Profmed Medical Scheme v Steyn and Others (A171/2021; 23378 / 2018) [2022] ZAWCHC 60 (26 April 2022)

Profmed Medical Scheme v Steyn and Others (A171/2021; 23378 / 2018) [2022] ZAWCHC 60 (26 April 2022)

The court held that the first respondent's failure to disclose her gastritis and hip arthroscopy constituted material non-disclosures relevant to risk assessment by the medical scheme. The administrative respondents acted within their powers and followed fair procedures. The court a quo erred by substituting the administrative decision and reconsidering the merits rather than limiting itself to legislated grounds of review. There were no exceptional circumstances justifying substitution. The appeal was upheld, the decision of the court a quo was set aside, and the review application was dismissed.

Citation
[2022] ZAWCHC 60
Parties
Appellant: Profmed Medical Scheme; Respondent: Mignon Adelia Steyn; Respondent: Registrar for Medical Schemes; Respondent: Council for Medical Schemes; Respondent: The Appeal Board
Court
Western Cape High Court, Cape Town
Jurisdiction
South Africa
Judgment Date
26 April 2022
Case Number
A171/2021; 23378/2018
Procedural Posture
Civil Appeal / Appeal From Review Judgment; Appellate Stage
Outcome
Appeal upheld; decision of the court a quo set aside; review application dismissed.
Judges
Baartman, Steyn, Wille
Legal Topics
Promotion of Administrative Justice Act, Material Non Disclosure, Medical Schemes Act, Judicial Review, Procedural Fairness
Administrative Law Civil Procedure Promotion of Administrative Justice Act Material Non Disclosure Medical Schemes Act Judicial Review Procedural Fairness

Case Brief

Summary, issues, holding and outcome

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Parties

Profmed Medical Scheme

Appellant

Mignon Adelia Steyn

Respondent

Registrar for Medical Schemes

Respondent

Council for Medical Schemes

Respondent

The Appeal Board

Respondent

Procedural Posture

Civil Appeal / Appeal From Review Judgment; Appellate Stage

Legal Issues

  1. 1 Whether the first respondent's non-disclosure of medical conditions constituted material non-disclosure justifying retrospective termination of membership.
  2. 2 Whether the proceedings before the administrative respondents and the Appeal Board were procedurally unfair.
  3. 3 Whether the court a quo erred in substituting the administrative decision rather than remitting for reconsideration.

Ratio Decidendi

The court held that the first respondent's failure to disclose her gastritis and hip arthroscopy constituted material non-disclosures relevant to risk assessment by the medical scheme. The administrative respondents acted within their powers and followed fair procedures. The court a quo erred by substituting the administrative decision and reconsidering the merits rather than limiting itself to legislated grounds of review. There were no exceptional circumstances justifying substitution. The appeal was upheld, the decision of the court a quo was set aside, and the review application was dismissed.

Court Disposition

Appeal upheld; decision of the court a quo set aside; review application dismissed.

Orders

  • The appeal is upheld, the decision of the court a quo is set aside, and the review application by the first respondent is dismissed.
  • The first respondent is ordered to pay the appellant's costs, including the costs of two counsel (where so employed) on the scale as between party and party as taxed or agreed.