DL Van Rensburg CC t/a Harmelia Pharmacy and Another v Discovery Health (Pty) Ltd and Another (2012/33590) [2012] ZAGPJHC 160 (14 September 2012)

DL Van Rensburg CC t/a Harmelia Pharmacy and Another v Discovery Health (Pty) Ltd and Another (2012/33590) [2012] ZAGPJHC 160 (14 September 2012)

The court found that neither the preferred provider network form, the scheme rules, nor the Medical Schemes Act imposed an obligation on the respondent to pay the applicant directly for medicines supplied to members. The scheme rules and section 59 of the Act permit payment either to the member or the supplier at the scheme's discretion. The historical practice of direct payment did not create a contractual right or legitimate expectation enforceable against the respondent. As no contract existed conferring the claimed right, the applicant was not entitled to urgent relief, and the application was dismissed.

Citation
[2012] ZAGPJHC 160
Parties
Applicant: DL Van Rensburg CC t/a Harmelia Pharmacy; Applicant: Yolandi Cunningham; Respondent: Discovery Health (Pty) Ltd; Respondent: Discovery Medical Scheme & Other Respondents
Court
South Gauteng High Court, Johannesburg
Jurisdiction
South Africa
Judgment Date
14 September 2012
Case Number
2012/33590
Procedural Posture
Urgent Application / Application for Urgent Interim Relief
Outcome
Application dismissed with costs, including costs of senior counsel.
Judges
C G Lamont
Legal Topics
Medical Schemes Act, Preferred Provider Networks, Contractual Obligation, Urgent Interim Relief
Commercial and Corporate Civil Procedure Medical Schemes Act Preferred Provider Networks Contractual Obligation Urgent Interim Relief

Case Brief

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Parties

DL Van Rensburg CC t/a Harmelia Pharmacy

Applicant

Yolandi Cunningham

Applicant

Discovery Health (Pty) Ltd

Respondent

Discovery Medical Scheme & Other Respondents

Respondent

Procedural Posture

Urgent Application / Application for Urgent Interim Relief

Legal Issues

  1. 1 Whether a contract exists obliging the respondent to pay the applicant directly for medicines supplied to members.
  2. 2 Whether the applicant has a right to enforce direct payment from the respondent.
  3. 3 Whether historical payment practice creates a legitimate expectation for continued direct payment.

Ratio Decidendi

The court found that neither the preferred provider network form, the scheme rules, nor the Medical Schemes Act imposed an obligation on the respondent to pay the applicant directly for medicines supplied to members. The scheme rules and section 59 of the Act permit payment either to the member or the supplier at the scheme's discretion. The historical practice of direct payment did not create a contractual right or legitimate expectation enforceable against the respondent. As no contract existed conferring the claimed right, the applicant was not entitled to urgent relief, and the application was dismissed.

Court Disposition

Application dismissed with costs, including costs of senior counsel.

Orders

  • The application is dismissed with costs including the costs consequent upon the employ of senior counsel.