Eppel v Discovery Medical Scheme and Others (09/29184) [2009] ZAGPJHC 54 (25 September 2009)

Eppel v Discovery Medical Scheme and Others (09/29184) [2009] ZAGPJHC 54 (25 September 2009)

The court found that the relationship between Dr Eppel and Discovery Medical Scheme was contractual, governed by the Premier Rate Agreement, and not by statute. Discovery's allegations of breach and cancellation of the agreement were uncontroverted. The provisions of the Medical Schemes Act did not apply to the dispute, as the Act does not regulate the relationship between medical schemes and medical practitioners. The applicant's reliance on sections 47 and 48 was therefore misconceived, and the application for interim relief was dismissed. Even if the Act were applicable, the applicant had not lodged a complaint as required by section 47, and the interpretation advanced by the applicant...

Citation
[2009] ZAGPJHC 54
Parties
Applicant: Steven Joel Eppel; Respondent: Discovery Medical Scheme; Respondent: Discovery Health (Pty) Ltd; Respondent: Council for Medical Schemes
Court
South Gauteng High Court, Johannesburg
Jurisdiction
South Africa
Judgment Date
25 September 2009
Case Number
09/29184
Procedural Posture
Urgent Application / Interim Relief Pending Appeal Before Council for Medical Schemes
Outcome
Application dismissed with costs.
Judges
FHD Van Oosten
Legal Topics
Interim Relief, Contractual Relationship, Medical Schemes Act, Declaratory Order
Civil Procedure Commercial and Corporate Interim Relief Contractual Relationship Medical Schemes Act Declaratory Order

Case Brief

Summary, issues, holding and outcome

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Parties

Steven Joel Eppel

Applicant

Discovery Medical Scheme

Respondent

Discovery Health (Pty) Ltd

Respondent

Council for Medical Schemes

Respondent

Procedural Posture

Urgent Application / Interim Relief Pending Appeal Before Council for Medical Schemes

Legal Issues

  1. 1 Whether the decision by Discovery Medical Scheme to suspend payment of claims from Dr Eppel's practice is automatically suspended pending appeal under section 48(2) of the Medical Schemes Act.
  2. 2 Whether the relationship between Dr Eppel and Discovery Medical Scheme is governed by statute or contract.
  3. 3 Whether Dr Eppel is entitled to interim relief restoring the status quo ante pending the outcome of his appeal to the Council for Medical Schemes.

Ratio Decidendi

The court found that the relationship between Dr Eppel and Discovery Medical Scheme was contractual, governed by the Premier Rate Agreement, and not by statute. Discovery's allegations of breach and cancellation of the agreement were uncontroverted. The provisions of the Medical Schemes Act did not apply to the dispute, as the Act does not regulate the relationship between medical schemes and medical practitioners. The applicant's reliance on sections 47 and 48 was therefore misconceived, and the application for interim relief was dismissed. Even if the Act were applicable, the applicant had not lodged a complaint as required by section 47, and the interpretation advanced by the applicant...

Court Disposition

Application dismissed with costs.

Orders

  • The application is dismissed with costs.