Ramba and Another v Government Employees Medical Scheme and Another (88884/2016) [2021] ZAGPPHC 357 (17 May 2021)

Ramba and Another v Government Employees Medical Scheme and Another (88884/2016) [2021] ZAGPPHC 357 (17 May 2021)

The court found that the declaration, when read with the relevant provisions of the Medical Schemes Act and regulations, establishes a sufficient legal nexus between the plaintiffs' claims and the second defendant, Metropolitan Health Group. The administrator's role, as defined by statute and interpreted by case law, includes the processing and payment of claims for health services rendered to scheme members. The argument that only the board of trustees is liable does not negate the administrator's statutory obligations. The exception raised by the second defendant therefore fails, as the declaration discloses a cause of action against it.

Citation
[2021] ZAGPPHC 357
Parties
Plaintiff: Johannes Ramoba; Plaintiff: Kgakgamotso Mokoka; Defendant: Government Employees Medical Scheme; Defendant: Metropolitan Health Group
Court
North Gauteng High Court, Pretoria
Jurisdiction
South Africa
Judgment Date
17 May 2021
Case Number
88884/2016
Procedural Posture
Civil Procedure / Exception to Amended Declaration
Outcome
Exception dismissed with costs.
Judges
Bam
Legal Topics
Medical Schemes Act, Exception Procedure, Administrator Liability
Civil Procedure Commercial and Corporate Medical Schemes Act Exception Procedure Administrator Liability

Case Brief

Summary, issues, holding and outcome

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Parties

Johannes Ramoba

Plaintiff

Kgakgamotso Mokoka

Plaintiff

Government Employees Medical Scheme

Defendant

Metropolitan Health Group

Defendant

Procedural Posture

Civil Procedure / Exception to Amended Declaration

Legal Issues

  1. 1 Does the amended declaration disclose a cause of action against the second defendant, Metropolitan Health Group, as administrator under the Medical Schemes Act?
  2. 2 Is an administrator liable for payment to suppliers of pharmaceutical drugs and services under section 59 of the Medical Schemes Act?

Ratio Decidendi

The court found that the declaration, when read with the relevant provisions of the Medical Schemes Act and regulations, establishes a sufficient legal nexus between the plaintiffs' claims and the second defendant, Metropolitan Health Group. The administrator's role, as defined by statute and interpreted by case law, includes the processing and payment of claims for health services rendered to scheme members. The argument that only the board of trustees is liable does not negate the administrator's statutory obligations. The exception raised by the second defendant therefore fails, as the declaration discloses a cause of action against it.

Court Disposition

Exception dismissed with costs.

Orders

  • The exception is dismissed with costs.