aid Claimant’s Past Expenses in Landmark Ruling

A recent Western Cape High Court judgment has clarified the Road Accident Fund’s (RAF) obligation to cover past medical expenses for road accident victims, even if those expenses were initially paid by medical aid schemes. The ruling comes amid ongoing legal battles over whether the RAF should reimburse victims when their medical costs have already been covered by private insurers.

RAF Must Compensate Victim Despite Medical Aid Payments

The case involved Rahldeyah Esack, the executrix of the estate of her late husband, Anwar Esack, who sustained injuries in a car accident in 2015. Despite the RAF’s claim that it was not liable to pay for Esack’s medical expenses since they were covered by his medical aid, Judge Lister Nuku ruled in favor of the claimant.

According to the judgment, the RAF is required to:

• Pay R935,477.28 for past loss of earnings.
• Pay R115,436.14 for past hospital and medical expenses.

Legal Precedent and Disputed Rulings

The ruling challenges a previous decision from the High Court in Pretoria in December 2024, where a majority judgment suggested that medical aid payments should be deducted from RAF claims. The RAF had argued that since medical aids are legally required to cover prescribed minimum benefits (PMBs) and emergency medical conditions (EMCs), the fund should not be responsible for reimbursing claimants.

However, Judge Nuku dismissed this argument, stating that the previous ruling had not altered the fundamental legal principle of ‘res inter alios acta’, which means that agreements between third parties (such as a claimant and their medical aid) should not impact a separate legal claim.

Implications for Future RAF Claims

The decision reaffirms that road accident victims can claim past medical expenses from the RAF, even if their medical aid covered the costs. This is significant for thousands of claimants who rely on medical schemes while waiting for compensation.

Legal experts believe this ruling could lead to further legal challenges, particularly from medical schemes that argue the RAF should reimburse them directly. The case also raises broader concerns about the RAF’s financial sustainability, as it continues to face revenue shortfalls.

What’s Next?

The RAF has not yet confirmed whether it will appeal the ruling, but legal battles over its financial responsibilities are expected to continue. This judgment provides clarity for accident victims seeking compensation, reinforcing that medical aid coverage should not prevent them from claiming what they are owed.

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