In the current 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 along with a demand to issue a declaratory order with regards to the interpretation of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Medical Schemes Act, 131 of 1998.
The applicants contended that the Judge was required to determine three concerns, that is: 1. The first applicant's right to initiate procedures for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by the candidates; and 3. The concise explanation of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of section 67 of the Act.
Regulation 8 has been in force since 1 January 2000. In accordance with the candidates, the current problem started on 11 November 2008 once the Appeal Board determined two cases on appeal which were referred by the Appeal Committee in terms of section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two judgements, interpreted the phrase "pay in full" in regulation 8 to mean that the healthcare scheme must make full repayment of the service providers' bill in respect of the expenses of offering healthcare services for Prescribed Minimum Benefits if you don't take the policies of the professional medical scheme into account in dealing with any claims.
It was actually the applicants' argument that "pay in full" means settlement in accordance with the procedures of the Healthcare Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned as yet and presently medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The principle complaint from the respondents could be that the first applicant didn't have immediate and significant interest in the application since the verdict would not have an effect on it. Although the first applicant contended that it defended 75 licensed professional medical aid schemes and for that reason had locus standi, a legal court found this to not be. This was because of the reason that the first candidate saw fit to have the second applicant, who's a registered healthcare aid scheme, combined. Furthermore, only 15 licensed medical schemes, within the founding and additional founding affidavits, verified that the declaratory order should be sought.
The Judge held that had the initial candidate been so sure that it defended all 75 professional medical aid schemes it wouldn't have been essential to join the other applicant or to receive affidavits and signatures of 15 members of the primary applicant. The Judge came to the conclusion from this that the first applicant didn't in reality legally represent 75 members, but only the 15 members pointed out within the paperwork.
The non-joinder of all the professional medical schemes made the application fatally flawed as the Courts could not find that the primary candidate, as being a general representative of the medical schemes, would be prejudicially affected by a verdict, but learned that its participants may all be prejudicially influenced and accordingly, many of the associates ought to have jointly instituted the application for a declaratory order.
The Judge found that the initial applicant was without locus standi for the following reasons:
1. The matter was one which may be considered a representative issue, but not every one of the professional medical schemes have been amalgamated and it had not been announced as a representative topic due to the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their associates;
2. In order to commence steps in terms of Section 38 in the Constitution, a litigant should reveal that the right enshrined inside the Bill of Rights has been encroached upon as well as sufficient concern in the relief sought. The initial applicant didn't explicitly aver such encroachment and the Court found that the 1st Plaintiff wouldn't be directly affected by the verdict and did not have an acceptable concern in the relief sought.
For the purpose of the other applicant the judge held it will not succeed in the application on its own, as not one of the other professional medical aid schemes or administrators had been amalgamated.
The applicants contended that the Judge was required to determine three concerns, that is: 1. The first applicant's right to initiate procedures for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by the candidates; and 3. The concise explanation of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of section 67 of the Act.
Regulation 8 has been in force since 1 January 2000. In accordance with the candidates, the current problem started on 11 November 2008 once the Appeal Board determined two cases on appeal which were referred by the Appeal Committee in terms of section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two judgements, interpreted the phrase "pay in full" in regulation 8 to mean that the healthcare scheme must make full repayment of the service providers' bill in respect of the expenses of offering healthcare services for Prescribed Minimum Benefits if you don't take the policies of the professional medical scheme into account in dealing with any claims.
It was actually the applicants' argument that "pay in full" means settlement in accordance with the procedures of the Healthcare Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned as yet and presently medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The principle complaint from the respondents could be that the first applicant didn't have immediate and significant interest in the application since the verdict would not have an effect on it. Although the first applicant contended that it defended 75 licensed professional medical aid schemes and for that reason had locus standi, a legal court found this to not be. This was because of the reason that the first candidate saw fit to have the second applicant, who's a registered healthcare aid scheme, combined. Furthermore, only 15 licensed medical schemes, within the founding and additional founding affidavits, verified that the declaratory order should be sought.
The Judge held that had the initial candidate been so sure that it defended all 75 professional medical aid schemes it wouldn't have been essential to join the other applicant or to receive affidavits and signatures of 15 members of the primary applicant. The Judge came to the conclusion from this that the first applicant didn't in reality legally represent 75 members, but only the 15 members pointed out within the paperwork.
The non-joinder of all the professional medical schemes made the application fatally flawed as the Courts could not find that the primary candidate, as being a general representative of the medical schemes, would be prejudicially affected by a verdict, but learned that its participants may all be prejudicially influenced and accordingly, many of the associates ought to have jointly instituted the application for a declaratory order.
The Judge found that the initial applicant was without locus standi for the following reasons:
1. The matter was one which may be considered a representative issue, but not every one of the professional medical schemes have been amalgamated and it had not been announced as a representative topic due to the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their associates;
2. In order to commence steps in terms of Section 38 in the Constitution, a litigant should reveal that the right enshrined inside the Bill of Rights has been encroached upon as well as sufficient concern in the relief sought. The initial applicant didn't explicitly aver such encroachment and the Court found that the 1st Plaintiff wouldn't be directly affected by the verdict and did not have an acceptable concern in the relief sought.
For the purpose of the other applicant the judge held it will not succeed in the application on its own, as not one of the other professional medical aid schemes or administrators had been amalgamated.
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Unknown - Saturday, September 29, 2012
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