In the recent matter of the Board of Healthcare Funders of Southern Africa v Council For Medical Schemes 2011 JDR 1471 (GNP), the first and second applicants approached the judge by way of a application to supply a declaratory order with regards to the meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant towards the Healthcare Schemes Act, 131 of 1998.
The candidates contended that the Judge had to determine three issues, which is: 1. The first applicant's right to initiate actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the candidates; and 3. The concise explanation of the words "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. According to the candidates, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which were referred from the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two decisions, interpreted the phrase "pay in full" in regulation 8 to mean that the professional medical scheme should effect complete settlement of a service providers' invoice in respect of the charges of supplying medical care services for Prescribed Minimum Benefits if you don't take the policies of the medical scheme into consideration in dealing with any grievances.
It was the applicants' contention that "pay in full" signifies settlement in accordance with the rules of the Medical Scheme, while in accordance with the participants, the decisions by the Appeal Board have not been questioned up to now and presently healthcare aid schemes are bound to this authority and still have to pay for service providers' accounts in full.
The primary complaint by the participants was that the first applicant didn't have immediate and substantial concern in the application since the judgment would not have a visible impact over it. Even though the first candidate suggested it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court found this to not be the case. It was due to the fact that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, joined. Additionally, only 15 registered healthcare schemes, in the founding and extra founding affidavits, verified that a declaratory order ought to be sought.
The Court held that had the first candidate been so confident that it defended all 75 healthcare aid schemes it would not have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the 1st applicant. The Judge deducted from this that the first applicant didn't in fact legally represent 75 members, but only the 15 members pointed out within the documents.
The non-joinder of all of the healthcare schemes rendered the application fatally flawed as the Court couldn't find that the 1st candidate, as a standard representative of the professional medical schemes, would be prejudicially affected by a judgment, but found that its members may all be prejudicially influenced and consequently, many of the participants should have jointly implemented the request for a declaratory order.
The Court discovered that the 1st applicant didn't have locus standi for these reasons:
1. The matter was one that could be considered a representative matter, although not all the healthcare schemes have been joined and it had not been launched as a representative issue because of the fact that the first applicant didn't have any authority to litigate on behalf of all 75 of its members;
2. In order to commence steps with respect to Section 38 in the Constitution, a litigant must demonstrate that the right enshrined inside the Bill of Rights has been encroached upon along with ample interest in the relief desired. The primary applicant did not clearly aver any such infringement and the Court found out that the 1st Complainant may not be directly affected by the ruling and didn't have a satisfactory concern in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application on its own, as not one of the alternative medical aid schemes or managers ended up being coupled.
The candidates contended that the Judge had to determine three issues, which is: 1. The first applicant's right to initiate actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the candidates; and 3. The concise explanation of the words "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. According to the candidates, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which were referred from the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two decisions, interpreted the phrase "pay in full" in regulation 8 to mean that the professional medical scheme should effect complete settlement of a service providers' invoice in respect of the charges of supplying medical care services for Prescribed Minimum Benefits if you don't take the policies of the medical scheme into consideration in dealing with any grievances.
It was the applicants' contention that "pay in full" signifies settlement in accordance with the rules of the Medical Scheme, while in accordance with the participants, the decisions by the Appeal Board have not been questioned up to now and presently healthcare aid schemes are bound to this authority and still have to pay for service providers' accounts in full.
The primary complaint by the participants was that the first applicant didn't have immediate and substantial concern in the application since the judgment would not have a visible impact over it. Even though the first candidate suggested it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court found this to not be the case. It was due to the fact that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, joined. Additionally, only 15 registered healthcare schemes, in the founding and extra founding affidavits, verified that a declaratory order ought to be sought.
The Court held that had the first candidate been so confident that it defended all 75 healthcare aid schemes it would not have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the 1st applicant. The Judge deducted from this that the first applicant didn't in fact legally represent 75 members, but only the 15 members pointed out within the documents.
The non-joinder of all of the healthcare schemes rendered the application fatally flawed as the Court couldn't find that the 1st candidate, as a standard representative of the professional medical schemes, would be prejudicially affected by a judgment, but found that its members may all be prejudicially influenced and consequently, many of the participants should have jointly implemented the request for a declaratory order.
The Court discovered that the 1st applicant didn't have locus standi for these reasons:
1. The matter was one that could be considered a representative matter, although not all the healthcare schemes have been joined and it had not been launched as a representative issue because of the fact that the first applicant didn't have any authority to litigate on behalf of all 75 of its members;
2. In order to commence steps with respect to Section 38 in the Constitution, a litigant must demonstrate that the right enshrined inside the Bill of Rights has been encroached upon along with ample interest in the relief desired. The primary applicant did not clearly aver any such infringement and the Court found out that the 1st Complainant may not be directly affected by the ruling and didn't have a satisfactory concern in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application on its own, as not one of the alternative medical aid schemes or managers ended up being coupled.
About the Author:
To find out more about medical law and other legal fields, please visit Dirk Markhen's recommendation for professional construction law attorneys.
No comments:
Post a Comment