Court orders RAF: Pay victims’ medical bills even if covered by medical aid

In a major decision that will impact accident victims nationwide, the Western Cape High Court ruled on Friday Road Accident Fund must cover medical costs regardless of whether a victim has medical aid.

The ruling came in the case of Lisa Basson, who suffered severe injuries in a 2019 car crash.

Her medical expenses reached R265,609.

The Road Accident Fund had refused to pay 204,853 rand, arguing Basson medical aid, Discovery Health, covered those costs under mandatory benefits rules. The Fund claimed this extinguished Basson right to compensation.

The court firmly rejected Road Accident Fund position.

Acting Judge Gayaat Salie clarified three key legal principles. First, the Fund duty to compensate victims exists independently of payments from medical aids.

The ruling emphasised that victims must be restored to their pre-accident financial position. Medical aid coverage cannot undermine this core purpose of the Road Accident Fund Act.

Second, the court distinguished between private contracts and public law.

Agreements between medical aids and members operate in the private realm. They cannot trigger a section of the Road Accident Fund Act designed to block profiteering from lawsuits.

Third, the judgment harmonized the Road Accident Fund Act and Medical Schemes Act.

These laws must work together, not against each other. Medical aid coverage for mandatory benefits does not remove the Road Accident Fund duty to compensate victims.

As a result, the Road Accident Fund must pay Basson the full 265,609.97 rand within 180 days.

The Fund must also cover her legal costs due to the weakness of its defense.

The ruling sets a critical precedent: Medical aid payments create only a right to reimbursement from Road Accident Fund settlements. They do not erase the Fund primary responsibility to victims.

This decision strengthens South Africa accident compensation system. It blocks attempts to shift public duties onto private medical schemes.

All road accident victims now have consistent protection, regardless of medical coverage.

The Road Accident Fund remains fully liable for compensating past medical costs.